Transvesicoscopic Cohen ureteric reimplantation for vesicoureteral reflux in children: A single-centre 5-year experience

Abstract 

Purpose

To evaluate our results with a new method of intravesical ureteric reimplantation using laparoscopic pneumovesicum in children.

Materials and methods

Seventy-two patients (mean age 4.2 years, range 0.5–20 years) with primary vesicoureteral reflux (VUR) underwent a laparoscopic transtrigonal ureteric reimplantation with CO₂ pneumovesicum. Ports were inserted suprapubically – 5mm for the camera and two 3–5-mm working ports. Having mobilized the ureter(s) intravesically, a submucosal tunnel is created and ureteric reimplantation performed with 5/0 and 6/0 absorbable sutures. Bladder drainage was maintained for 2–3 days postoperatively. Patients were followed up with clinical assessment and renal ultrasonography±voiding cystourethrogram.

Results

Ninety percent had VUR grade ≥3. A total of 113 ureters were reimplanted. The mean operative time was 82min for unilateral and 130min for bilateral reimplantation. Four cases (6%) were converted. Three patients presented with temporary ureteric dilatation without symptoms on follow-up renal ultrasound. Seven patients had postoperative urinary tract infection without persistent reflux on cystography. Follow-up cystogram was performed in 50 patients (81 ureters). Reflux persisted in four patients (8%).

Conclusions

Laparoscopic ureteric reimplantation with CO₂ pneumovesicum is technically feasible with a high success rate (92%). The role of this new technique in the treatment of VUR remains to be determined.

Keywords: Vesicoureteral reflux, Reimplantation, Surgical procedure, Minimally invasive, Laparoscopic