1
|
Benaired AM, Zahaf H, Bourazi N. Pneumovesicoscopic correction of primary vesicoureteral reflux (VUR) in children. - Our Initial experience. J Endourol 2021; 35:1808-1812. [PMID: 34060919 DOI: 10.1089/end.2020.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Purpose The main objective of our prospective,descriptive,monocentric,longitudinal study is to demonstrate the feasibility of vesicoscopic cross-trigonal ureteral reimplantation under CO2 pneumovesicum in treatment on primary vesicoureteral reflux,analyze results and specify the age limit of this approach. METHODS A total of 60 patients underwent transvesicoscopic ureteral reimplantation (33 boys, 27 girls) by the same surgeon from Mai 2011 to Mai 2015. All patients had primary vesicoureteral reflux,and surgery was performed because of breakthrough urinary tract infection despite antibiotic prophylaxis, persistent high grade of vesicoureteral reflux especially in association with significant renal scarring, mean age at operation was 47.47month (6 month-12 years). Of the 60 patients, 34 had bilateral reflux and 26 had unilateral reflux. The reflux grade in the total of 94 ureters was grade IV, V in 59.57%, grade III in 35.11% and grade II in 5.32% in association with contralateral high grade vesicoureteral reflux. RESULTS The transvesicoscopic procedure was successfully completed in all patients without perioperative complication except one case of pneumoperitoneum that required exsufflation by open laparoscopy. The mean overall operative time decreased significantly with an average of 58.43 +/- 11.26 minutes for unilateral reimplantation and 101.18+/- 26.5 minutes for bilateral reimplantation.The postoperative hospital stay was 3 days for all patients.The mean follow-up period was 03 years.Cystography was performed 3 month after surgery in all patients and showed the disappearance of vesicoureteral reflux in 57/60 patients (95%) or 91/94 of ureters (97%). Persistent vesicoureteral reflux was documented in 3 of 94 ureters and had resolved spontaneously at 12 month after reimplantation. CONCLUSION Our preliminary results indicate that vesicoscopic ureteral reimplantation is safe and effective procedure with minimal morbidity when compared to traditional open method. It can be apply in children under 12 months. Key words: Primary vesicoureteral reflux, surgical treatment of primary vesicoureteral reflux,vesicoscopic Cross-Trigonal Ureteral Reimplantation, childre.
Collapse
Affiliation(s)
- Amine Mouloud Benaired
- Hôpital Central de l'Armée, 164770, cité hospitalière BP 244 Kouba, Alger, Algeria, 16050.,Cité hospitalière BP 244 kouba17 cité elyasmine oued roumaneCité hospitalière BP 244 kouba, 17 cité elyasmine oued roumaneKouba, Algeria;
| | - Hamid Zahaf
- Hopital Central de l'Armee, 164770, Ain Naadja, Alger, Algeria;
| | - Nassima Bourazi
- Hopital Militaire Ain Naadja, 484654, Kouba, Alger, Algeria;
| |
Collapse
|
2
|
Babu R, Chandrasekharam VVS. A systematic review and meta-analysis comparing outcomes of laparoscopic extravesical versus trans vesicoscopic ureteric reimplantation. J Pediatr Urol 2020; 16:783-789. [PMID: 33023851 DOI: 10.1016/j.jpurol.2020.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE When considering treatment for vesico ureteric reflux via inimally invasive surgery there is a dilemma to choose between laparoscopic extravesical (LEVUR) and transvesicoscopic (TVUR) ureteric reimplantation. In this systematic review and meta-analysis we have analyzed the articles on LEVUR and TVUR and compared the outcomes. METHODS We searched the databases to identify all papers pertaining to TVUR and LEVUR in the pediatric population. Duplicate publications, review articles, incomplete articles and robotic assistance were excluded. Systematic review was performed to identify patient data, reflux grades, laterality, duration of surgery, time to discharge, success rate and complications. Meta-analysis of heterogeneity was reported with I 2 statistics. Once heterogeneity was found low, the pooled outcomes were compared with students t test and Fishers exact test, wherever appropriate. RESULTS After screening a total of 45 articles, 23 articles were included (13 articles on TVUR and 10 articles on LEVUR). The I 2 statistics for TVUR and LEVUR showed low heterogeneity with I 2 of 0% (95% C.I 0-37%) and 25% (95% C.I 0-64%) respectively. With low heterogeneity both were suitable to be considered to have been conducted under similar conditions with possibility of using fixed effect model. The percentage of Grade 5 VUR was significantly higher (p = 0.001; X 2) in TVUR (11.9%) compared to LEVUR (2.2%). The proportion of bilateral reimplantation was significantly higher (p = 0.001; X 2) in TVUR compared to LEVUR (summary table). The success rate of LEVUR was significantly higher at 96.7% compared to TVUR at 93.7% (p = 0.007 X 2). Unilateral/Bilateral TVUR took significantly longer duration of surgery (155/194 min vs 107/161 min) compared to LEVUR (p = 0.001; Fishers). The mean (s.d) time to discharge was longer at 3.2 (1.6) days for TVUR compared to 1.6 (0.4) days for LEVUR (p = 0.001; Fishers). The complication rate was comparable, 7.35% for TVUR and 5.35% for LEVUR (p = 0.167; X 2). DISCUSSION In this meta-analysis we found that LEVUR had shorter operating time, higher success, and shorter hospital stay compared to TVUR. A probable explanation could be higher number unilateral VURs and lower number of grade 5 VUR cases in LEVUR group. Both the techniques had comparable overall complication rate: LEVUR had more post-operative urinary retention while TVUR had more port-related problems.
Collapse
Affiliation(s)
- Ramesh Babu
- Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education & Research, Chennai, 600116, India.
| | - V V S Chandrasekharam
- Department of Pediatric Surgery, Pediatric Urology & MAS, Ankura Children's Hospital, Hyderabad, India
| |
Collapse
|
3
|
Miyakita H, Hayashi Y, Mitsui T, Okawada M, Kinoshita Y, Kimata T, Koikawa Y, Sakai K, Satoh H, Tokunaga M, Naitoh Y, Niimura F, Matsuoka H, Mizuno K, Kaneko K, Kubota M. Guidelines for the medical management of pediatric vesicoureteral reflux. Int J Urol 2020; 27:480-490. [PMID: 32239562 PMCID: PMC7318347 DOI: 10.1111/iju.14223] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 12/27/2022]
Abstract
Urinary tract infection is a bacterial infection that commonly occurs in children. Vesicoureteral reflux is a major underlying precursor condition of urinary tract infection, and an important disorder in the field of pediatric urology. Vesicoureteral reflux is sometimes diagnosed postnatally in infants with fetal hydronephrosis diagnosed antenatally. Opinions vary regarding the diagnosis and treatment of vesicoureteral reflux, and diagnostic procedures remain debatable. In terms of medical interventions, options include either follow‐up observation in the hope of possible spontaneous resolution of vesicoureteral reflux with growth/development or provision of continuous antibiotic prophylaxis based on patient characteristics (age, presence/absence of febrile urinary tract infection, lower urinary tract dysfunction and constipation). Furthermore, there are various surgical procedures with different indications and rationales. These guidelines, formulated and issued by the Japanese Society of Pediatric Urology to assist medical management of pediatric vesicoureteral reflux, cover the following: epidemiology, clinical practice algorithm for vesicoureteral reflux, syndromes (dysuria with vesicoureteral reflux, and bladder and rectal dysfunction with vesicoureteral reflux), diagnosis, treatment (medical and surgical), secondary vesicoureteral reflux, long‐term prognosis and reflux nephropathy. They also provide the definition of bladder and bowel dysfunction, previously unavailable despite their close association with vesicoureteral reflux, and show the usefulness of diagnostic tests, continuous antibiotic prophylaxis and surgical intervention using site markings.
Collapse
Affiliation(s)
- Hideshi Miyakita
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Tokai University Oiso Hospital, Oiso, Kanagawa, Japan
| | - Yutaro Hayashi
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takahiko Mitsui
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo, Yamanashi, Japan
| | - Manabu Okawada
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric General and Urogenital Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Yoshiaki Kinoshita
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takahisa Kimata
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yasuhiro Koikawa
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Fukuoka City Medical Center of Sick Children, Fukuoka, Japan
| | - Kiyohide Sakai
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Miyagi Children's Hospital, Sendai, Miyagi, Japan
| | - Hiroyuki Satoh
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology and Kidney Transplantation, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masatoshi Tokunaga
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Tokai University Oiso Hospital, Oiso, Kanagawa, Japan
| | - Yasuyuki Naitoh
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumio Niimura
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatrics, Tokai University School of Medicine, Hiratsuka, Kanagawa, Japan
| | - Hirofumi Matsuoka
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kentaro Mizuno
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Kazunari Kaneko
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masayuki Kubota
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| |
Collapse
|
4
|
Baek M, Han DH. Transvesicoscopic Politano-Leadbetter ureteral reimplantation in children with vesicoureteral reflux: A novel surgical technique. Investig Clin Urol 2019; 60:405-411. [PMID: 31501804 PMCID: PMC6722406 DOI: 10.4111/icu.2019.60.5.405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/23/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose We introduce our novel procedure for transvesicoscopic ureteral reimplantation using the Politano-Leadbetter technique (TVUR-PL). We describe the detailed surgical procedure and report operative outcomes. Materials and Methods We report a retrospective analysis of operative outcomes of TVUR-PL performed in children with vesicoureteral reflux (VUR) from January 2017 to July 2018. The analyzed operative outcomes included patient demographics, operative times, intra- and postoperative complications, indwelling duration of urethral Foley catheter, hospital length of stay, and treatment success. Results A total of 47 patients (17 males, 30 females) underwent TVUR-PL during the study period, including 18 unilateral and 29 bilateral cases (76 ureters). All operations were successfully completed without open conversion. The median operative time was 121 minutes for unilateral cases and 178 minutes for bilateral cases. The median duration of placement of a urethral Foley catheter was 2 days. There were no intra- or postoperative complications. Only one patient (1/47 patients, 2.1%), who had no postoperative VUR on voiding cystourethrography, experienced febrile urinary tract infection during the follow-up period. Conclusions Our novel TVUR-PL technique is a safe and effective minimally invasive surgical treatment option for children with VUR. The main advantage of our new operation is that it allows us to maintain the natural direction of the ureter after surgery.
Collapse
Affiliation(s)
- Minki Baek
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Laparoscopic Approach for Intravesical Surgery Using Pneumovesicum in Urology: Literature Review. Int Neurourol J 2018; 22:S10-22. [PMID: 29385784 PMCID: PMC5798636 DOI: 10.5213/inj.1836022.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/19/2018] [Indexed: 12/27/2022] Open
Abstract
Minimally invasive laparoscopic surgical procedures are increasingly being used in the management of various urological diseases. In particular, the laparoscopic approach for intravesical surgery using pneumovesicum (LPV) is a minimally invasive alternative with potential advantages including decreased morbidity, shorter hospital stays, and improved cosmesis. We review the applications of LPV in urology, summarize data for different surgical approaches, and provide an overview of patient management, as well as other considerations. This narrative review focused primarily on articles indexed in PubMed, Google Scholar, Scopus, and Embase databases. No formal search strategy was used, and no meta-analysis of data was performed.
Collapse
|
6
|
Li BS, He Y, Chen Z, Wang ZH, Wen ZQ, Chen X. Transperitoneal Intravesical Technique for Laparoscopic Ureteral Reimplantation to Treat Terminal Ureteral Stenosis. J Laparoendosc Adv Surg Tech A 2017; 27:623-628. [PMID: 28051910 DOI: 10.1089/lap.2016.0431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bing-Sheng Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yao He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhao-Hui Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhi-Qiang Wen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
7
|
Bilateral Transvesicoscopic Cross-trigonal Ureteric Reimplantation in Children: Surgical Subtleties and a Prospective Summary. Urology 2017; 101:67-72. [DOI: 10.1016/j.urology.2016.11.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/19/2016] [Accepted: 11/22/2016] [Indexed: 11/20/2022]
|
8
|
Naitoh Y, Oishi M, Kobayashi K, Yamada Y, Nakamura T, Johnin K, Hongo F, Naya Y, Okihara K, Kawauchi A. Transvesical laparoscopic surgery for double renal pelvis and ureter with or without ureterocele. Int J Urol 2016; 23:332-6. [DOI: 10.1111/iju.13049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 12/06/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Yasuyuki Naitoh
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Masakatsu Oishi
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Kenichi Kobayashi
- Department of Urology; Shiga University of Medical Science; Otsu Japan
| | - Yasuhiro Yamada
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Terukazu Nakamura
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Kazuyoshi Johnin
- Department of Urology; Shiga University of Medical Science; Otsu Japan
| | - Fumiya Hongo
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Yoshio Naya
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Koji Okihara
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Akihiro Kawauchi
- Department of Urology; Shiga University of Medical Science; Otsu Japan
| |
Collapse
|
9
|
Soh S, Kobori Y, Shin T, Suzuki K, Iwahata T, Sadaoka Y, Sato R, Nishi M, Iwamura M, Okada H. Transvesicoscopic ureteral reimplantation: Politano-Leadbetter versus Cohen technique. Int J Urol 2015; 22:394-9. [PMID: 25754455 DOI: 10.1111/iju.12702] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/03/2014] [Accepted: 12/03/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare the outcomes of the Politano-Leadbetter and Cohen techniques in laparoscopic pneumovesicum approach for ureteral reimplantation. METHODS We retrospectively reviewed the medical records of 24 patients who underwent transvesicoscopic ureteral reimplantation during the period from 2007 to 2014. The patients were treated with either the Cohen or Politano-Leadbetter technique. Operative duration, duration of hospital stay, and success and complication rates were compared. RESULTS Operative duration was 1 h longer for the Politano-Leadbetter technique than for the Cohen technique (P < 0.05). Foley catheters were removed 2-3 days after the procedures. The mean hospital stay was 3.6 days. Reflux completely resolved in 21 patients (35 ureters, 94.6%), but not in two patients (2 ureters). There was no difference in the success rate or durations of catheterization or hospital stay between patients treated with the Politano-Leadbetter technique and those treated with the Cohen technique. CONCLUSIONS The Politano-Leadbetter and Cohen techniques are both reliable for transvesicoscopic ureteral reimplantation. Despite a longer operative time, because of the higher surgical complexity, the Politano-Leadbetter ureteral reimplantation offers important physiological advantages over other techniques.
Collapse
Affiliation(s)
- Shigehiro Soh
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Ellsworth P. Evaluation of a process-of-care model for open intravesical ureteral reimplantation in children from a contemporary health care perspective. Hosp Pract (1995) 2013; 41:24-30. [PMID: 24145586 DOI: 10.3810/hp.2013.10.1077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Surgical management of patients with vesicoureteral reflux consists of both open and minimally invasive approaches. Open approaches are associated with postoperative hospitalization and stays of 2 to 3 days, dependent on the type of procedure; alternately, when endoscopic correction is performed, it is a same-day procedure. Changes in health care policy emphasize reduction in cost while maintaining and improving quality of care. We sought to evaluate the impact of a "1-night cost-saving process-of-care" model for open surgical correction of vesicoureteral reflux in children on quality of care, which was defined as a return to the emergency room (ER)/office or readmission to the hospital within 2 days of discharge. MATERIALS AND METHODS An institutional review board-approved retrospective chart review of all open ureteral reimplantations for uncomplicated vesicoureteral reflux from January 2009 through January 2013 was performed. Children who underwent ureteral stent placement and those who did not have a caudal anesthetic were excluded from the study. Length of postoperative stay, ER records, hospitalizations, and office records were reviewed to assess for presentation to the ER/office or readmission to the hospital within 2 days of discharge. RESULTS During the 4-year study period, 92 children (23 males, 69 females) underwent open ureteral reimplantation-there were 83 (89.1%) discharges on the first postoperative day; 9 (9.8%) on the second postoperative day; and 1 (1.1%) on the third postoperative day. One patient presented to the ER within 2 days of discharge, and 4 patients presented to the ER/office or were readmitted > 2 days after discharge. CONCLUSION Use of a caudal anesthetic, earlier catheter removal, a knowledgeable nursing team, and parental education allowed us to decrease the length of stay to 1 night in 82 of 92 patients (89.1%). These procedural changes allowed for a decrease in hospital stay comparable with and potentially shorter than robotic-assisted laparoscopic approaches. Additionally, these changes did not seem to increase the risk of early (≤ 2 days of discharge) presentation to the ER/office or readmission.
Collapse
Affiliation(s)
- Pamela Ellsworth
- Professor of Urology/Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI.
| |
Collapse
|
11
|
Abstract
The surgical armamentarium of the pediatric urologist has changed greatly in the past 2 decades on account of new technology and careful adaptation of minimally invasive techniques in children. Conventional laparoscopy, robotic-assisted laparoscopy, laparoendoscopic single-site surgery, and endourologic surgery have, to varying degrees, provided new approaches to urologic surgery in the pediatric population. This article reviews the technology and adaptations behind these recent advances as well as their current applications in management of urologic disease in children.
Collapse
Affiliation(s)
- Robert M Turner
- Division of Pediatric Urology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| | | | | |
Collapse
|
12
|
Chung MS, Han SW, Jung HJ, Im YJ, Han HH, Na JC, Hong CH. Transvesicoscopic ureteral reimplantation in children with bilateral vesicoureteral reflux: surgical technique and results. J Laparoendosc Adv Surg Tech A 2012; 22:295-300. [PMID: 22356205 DOI: 10.1089/lap.2011.0318] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To report our initial experience with transvesicoscopic cross-trigonal ureteral reimplantation (TVUR), describing stepwise the surgical procedure and determining critical aspects of this surgery in the actual surgical field. SUBJECTS 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 set-up, 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 versus increase in surgeon experience (dividing our cases into three groups: the first third, the second third, 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 a total of 48 cases, 45 patients underwent TVUR successfully except for 3 cases of open conversion. Among the 45 cases, the mean overall operative time was 155.6 min. In 1 patient, proximal migration of the ureteral catheter occurred. 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.
Collapse
Affiliation(s)
- Mun Su Chung
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
13
|
Marchini GS, Hong YK, Minnillo BJ, Diamond DA, Houck CS, Meier PM, Passerotti CC, Kaplan JR, Retik AB, Nguyen HT. Robotic Assisted Laparoscopic Ureteral Reimplantation in Children: Case Matched Comparative Study With Open Surgical Approach. J Urol 2011; 185:1870-5. [DOI: 10.1016/j.juro.2010.12.069] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Indexed: 11/29/2022]
Affiliation(s)
- Giovanni S. Marchini
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Young Kwon Hong
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Brian J. Minnillo
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - David A. Diamond
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Constance S. Houck
- Center for Pediatric Urologic Anesthesia, Children's Hospital Boston, Boston, Massachusetts
- Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts
| | - Petra M. Meier
- Center for Pediatric Urologic Anesthesia, Children's Hospital Boston, Boston, Massachusetts
- Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts
| | - Carlo C. Passerotti
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Joshua R. Kaplan
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Alan B. Retik
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital Boston, Boston, Massachusetts
- Center for Pediatric Urologic Anesthesia, Children's Hospital Boston, Boston, Massachusetts
| | - Hiep T. Nguyen
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital Boston, Boston, Massachusetts
- Center for Pediatric Urologic Anesthesia, Children's Hospital Boston, Boston, Massachusetts
| |
Collapse
|
14
|
Hong CH, Kim JH, Jung HJ, Im YJ, Han SW. Single-surgeon experience with transvesicoscopic ureteral reimplantation in children with vesicoureteral reflux. Urology 2011; 77:1465-9. [PMID: 21333340 DOI: 10.1016/j.urology.2010.11.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 10/01/2010] [Accepted: 11/14/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To review our initial experience with transvesicoscopic ureteral reimplantation (TVUR) in children with vesicoureteral reflux and to evaluate the learning curve for the feasibility and reproducibility of TVUR. METHODS TVUR was performed in 28 consecutive patients with a mean age of 6.0 years. Cohen's classic technique was reproduced using a laparoscopic technique with two 3-mm working ports and a 5-mm camera port. RESULTS TVUR was successfully completed in 26 patients. In 2 patients, TVUR was converted to open intravesical reimplantation. The postoperative vesicoureteral reflux resolution rate was 94.6% (35 of 37 ureters). The mean operative time for TVUR was 166 minutes for unilateral reimplantation and 189 minutes for bilateral reimplantation. When the operation times of the first 13 and the last 13 patients were compared, the mean operative time had decreased significantly for the last 13 patients compared to that for the first 13 patients (140 vs 220 minutes). The mean postoperative hospital stay was also significantly shorter for the last 13 patients than for the first 13 patients (1.08 vs 1.69 days). CONCLUSIONS TVUR is currently performed at only at a few centers because of the technical difficulties and the potentially steep learning curve. However, our results have indicated rapid improvement in the operative time within a short period, suggesting a shorter learning curve for TVUR than expected. TVUR is a reproducible procedure and is a reasonable option for the treatment of vesicoureteral reflux.
Collapse
Affiliation(s)
- Chang Hee Hong
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|