Surgical Management of Pediatric Vesicoureteral Reflux: A Comparative Study Between Endoscopic, Laparoscopic, and Open Surgery

Esposito, Ciro; Escolino, Maria; López, Manuel; Farina, Alessandra; Cerulo, Mariapina; Savanelli, Antonio; A, La Manna; Caprio, Maria Grazia; Settimi, Alessandro; Varlet, François

doi:10.1089/lap.2016.0055

Cited by 51 publications

(59 citation statements)

References 33 publications

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“…haematuria and bladder spasms) and shorter hospitalization [3][4][5]. The extravesical ureteric reimplantation technique has been performed using both a laparoscopic and a robot-assisted approach, with reported success rates ranging from 77 to 100% [6][7][8][9]. Bladder dysfunction, including urinary retention, has been reported as a potential complication of extravesical ureteric reimplantation, especially in bilateral cases, caused by injury of the pelvic nerve plexus during ureteric dissection [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot‐assisted approach: results of a multicentre international survey

et al. 2019

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Objectives To assess and compare postoperative bladder dysfunction rates and outcomes after laparoscopic and robot‐assisted extravesical ureteric reimplantation in children and to identify risk factors associated with bladder dysfunction. Patients and Methods A total of 151 children underwent minimally invasive extravesical ureteric reimplantation in five international centres of paediatric urology over a 5‐year period (January 2013–January 2018). The children were divided in two groups according to surgical approach: group 1 underwent laporoscopic reimplantation and included 116 children (92 girls and 24 boys with a median age of 4.5 years), while group 2 underwent robot‐assisted reimplantation and included 35 children (29 girls and six boys with a median age of 7.5 years). The two groups were compared with regard to: procedure length; success rate; postoperative complication rate; and postoperative bladder dysfunction rate (acute urinary retention [AUR] and voiding dysfunction). Univariate and multivariate logistic regression analyses were performed to assess predictors of postoperative bladder dysfunction. Factors assessed included age, gender, laterality, duration of procedure, pre‐existing bladder and bowel dysfunction (BBD) and pain control. Results The mean operating time was significantly longer in group 2 compared with group 1, for both unilateral (159.5 vs 109.5 min) and bilateral procedures (202 vs 132 min; P = 0.001). The success rate was significantly higher in group 2 than in group 1 (100% vs 95.6%; P = 0.001). The overall postoperative bladder dysfunction rate was 8.6% and no significant difference was found between group 1 (6.9%) and group 2 (14.3%; P = 0.17). All AUR cases were managed with short‐term bladder catheterization except for two cases (1.3%) in group 1 that required short‐term suprapubic catheterization. Univariate and multivariate analyses showed that bilateral pathology, pre‐existing BBD and duration of procedure were predictors of postoperative bladder dysfunction (P = 0.001). Conclusion Our results confirmed that short‐term bladder dysfunction is a possible complication of extravesical ureteric reimplantation, with no significant difference between the laparoscopic and robot‐assisted approaches. Bladder dysfunction occurred more often after bilateral repairs, but required suprapubic catheterization in only 1.3% of cases. Bilaterality, pre‐existing BBD and duration of surgery were confirmed on univariate and multivariate analyses as predictors of postoperative bladder dysfunction in this series.

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Section: Introductionmentioning

confidence: 99%

Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot‐assisted approach: results of a multicentre international survey

et al. 2019

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“…Often, however, this takes considerable time. It seems that in children resolution of VUR grades I to III was 50% 3.5 years after diagnosis (2,6). Grade IV VUR resolved much less frequently, with resolution in 50% in children after about 11 years (7).…”

Section: Introductionmentioning

confidence: 94%

“…Considering the prospect of numerous radiologic studies and years of antibiotic prophylaxis without good odds of spontaneous resolution of VUR, many families elect to proceed with surgery, particularly if a relatively less morbid (i.e., laparoscopic or endoscopic) approach is available. There are now 3 different techniques available to correct surgically the VUR (6,15). The open approach, that consist in to open the bladder and to reimplant the ureter according to Cohen or Politano technique, this technique now is indicated rarely only in high grade reflux when a ureteral tailoring is necessary.…”

Section: Technical and Surgical Considerationsmentioning

confidence: 99%

Treatment of vesico-ureteral reflux in infants and children using endoscopic approaches

et al. 2017

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Vesicoureteral reflux (VUR) represents one of the most significant risk factors for acute pyelonephritis in children. Endoscopic treatment of VUR dates back to 1981 when Matouschek first described injection of the ureteral orifice in an attempt to correct VUR. In addition, also Politano and colleagues and McDonald described successful correction of reflux using endoscopic techniques. After these reports subureteral Teflon injection (STING) came to be appreciated as a viable new way to less invasively correct one of the most common pediatric urologic problems. The technique is technically easy to perform and is usually performed as an outpatient procedure. It is performed in general anesthesia in children and may require repeat injections, particularly in patients with high-grade reflux. As for endoscopic technique, a main problem existed. The success in children with high grade reflux was less than reported for open or laparoscopic reimplant techniques. However, in the past 10 years, newer products have become available that are changing the indications for endoscopic correction. In these review, we analyzed the papers published in the literature on this topic to give to the readers an updated overview about the results of endoscopic treatment of VUR after 30-years of his first description.

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“…The authors used a HD wide view camera system (Karl Storz, Tuttlingen, Germany) after our published first series, and we are in opinion that this definitively better visualization with a large angel has added a great value to our technique. More technical advances will facilitate reconstructive procedures in the future (16).…”

Section: Current Developmentsmentioning

confidence: 99%

Laparoscopic extravesical ureteral reimplantation (LEVUR): a systematic review

et al. 2017

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Background: Laparoscopic ureteral reimplantation is a feasible method for treating ureteral pathology with good preliminary results in the literature. In this study, we review medium term results for laparoscopic ureteral reimplantation and discuss current developments of this procedure.Methods: Medline and Embase databases were searched using relevant key terms to identify reports of paediatric laparoscopic extravesical ureteral reimplantation (LEVUR). Literature reviews, case reports, series of <3 children and adult studies (age >20 years) were excluded.Results: Five studies were assessed, overall, 69 LEVUR were performed in children. Despite different surgical technique, in all case the technique was respected. Patient demographics, preoperative symptoms, radiological imaging, complications, and postoperative outcomes were analyzed. Median success rate was 96%. Complications were reported in five cases.Conclusions: This study is limited by the data given in the individual series: varied criteria used for patient selection and outcome as well as inconsistent pre-and post-operative imaging data precluded a metaanalysis. But it demonstrates that the laparoscopic ureteral reimplantation is an effective procedure with good medium-term results. We believe that in well selected patients this procedure will become an established treatment option.

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Surgical Management of Pediatric Vesicoureteral Reflux: A Comparative Study Between Endoscopic, Laparoscopic, and Open Surgery

Cited by 51 publications

References 33 publications

Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot‐assisted approach: results of a multicentre international survey

Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot‐assisted approach: results of a multicentre international survey

Treatment of vesico-ureteral reflux in infants and children using endoscopic approaches

Laparoscopic extravesical ureteral reimplantation (LEVUR): a systematic review

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