Abstract
Objectives:
To report our initial experience with transvesicoscopic ureteral reimplantation (TVUR), describing stepwise the surgical procedure and determining critical aspects of this surgery in actual surgical field.
Materials and Methods:
Between September 2008 and April 2010, 48 patients with bilateral vesicoureteral reflux (VUR) underwent TVUR. To identify the critical aspects affecting the surgical difficulty, we divided our TVUR procedure into four steps: TVUR setup, mobilization of ureters, creation of submucosal tunnels, and ureterovesical anastomosis. To evaluate the evolution of our TVUR, we analyzed changes in the operative time and complications over time (dividing our cases into three groups: the first, the second, and the last third). Changes in operative time for all four steps of TVUR were analyzed separately, as well as change in overall operative time.
Results:
Of total 48 cases, 45 patients underwent TVUR successfully except 3 cases of open conversion. Among the 45 cases, the mean overall operative time was 155.6 minutes. In one patient, ureteral catheter migrated proximally. No other perioperative complications were observed. The mean postoperative hospital stay was 1.6 days. The VUR resolution rate was 96.4%. Upon analysis of our results by step, step 4 (ureterovesical anastomosis) required the largest portion of the overall operative time in most cases. During the early period of our TVUR, we encountered several technical difficulties. However, the operative times for all four steps were stabilized with increasing number of cases, without deteriorating surgical outcomes.
Conclusions:
Our report demonstrates that TVUR might potentially be a safe and effective alternative to open ureteral reimplantation in children with VUR, with a shorter learning curve than expected.
No competing financial interests exist.
Runtime of video: 8 mins 26 secs
Get full access to this article
View all access options for this article.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
