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Transvesicoscopic ureteral reimplantation in children with bilateral vesicoureteral reflux: surgical technique and results

Authors
 Mun Su Chung  ;  Sang Won Han  ;  Hyun Jin Jung  ;  Young Jae Im  ;  Hyun Ho Han  ;  Joon Chae Na  ;  Chang Hee Hong 
Citation
 JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES, Vol.22(3) : 295-300, 2012 
Journal Title
JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES
ISSN
 1092-6429 
Issue Date
2012
MeSH
Adolescent ; Anastomosis, Surgical ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Laparoscopy/methods* ; Male ; Postoperative Complications ; Replantation/methods* ; Retrospective Studies ; Time Factors ; Ureter/surgery* ; Vesico-Ureteral Reflux/surgery*
Keywords
Adolescent ; Anastomosis, Surgical ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Laparoscopy/methods* ; Male ; Postoperative Complications ; Replantation/methods* ; Retrospective Studies ; Time Factors ; Ureter/surgery* ; Vesico-Ureteral Reflux/surgery*
Abstract
OBJECTIVES: To report our initial experience with transvesicoscopic cross-trigonal ureteral reimplantation (TVUR), describing stepwise the surgical procedure and determining critical aspects of this surgery in the actual surgical field.

SUBJECTS AND METHODS: Between September 2008 and April 2010, 48 patients with bilateral vesicoureteral reflux (VUR) underwent TVUR. To identify the critical aspects affecting the surgical difficulty, we divided our TVUR procedure into four steps: TVUR set-up, mobilization of ureters, creation of submucosal tunnels, and ureterovesical anastomosis. To evaluate the evolution of our TVUR, we analyzed changes in the operative time and complications versus increase in surgeon experience (dividing our cases into three groups: the first third, the second third, and the last third). Changes in operative time for all four steps of TVUR were analyzed separately, as well as change in overall operative time.

RESULTS: Of a total of 48 cases, 45 patients underwent TVUR successfully except for 3 cases of open conversion. Among the 45 cases, the mean overall operative time was 155.6 min. In 1 patient, proximal migration of the ureteral catheter occurred. No other perioperative complications were observed. The mean postoperative hospital stay was 1.6 days. The VUR resolution rate was 96.4%. Upon analysis of our results by step, Step 4 (ureterovesical anastomosis) required the largest portion of the overall operative time in most cases. During the early period of our TVUR, we encountered several technical difficulties. However, the operative times for all four steps were stabilized with increasing number of cases, without deteriorating surgical outcomes.

CONCLUSIONS: Our report demonstrates that TVUR might potentially be a safe and effective alternative to open ureteral reimplantation in children with VUR, with a shorter learning curve than expected.
Full Text
http://online.liebertpub.com/doi/abs/10.1089/lap.2011.0318
DOI
22356205
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Na, Joon Chae(나준채) ORCID logo https://orcid.org/0000-0003-4449-8472
Im, Young Jae(임영재)
Chung, Mun Su(정문수)
Jung, Hyun Jin(정현진)
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
Han, Hyun Ho(한현호) ORCID logo https://orcid.org/0000-0002-6268-0860
Hong, Chang Hee(홍창희) ORCID logo https://orcid.org/0000-0002-0946-7702
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/90935
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