356 / 492
S28-14
(P)
VESICOSCOPIC CROSS-TRIGONAL URETERAL REIMPLANTATION FOR PRIMARY
REFLUX
Venkata JAYANTHI and Megan SCHOBER
Nationwide Children's Hospital, Section of Urology, Columbus, USA
PURPOSE
Ureteral reimplantation is the gold standard for the surgical management of vesicoureteral reflux. We present our
extensive experience with vesicoscopic Cohen repair.
MATERIAL AND METHODS
We retrospectively reviewed all patients who underwent vesicoscopic ureteral reimplantation at our institution. Only
patients with primary reflux with standard indications for correction requiring a nontapered reimplant were considered to
be appropriate candidates. Under CO2 "pneumovesicum" a 5 mm camera port and two 3 mm working ports were placed
directly into the bladder. In a manner analgous to open repair, the ureters were mobilized, submucosal tunnels were
created and ureters were transposed to the contralateral side and secured. Postoperatively, the bladder was drained
overnight. All patients underwent ultrasonography at 1 month and were offered cystography at 3 months
postoperatively.
RESULTS
167 children (151 girls and 16 boys) underwent vesicoscopic ureteric reimplantation. Mean age at the time of
reimplantation was 79 months (16 - 226). Thirteen of these children had failed injection therapy prior to reimplantation.
There were 126 bilateral and 41 unilateral procedures. Mean operative time was 186 mins (99 min- 288 min). There
were 4 open conversions. Resolution of reflux was noted in 91/96 (95%) of children tested. 4 of the failures were
amongst the first 30 patients. Complications included bladder stones in one, extraperitoneal urine leak in the first
patient and ureteral obstruction in 2.
CONCLUSIONS
Vesicoscopic ureteral reimplantation is a technically challenging procedure to learn. However, after the learning curve,
success rates appear to be equivalent to open repair. Vesicoscopic ureteral reimplantation is a minimally invasive
procedure for the definitive repair of primary reflux.