Minimally Invasive Intravesical Ureteric Reimplantation

Abstract

Background and Purpose:

The aim of this study was to determine the feasibility of ureteric reimplantation for the correction of vesicoureteric reflux (VUR) using an entirely intravesical, minimally invasive technique with 2-mm endoscopic mini-instruments.

Materials and Methods:

Under general anesthetic, two female pigs (35 kg) underwent cystoscopy and insertion of a 3F ureteric stent into the left ureter. Three ports were inserted into the bladder under cystoscopic guidance: one 5 mm (Pediport, Dexide; Tyco) in the midline near the dome of the bladder and two 2-mm ports on either side. The bladder was emptied and then insufflated with carbon dioxide to a maximum pressure of 8 mm Hg. The left ureteric orifice was circumscribed and mobilized over a distance of 2 to 2.5 cm. The bladder muscle was repaired, and a 2-cm submucosal tunnel was made transversely across to the right side of the bladder. The ureter was placed under the submucosal tunnel and sutured in its new position. The ureteric catheter was reinserted into the ureter to confirm patency, and the animals were killed following the procedure.

Results:

The procedure was performed on both pigs entirely intravesically. Both ureters were easily mobilized and reimplanted without obstruction. The average operating time was 90 minutes. No major intraoperative complications occurred.

Conclusion:

The open surgical technique of transverse advancement for reimplantation of ureters has been used for many years with a 98% success rate. The minimally invasive approach described here is technically feasible and may afford great benefits to children who would otherwise undergo open surgery with greater discomfort and prolonged hospitalization.