Robot-assisted Laparoscopic Extravesical Cross-trigonal Ureteral Reimplantation With Tailoring for Primary Obstructive Megaureter

Neheman, Amos; Shumaker, Andrew; Gal, Jonathan S.; Haifler, Miki; Kord, Eyal; Rappaport, Yishai H.; Zisman, Amnon; Noh, Paul H.; Chertin, Boris

doi:10.1016/j.urology.2019.09.003

Cited by 11 publications

(4 citation statements)

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“…Reports on laparoscopic and robotic correction of POM in children are still relatively rare. Small series have been published treating POM with laparoscopic [ 37 ] and robotic ureteral reimplantation [ 38 – 40 ], and results seem comparable to those of open repair. However, more data and long-term follow up studies are needed to ascertain this.…”

Section: Discussionmentioning

confidence: 99%

High-pressure balloon dilatation of primary obstructive megaureter in children: a systematic review

2023

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Objective We aimed to evaluate the effectiveness and complication rates of endoscopic high-pressure balloon dilatation (HPBD) in treating primary obstructive megaureter (POM) in children based on current literature. Specifically, we wanted to clarify the evidence on the use of HPBD in children under one year of age. Methods A systematic search of the literature was performed via several databases. The preferred reporting items for systematic reviews and meta-analyses guidelines were followed. The primary outcomes studied in this systematic review were the effectiveness of HBPD in relieving obstruction and reducing hydroureteronephrosis in children. The secondary outcome was to study the complication rate of endoscopic high-pressure balloon dilatation. Studies that reported one or both of these outcomes (n = 13) were considered eligible for inclusion in this review. Results HPBD significantly decreased both ureteral diameter (15.8 mm [range 2–30] to 8.0 mm [0–30], p = 0.00009) and anteroposterior diameter of renal pelvis (16.7 mm [0–46] to 9.7 mm [0–36], p = 0.00107). The success rate was 71% after one HPBD and 79% after two HPBD. The median follow-up time was 3.6 years (interquartile range 2.2–6.4 years). A complication rate of 33% was observed, but no Clavien–Dindo grade IV–V complications were reported. Postoperative infections and VUR were detected in 12% and 7.8% of cases, respectively. For children under one year of age, outcomes of HPBD seem to be similar to those in older children. Conclusions This study indicates that HPBD appears to be safe and can be used as the first-line treatment for symptomatic POM. Further comparative studies are needed addressing the effect of treatment in infants, and also long-term outcomes of the treatment. Due to the nature of POM, identifying those patients who will benefit from HPBD remains challenging.

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Section: Discussionmentioning

confidence: 99%

High-pressure balloon dilatation of primary obstructive megaureter in children: a systematic review

2023

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“…In our opinion, this technique, leaving a portion of pathologic ureter attached to the bladder, could lead to incomplete ureteral washout and recurrence of the dilatation; thus, we prefer to perform a fulldismembered reimplantation. Tunnel orientation is argument of debate: Bondarenko assesses that a transverse tunnel orientation in comparison with anterolateral provides a longer length, reducing the post-operative VUR incidence [25]; Neheman in 2019 described the extravesical cross-trigonal ureteral reimplantation with intracorporeal tailoring of the ureter by robotic approach; they conclude that this technique is safe, feasible and reproducible, although their follow-up period was short [28]. In our series, all tunnels were performed with an antero-lateral direction.…”

Section: Discussionmentioning

confidence: 99%

Minimal invasive surgery of the distal ureter: indications, advantages and technical considerations from a single-center preliminary experience

et al. 2020

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Purpose The management of vesicoureteric junction (VUJ) diseases is a common and controversial problem in pediatric urology. Minimal invasive approaches were described for vesicoureteric reflux (VUR), obstructive megaureter (POM) and complicated duplex systems treatments. The aim of this paper is to describe our experience with minimal invasive approach focusing on technical considerations and preliminary outcomes. Materials and methods Data about patient aged between 0 and 18 years who underwent minimal invasive surgery for VUR, POM or complicated duplex system, were prospectively collected. Complications were classified according to Clavien-Dindo classification. One senior surgeon, trained in laparoscopy, performed surgeries (Lich Gregoir reimplantation, dismembered reimplantation and ureteroureterostomy). Results Seventeen patients were included in the study; thirteen had an extravesical reimplantation (nine non-dismembered, four dismembered) and four had an ureteroureterostomy. No complications were described. Median operating time was 98.5 min and median hospital stay was 4.1 days. Median follow-up was 7.5 months. Success rate for VUR was 78%; for dismembered reimplantation, one case showed post-operative VUR. Functional studies showed an improvement in split renal function on the pathologic moieties in patients treated by ureteroureterostomy for complicated ectopic ureters. Conclusion This preliminary experience in minimal invasive surgery of the distal ureter shows that this approach is feasible and safe, reduces hospitalization and gives better cosmetic. Results may be impacted by the surgeon's learning curve and technical modifications. As robotic procedures are described to be more effective and safe, less technical demanding and associated with good results, switching from laparoscopic to robot-assisted surgery could be useful to improve results.

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“…According to our search, several case series of RALUR have described high success rates for managing POM in adults and children (Table 2) (39)(40)(41)(42)(43)(44)(45). In 2009, Hemal et al first reported RALUR for 7 symptomatic POMs aged 6 to 60 years (39).…”

Section: Ralurmentioning

confidence: 95%

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

Yang

et al. 2022

Transl Androl Urol

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Background and Objective: Primary obstructive megaureter (POM) has various courses in different age populations. Although open ureteral reimplantation (OUR) remains the standard treatment for symptomatic POM, it is highly invasive with potential complications. In recent years, minimally invasive ureteral reimplantation (MIUR), including laparoscopic ureteral reimplantation (LUR) and roboticassisted laparoscopic ureteral reimplantation (RALUR), and endoscopic management, such as double-J stent insertion, endoureterotomy and endoscopic balloon dilatation (EBD), have been utilized for POM in selected patients. However, few comparable studies between MIUR and endoscopic management have been published to date, and it remains unclear which surgical management is the optimal choice for POM in different age groups. This review provides a comprehensive perspective on technical development and clinical outcomes of MIUR and endoscopic management for POM in pediatric and adult populations. Methods:The PubMed and Web of Science databases were used to comprehensively search English language articles related to MIUR and endoscopic management for POM in pediatric and adult populations up to March 2022. The technical modifications and the relevant clinical outcomes were reviewed. Key Content and Findings: MIUR with various technical modifications related to intracorporealsuturing and ureteroneocystostomy with anti-reflux techniques appears to be as safe and effective for POM in different age groups as the open procedure. Double-J stent insertion should be regarded as a temporary option for infants by achieving internal urinary drainage, as it may present limited success rates and various complications. Endoureterotomy using pure cutting current or laser appears to be a safer, easier, and less invasive alternative to open surgical management. While EBD has emerged as a definite treatment for POM in the pediatric population, it is debatable whether EBD can substitute for MIUR in adult patients. Conclusions:The safety and feasibility of MIUR and endoscopic management in patients from all age groups still need further investigation.

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Robot-assisted Laparoscopic Extravesical Cross-trigonal Ureteral Reimplantation With Tailoring for Primary Obstructive Megaureter

Cited by 11 publications

References 0 publications

High-pressure balloon dilatation of primary obstructive megaureter in children: a systematic review

High-pressure balloon dilatation of primary obstructive megaureter in children: a systematic review

Minimal invasive surgery of the distal ureter: indications, advantages and technical considerations from a single-center preliminary experience

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

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