Laparoscopic Reconstruction for Obstructive Megaureter: Single Institution Experience with Short- and Intermediate-Term Outcomes

Abraham, George P.; Das, Krishanu; Ramaswami, Krishnamohan; Siddaiah, Avinash T.; George, Datson P.; Abraham, Jisha J.; Thampan, Oppukeril S.

doi:10.1089/end.2012.0039

Cited by 19 publications

(12 citation statements)

References 22 publications

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“…Joseph and Gundeti [5] have suggested anterior wall detrusorotomy to achieve straight direction of implanted ureter to prevent ureteral angulation. In the laparoscopic or robotic approach, some authors use intracorporeal excisional tailoring and reimplantation of the ureter in according to the classical Lich-Gregoire technique [5][6][7]. Lopez et al [9] have used Hendren extracorporeal technique for tapering of megaureters in 7 pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…In patients over 1 year, indications for surgery in 10 cases of POM included progress of hydroureteronephrosis, with deteriorating on MAG3 and breakthrough UTI in spite of continues antibiotic prophylaxis during of 16.1 ± 5.2 months of conservative management. Others 36 patients were operated due to refluxing megaureter (18), megaureter of duplex kidney (8), 6 after failed open reimplantation and 3 after ureterocutaneostomy. Of patients with VUR, seven had a combination of a diverticulum and six had a combination VUR and vesico-ureteral (25) junction obstruction.…”

Section: Methodsmentioning

confidence: 99%

“…Nevertheless, paediatric laparoscopic ureteral reimplantation for megaureter has not yet been widely reported. To our knowledge, laparoscopic dismembered extravesical ureteric reimplantation has been reported only in a limited series of 1 3 paediatric patients with a primary obstructive megaureter (POM) using Lich-Gregoir technique [3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Traditionally, open ureteral reparation and reimplantation is the gold standard therapy for primary symptomatic obstructive megaureter. Within the past decade, however, laparoscopic surgery has become popular in urology and has resulted in improved outcomes compared with open surgery, even in reconstruction procedures [2]. Today, the Da Vinci robot-assisted laparoscopic surgery platform (Intuitive Surgical, Sunnyvale, CA), which is characterized by stereoscopic vision and a flexible operating arm, provides us with the distinct advantages of minimally invasive reconstruction of the urinary tract, particularly in intracorporeal reparation and suturing.…”

Section: Introductionmentioning

confidence: 99%

Pure Laparoscopic and Robot-Assisted Laparoscopic Reconstructive Surgery in Congenital Megaureter: A Single Institution Experience

Zhang

et al. 2014

PLoS ONE

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To report our experience of pure laparoscopic and robot-assisted laparoscopic reconstructive surgery in congenital megaureter, seven patients (one bilateral) with symptomatic congenital megaureter underwent pure laparoscopic or robot-assisted laparoscopic surgery. The megaureter was exposed at the level of the blood vessel and was isolated to the bladder narrow area. Extreme ureter trim and submucosal tunnel encapsulation or papillary implantations and anti-reflux ureter bladder anastomosis were performed intraperitoneally by pure laparoscopic or robot-assisted laparoscopic surgery. The clinical data of seven patients after operation were analyzed, including the operation time, intraoperative complications, intraoperative bleeding volumes, postoperative complications, postoperative hospitalization time and pathological results. All of the patients were followed. The operation was successfully performed in seven patients. The mean operation times for pure laparoscopic surgery and robotic-assistant laparoscopic surgery were 175 (range: 150–220) and 187 (range: 170–205) min, respectively, and the mean operative blood loss volumes were 20 (range: 10–30) and 28.75 (range: 15–20) ml, respectively. There were no intraoperative complications. The postoperative drainage time was 5 (range: 4–6) and 5.75 (range: 5–6) d, respectively, and the indwelling catheter time was 6.33 (range: 4–8) d and 7 (range: 7–7) d, respectively. The postoperative hospitalization time was 7.67 (range: 7–8) d and 8 (range: 7–10) d, respectively. There was no obvious pain, no secondary bleeding and no urine leakage after the operation. Postoperative pathology reports revealed chronic urothelial mucosa inflammation. The follow-up results confirmed that all patients were relieved of their symptoms. Both pure laparoscopic and robot-assisted laparoscopic surgery using different anti-reflux ureter bladder anastomoses are safe and effective approaches in the minimally invasive treatment of congenital megaureter.

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“…Short distal ureteric defects can be managed by laparoscopic ureteroneocystostomy [4,7]. Recently, surgeons have proposed several modifications for laparoscopic ureteroneocystostomy so as to shorten the operation time and reduce the complexity of this operation [9,10,11,12,13]. Nevertheless, Austenfeld and Snow [14] and Mor et al [15] found that women who underwent ureteral reimplantation as children were at higher risk of ureteral obstruction and renal failure during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Ureteral Reimplantation underneath Broad Ligament Tunnel for Female Vesicoureteral Stenosis: A Technical Innovation

Zeng²,

Zhang³

et al. 2014

Urol Int

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Introduction: In order to anatomically reconstruct ureteral stenosis, we present a novel technique for laparoscopic ureteral reimplantation. Patients and Methods: Three young females, who were diagnosed with hydroureteronephrosis caused by congenital vesicoureteral junction obstruction, were treated by laparoscopic ureteral reimplantation with a tunnel underneath the broad ligament. Results: Surgery was performed successfully without conversion to open surgery. No major intra- or postoperative complications occurred. Postoperative follow-up was 38, 33 and 26 months, respectively. The operative time was between 220 and 260 min. The mean estimated blood loss was less than 20 ml. Subsequent imaging performed 3 months after surgery revealed relief of hydroureteronephrosis for all patients. The patients all gave birth to healthy neonates and showed normal urinary tract sonogram and urine analysis during the gestation period. Conclusion: Laparoscopic ureteral reimplantation with broad ligament tunnel is safe and effective, allowing for anatomical reconstruction of ureter defects. However, a larger clinical sample and longer follow-up period will be needed.

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Laparoscopic Reconstruction for Obstructive Megaureter: Single Institution Experience with Short- and Intermediate-Term Outcomes

Abstract: Laparoscopic reconstruction of obstructive MGU offers satisfactory immediate- and intermediate-term outcome without undue prolonged morbidity.

Cited by 19 publications

References 22 publications

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

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

Pure Laparoscopic and Robot-Assisted Laparoscopic Reconstructive Surgery in Congenital Megaureter: A Single Institution Experience

Laparoscopic Ureteral Reimplantation underneath Broad Ligament Tunnel for Female Vesicoureteral Stenosis: A Technical Innovation

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