Summary
Introduction
Various intravesical and extravesical techniques have been described for the surgical
correction of vesicoureteral reflux (VUR). Among those techniques Cohen (intra-vesical)
and Lich-Gregoir (extra-vesical) are the most commonly used ones. However, there are
limited studies that compare those two surgical techniques in the literature.
Objective
In this study, we aim to compare the outcomes of the open intravesical and extravesical
procedures for unilateral primary VUR in children.
Methods
We analyzed the records of 118 consecutive children with primary VUR who underwent
open ureteral reimplantation surgery by single surgeon from January 2011 to October
2015 at our institution. Among them, intravesical reimplantation was group A, and
extravesical reimplantation procedure was group B. We retrospectively analyzed the
clinical data of both groups, including age, sex, preoperative reflux grade, presence
of lower urinary tract symptoms (LUTS), operative time, postoperative complications
and hospitalization period. Success of surgery was defined as the resolution of the
VUR as determined by voiding cystourethrography 6 -12 months after surgery. All the
parameters were statistically compared.
Results
A total of 58 patients were found eligible for the study. In 23 cases intravesical
(group A) and in 35 cases extravesical (group B) procedure were performed. The operative
time in group A was significantly higher than group B (110.3±16.9 and 87±29.8 min,
respectively, p = 0.002). The mean hospital stay was also longer in group A (2.8±0.8 and 1.2±0.6
days, respectively, p = 0.007). The ureteral catheterization periods were 14.1±6.1 days for group A and
there was no ureteral catheter placement in group B. The success rate of the two groups
were comparable (100% vs 94.9%, p = 0.513). No intraoperative complications were detected in either group. The number
of febrile urinary tract infections were similar between the groups after a mean follow
up of 18.2 months (p = 0.746).
Discussion
Our results confirmed that both Cohen and Lich-Gregoir procedures had equivalent success
and complication rates. Lich-Gregoir technique was found superior to Cohen technique
in terms of hospital stay and operative time. Moreover, it avoids the necessity of
urethral and ureteral stenting which probably might increase the comfort of the patients
postoperatively. The main limitations of our study are unrecorded pain scores and
amount of analgesics taken the after surgery and retrospective analysis of the data.
Conclusion
TablePatient demographics.
| Cohen (n = 23) | Lich–Gregoir (n = 35) | p | |
|---|---|---|---|
| Age (years) (Mean + SD) (range) | 4.6 ± 1.6 (1–7) | 7.6 ± 4.2 (3–17) | 0.002 |
| M/F ratio | 17/6 | 2/33 | <0.001 |
| Prior endoscopic injection (n) | 13/23 | 19/35 | 0.866 |
| Reflux grade | 3.4 ± 0.6 (3–5) | 3.9 ± 0.5 (3–5) | 0.870 |
| Split kidney function (%) | 41.5 ± 10.8 (32–49) | 34.5 ± 10.1 (28–45) | 0.242 |
| Anticholinergic usage (%) | 6 (26.1%) | 16 (45.7%) | 0.132 |
Keywords
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Article info
Publication history
Published online: October 13, 2017
Accepted:
September 22,
2017
Received:
March 22,
2017
Identification
Copyright
© 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
