Laparoscopic extravesical transverse ureteral reimplantation for megaureter in children: results from a multi-institutional study

Abstract

Introduction The conservative management of the primary obstructive megaureter (POM) is considered to be the optimal option in patients with an adequate ureteral drainage. However, in cases of clinically significant obstruction, massive hydroureteronephrosis, decline of renal function and breakthrough febrile urinary tract infection, the surgical intervention is recommended. At present an open surgery is the standard practice for the primary megaureter in children. Recently, less invasive alternatives have been reported. Objectives We aimed to perform the multi-institutional study to assess the effectiveness of the laparoscopic extravesical transverse ureteral reimplantation (LETUR) in children with megaureter. Study design This is a retrospective study of the results of the LETUR in seventy-six children with megaureter (78 ureters). There were 50 obstructive and 28 refluxing megaureters. The data was collected from four paediatric centers between 2011 and 2017. Results Of the 78 megaureters, in 31 (39.7%) anatomy was classified as complex, and included 15 ureteral duplications, 7 bladder diverticulums, 6 post-previous anti-reflux surgery, and 3 previously diverted ureters. Of the 78 ureters, 34 were tailored, and 44 ureters were reimplanted without tailoring. There were 8 (10.5%) postoperative complications. One patient demonstrated temporary ureteral obstruction. Overall radiographic success rate (no obstruction, no VUR) was seen in 69 of the 78 (88.5%) ureters that were studied. Neither type of reimplantation (tailored or non-tailored), nor age of patients influenced the success rate of LETUR. Conclusion We believe that the laparoscopic extravesical transverse ureteral reimplantation is a safe and feasible option when the ureteral reimplantation is indicated.

Laparoscopic Versus Open Transvesical Ureteric Reimplantation for Correction of Vesico-Ureteral Reflux in Children, A comparative Study

“…While the study by Dubrov et al, 10 Regarding Laterality distribution between the two studied groups, we found that regarding group 1, 50% of the patients were on both right and left and regarding group 2, 50% of the patients were on left without statistical significance difference between the two groups.…”

“…Furthermore, the study by Dubrov et al, 10 reported that the average distal diameter of the ureter was 18.4 mm. They performed univariate logistic regression of factors related to radiographic failure and found that the diameter of the ureter at surgery ≥15 was not significantly associated with radiographic failure (pvalue = 0.087).…”

Minimally invasive ureteral reimplantation or endoscopic management for primary obstructive megaureter: a narrative review of technical modifications and clinical outcomes

“…In the pediatric population, Bondarenko performed laparoscopic extravesical transverse ureteral reimplantation for POM aged 6 months to 5 years, where the submucosal tunnel was oriented transversely on the lower part of the posterior bladder wall. It is easier than intravesical Cohen techniques and provides a longer tunnel length than anterolateral orientation ( 31 , 32 ). For adult cases, inspired by the anti-reflux nipple technique openly for the treatment of megaureters, our institute modified the LUR with extracorporeal tailoring and direct nipple ureteroneocystostomy, where the distal end was tailored and formed into an anti-reflux nipple extracorporeally and the ureteral nipple was intracorporeally reimplanted into the posterolateral wall of the bladder ( 33 ).…”

Laparoscopic Ureteral Reimplantation after Failed Open Surgery: Incorporating the Psoas Hitch Maneuver for Sufficient Tunnel Length

“…Extravesical cross-trigonal ureteral reimplantation is our approach of choice if the ureter has sufficient length. 14,15 This extravesical procedure has the advantage of not opening the bladder. In cases where a short ureter was encountered, sufficient tunnel length was achieved via the combination of an intravesical approach and ureter reimplantation on the ipsilateral side of the bladder.…”