Summary
Introduction
Vesicoureteral reflux (VUR), commonly referred to as urinary reflux, is one of the
most common congenital urological anomaly to occur during childhood. Historically,
open vesicoureteral reimplantation has been the gold standard in the surgical treatment
of VUR. Currently, vesicoscopic ureteral reimplantation is used as a minimally invasive
alternative to open ureteral reimplantation. Most vesicoscopic procedures are performed
using the transtrigonal Cohen technique. As a non-transtrigonal technique, the vesicoscopic
Politano-Leadbetter technique is also performed, but requires dissection outside the
bladder under a narrow surgical field, and in boy carries a risk of vas deferens injury.
Objective
This study evaluated surgical outcomes and perioperative findings for vesicoscopic
ureteral reimplantation using a modified Glenn-Anderson technique in children with
VUR.
Study design
Eighteen consecutive children who underwent vesicoureteral ureteral reimplantation
using a modified Glenn-Anderson technique were included in this study. The surgical
procedure was explained and surgical outcomes and perioperative findings were evaluated.
Results
Patients comprised 9 boys and 9 girls with 29 cases of ureteral reflux (7 unilateral
cases, 11 bilateral cases). All procedures were performed laparoscopically, with no
cases requiring conversion to open surgery. Median operative time was 143 min for
unilateral VUR and 194 min for bilateral VUR. Only one case showed a complication
(Clavien-Dindo grade 1). The remaining 17 cases showed no complications, with removal
of the urethral catheter and discharge 2 days postoperatively. Seventeen of the 18
cases underwent postoperative voiding cystourethrography, showing no VUR in all cases.
Discussion
Vesicoscopic ureteral reimplantation is a minimally invasive alternative to open surgery,
with most procedures performed using a transtrigonal Cohen technique. Regardless of
whether the surgery is open or laparoscopic, a disadvantage of the Cohen technique
is that postoperative transureteral treatment may not be possible. The Politano-Leadbetter
technique has been reported as a non-transtrigonal technique. However, this requires
dissection outside the bladder under a narrow surgical field, and carries a risk of
vas deferens injury in boys. In this study, vesicoscopic ureteral reimplantation using
a modified Glenn-Anderson technique provided good surgical outcomes with minimal perioperative
complications and easy manipulation under a wide field of view.
Conclusion
Although many minimally invasive treatments are available, vesicoscopic ureteral reimplantation
using a modified Glenn-Anderson technique is safe and effective for patients with
VUR 4 years old. To demonstrate the further utility of this procedure, long-term outcomes
and safety evaluations are needed in a larger number of cases.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Vesicoureteral reflux.J Am Soc Nephrol. 2008; 19: 847-862
- What is the normal prevalence of vesicoureteral reflux?.Pediatr Radiol. 2000; 30: 587-593
- Predictive factors for resolution of congenital high grade vesicoureteral reflux in infants: results of univariate and multivariate analyses.J Urol. 2010; 183: 1177-1184
- Voiding cystourethrography after uncomplicated ureteral reimplantation in children: is it necessary?.J Urol. 1997; 158: 1229-1231
- Cystography after the Cohen ureterovesical reimplantation: is it necessary at a training center?.J Urol. 1999; 162: 1201-1202
- Initial experience with laparoscopic transvesical ureteral reimplantation at the Children's Hospital of Philadelphia.J Urol. 2006; 176: 2222-2225
- Vesicoscopic cross-trigonal ureteral reimplantation: a minimally invasive option for repair of vesicoureteral reflux.J Urol. 2007; 178: 269-273
- Vesicoscopic ureteral reimplantation: a minimally invasive technique for the definitive repair of vesicoureteral reflux.Adv Urol. 2008; 2008973616
- Transvesicoscopic Cohen ureteric reimplantation for vesicoureteral reflux in children: a single-centre 5-year experience.J Pediatr Urol. 2009; 5: 466-471
- Transvesicoscopic ureteral reimplantation in children with bilateral vesicoureteral reflux: surgical technique and results.J Laparoendosc Adv Surg Tech. 2012; 22: 295-300
- Transvesicoscopic cross-trigonal ureteroneocystostomy in children: a single-center experience.J Pediatr Urol. 2012; 8: 83-86
Antoine E, Khoury DJB. In: Kavoussi LR, Wein alan J, Partin AW, Peters C, editors. Campbell-Walsh Urology; 2016. p. 3158-3161.
- Ureteral reimplantation aligned laparoscopically: pneumovesicoscopic Politano-Leadbetter reimplantation in children.J Pediatr Urol. 2021; 17: 413.e1-413.e8
- Distal tunnel ureteral reimplantation.J Urol. 1967; 97: 623-626
- Technical considerations in distal tunnel ureteral reimplantation.J Urol. 1978; 119: 194-198
- Evolving surgical management of pediatric vesicoureteral reflux: is open ureteral reimplantation still the 'gold standard'?.Int Braz Urol. 2020; 46: 314-321
- Dextranomer/hyaluronic acid for pediatric vesicoureteral reflux: systematic review.Pediatrics. 2010; 125: 1010-1019
- Vesicoscopic ureteral reimplant: is there a role in the age of robotics?.Urol Clin. 2015; 42: 53-59
- Endoscopic crosstrigonal ureteral reimplantation under carbon dioxide bladder insufflation: a novel technique.J Endourol. 2005; 19: 295-299
- Management of nephrolithiasis after Cohen cross-trigonal and Glenn-Anderson advancement ureteroneocystostomy.J Urol. 2007; 177: 174-178
- Transvesicoscopic ureteral reimplantation: Politano-Leadbetter versus Cohen technique.Int J Urol. 2015; 22: 394-399
- Initial experiences of laparoscopic intravesical detrusorraphy using the Politano-Leadbetter technique.J Pediatr Urol. 2016; 12: 110.e1-110.e7
- Retrospective study to determine the short-term outcomes of a modified pneumovesical GlenneAnderson procedure for treating primary obstructing megaureter.J Pediatr Urol. 2015; 11: 266.e1-266.e6
Article info
Publication history
Published online: February 26, 2023
Accepted:
February 22,
2023
Received in revised form:
December 19,
2022
Received:
September 9,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
