1
|
He Y, Wu X, Xu Y, Liu Z, Du G, Wu X, Liu W, Wu R. Ureteral dilation recovery after intravesical reimplantation in children with primary obstructive megaureter. Front Pediatr 2023; 11:1164474. [PMID: 37425259 PMCID: PMC10326513 DOI: 10.3389/fped.2023.1164474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023] Open
Abstract
Background To observe the postoperative recovery following ureteral dilation in primary obstructive megaureter (POM) after ureteral implantation, and evaluate the risk factors affecting ureter diameter resolution. Materials and Methods A retrospective study was performed in patients with POM who underwent ureteral reimplantation using the Cohen procedure. Patient characteristics, perioperative parameters, and postoperative outcomes were also analysed. A widest ureteral diameter of <7 mm was defined as a normal shape and outcome. Survival time was defined as the time from surgery to ureteral dilation recovery or to the last follow-up. Results A total of 49 patients (54 ureters) were included in the analysis. The survival time ranged from 1 to 53 months. The shapes of a total of 47 (87.04%) megaureters recovered, and most (29/47) resolutions happened within 6 months after surgery. In the univariate analysis, bilateral ureterovesical reimplantation (p = 0.015), ureteral terminal tapering (p = 0.019), weight (p = 0.036), and age (p = 0.015) were associated with the recovery time of ureteral dilation. A delayed recovery of ureteral diameter was noted in bilateral reimplantation (HR = 0.336, p = 0.017) using multivariate Cox regression. Conclusions Ureteral dilation in POM mostly returned to normal within six postoperative months. Moreover, bilateral ureterovesical reimplantation is a risk factor for delayed postoperative recovery of ureter dilation in POM.
Collapse
Affiliation(s)
- Yan He
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Xuemin Wu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Yingrui Xu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Zhaoquan Liu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Guoqiang Du
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiangyu Wu
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Wei Liu
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Rongde Wu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| |
Collapse
|
2
|
Shumaker AD, Kord E, Dubrov V, Bondarenko S, Visman Y, Stav K, Zisman A, Neheman A. Laparoscopic Ureteral Reimplantation after Failed Open Surgery: Incorporating the Psoas Hitch Maneuver for Sufficient Tunnel Length. Eur J Pediatr Surg 2023; 33:41-46. [PMID: 35858643 DOI: 10.1055/a-1905-4636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Failure after open ureteral reimplantation has been reported to occur in 2 to 7% of cases. While a second open reconstructive surgery is appropriate in most cases, there are data suggesting similar outcomes utilizing the laparoscopic approach. The objective of this study is to describe a modification and report our experience with laparoscopic ureteral reimplantation after failed open reimplantation reinforced with a psoas hitch. MATERIALS AND METHODS A retrospective review of pediatric patients who underwent laparoscopic ureteral reimplantation after failed open surgery between September 2012 and April 2018 at three different academic centers was performed. Patient demographics, surgical indications, complications, and outcomes were reviewed. Either ipsilateral ureteral reimplantation with a combined intravesical and extravesical approaches or a cross-trigonal extravesical approach was utilized, depending on the length of the ureter. In all cases, a psoas hitch was performed to gain a longer submucosal tunnel and relieve tension, thus facilitating an efficient antireflux mechanism. RESULTS Seventeen patients underwent a laparoscopic ureteral reimplantation after failed open surgery. Median age at second surgery was 106 months (interquartile range [IQR]: 53-122.5). Ipsilateral ureteral reimplantation with a combined intravesical and extravesical approaches was performed in 11 cases and cross-trigonal extravesical approach in 6 cases. Median ureteral diameter before the redo surgery was 16 mm (IQR: 14.5-18.5) and after surgery was 6 mm (IQR: 3.5-8.5) (p < 0.001). Postoperative mercaptoacetyltriglycine renal scan showed a nonobstructive pattern and stable renal function in all cases. CONCLUSION Laparoscopic ureteral reimplantation with incorporation of a psoas hitch after failed open reimplantation is safe and effective.
Collapse
Affiliation(s)
- Andrew D Shumaker
- Department of Urology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Kord
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | - Vitaly Dubrov
- Department of Urology, Children's City Clinical Hospital, Minsk, Belarus
| | - Sergey Bondarenko
- Department of Urology, Municipal Hospital, Volgograd, Russian Federation
| | | | - Kobi Stav
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | - Amos Neheman
- Department of Urology, Shamir Medical Center, Zerifin, Israel.,Department of Infectious Diseases, Shamir Medical Center, Zerifin, Israel
| |
Collapse
|
3
|
Li W, Dong H, Chen P, Su C, Wang C, Li Y, Li Y, Chen J, Luo Y. Surgical management of vesicoureteral junction obstruction (VUJO) in children: A comparative study between transvesicoscopic Cohen reimplantation and transumbilical laparoendoscopic single-site (TU-LESS) Lich-Gregoir techniques. J Endourol 2022; 36:1043-1049. [PMID: 35323047 DOI: 10.1089/end.2021.0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are many reports on the application of minimally invasive technology in the correction of children's VUJO, but there is no report on the treatment of children's VUJO by the TU-LESS Lich-Gregoir method. We aimed to comparatively analyze the therapeutic outcomes of transvesicoscopic ureteral reimplantation Cohen procedure (TUR-C) and TU-LESS surgery Lich-Gregoir procedure (TU-LESS-LG) in pediatric VUJO. METHODS The data of 49 children with VUJO admitted from January 2016 to January 2020 were retrospectively analyzed. Based on different surgical methods, they were divided into the TUR-C group (23 cases) and the TU-LESS-LG group (26 cases). The demographic characteristics, perioperative characteristics, postoperative complications, the recovery of renal function, and the improvement of hydronephrosis were compared between the two groups. RESULTS There were no statistical differences in demographic characteristics and preoperative data between the two groups. The TU-LESS-LG group was superior to the TUR-C in terms of average operation time and postoperative hospital stay. There was no statistical difference between the two groups in terms of postoperative complications, postoperative recovery of renal function, and improvement of hydronephrosis. CONCLUSION The two surgical methods can achieve a similar curative effect in the treatment of VUJO. The TU-LESS-LG has more advantages in operation time, postoperative hospital stays, the wider age selection range of cases, megaureter tapering, and cosmetic incision, but the operation is more difficult.
Collapse
Affiliation(s)
- Wei Li
- Guangxi Medical University First Affiliated Hospital, 117742, pediatric surgery, 6 Shuangyong Road, Nanning, guangxi, China, 530021;
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Gander R, Asensio M, Royo GF, López M. Laparoscopic extravesical ureteral reimplantation (LEUR) of obstructed megaureters: STEP-BY-STEP video of a simplified approach. J Pediatr Urol 2021; 17:581-582. [PMID: 34332834 DOI: 10.1016/j.jpurol.2021.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/07/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In this video we aim to describe step-by-step a simplified surgical technique for the treatment of primary and secondary obstructed megaureters in children by laparoscopic extravesical ureteral reimplantation (LEUR). MATERIAL AND METHODS A transperitoneal approach is used in all cases. The distal ureter is dissected and transected at the level of the stenosis. Detrusor fibers are divided to expose bladder mucosa and the distal ureter is introduced into the bladder to create a valve-like mechanism (modified-Shanfield technique). RESULTS Between 2016 and 2020, 9 patients underwent LEUR (5 female, 4 male). Mean age at surgery was 31.6 months (SD:22.74) and indications were infection (2), obstruction (3), increase hydronephrosis (2) and decrease in renal differential function (2). The procedure was completed laparoscopically in all cases with a median operative time of 144 min (r: 120-160). The postoperative MAG-3 renogram revealed a non-obstructive pattern in 8/9 patients and MCUG demonstrated absence of VUR in all 8/9. With a mean follow-up of 2.4 years (SD:1.4) all are asymptomatic. CONCLUSIONS LEUR by this new simplified technique is a feasible treatment of megaureters associated with good short and long-term results.
Collapse
Affiliation(s)
- Romy Gander
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d´Hebron Barcelona, Hospital Vall d´Hebron, Passeig de la Vall d´Hebrón 119-129, 08035 Barcelona, Spain.
| | - Marino Asensio
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d´Hebron Barcelona, Hospital Vall d´Hebron, Passeig de la Vall d´Hebrón 119-129, 08035 Barcelona, Spain
| | - Gloria Fatou Royo
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d´Hebron Barcelona, Hospital Vall d´Hebron, Passeig de la Vall d´Hebrón 119-129, 08035 Barcelona, Spain
| | - Manuel López
- Department of Pediatric Surgery, University Hospital Vall d´Hebron, Barcelona, Spain; Hospital Vall d´Hebron, Passeig de la Vall d´Hebrón 119-129, 08035 Barcelona, Spain; Universidad autónoma de Barcelona, Hospital Vall d´Hebron, Passeig de la Vall d´Hebrón 119-129, 08035 Barcelona, Spain
| |
Collapse
|
5
|
Lopez M, Perez-Etchepare E, Bustangi N, Godik O, Juricic M, Varlet F, Gutierrez R, Gomez Culebras M, Gander R, Royo G, Asensio M. Laparoscopic Extravesical Reimplantation in Children with Primary Obstructive Megaureter. J Laparoendosc Adv Surg Tech A 2020. [PMID: 32212997 DOI: 10.1089/lap.2019.0396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Conservative management of primary obstructive megaureter (POM) appears as the best option in patients with adequate ureteral drainage. Nevertheless, surgical intervention is indicated in cases of recurrent urinary tract Infections (UTIs), deterioration of split renal function, and significant obstruction. The gold standard includes: Ureteral reimplantation with or without tapering by open approach. Our objective is to report our results in the treatment of POM by Laparoscopic-Assisted Extracorporeal Ureteral Tapering Repair (EUTR) and Laparoscopic Ureteral Extravesical Reimplantation (LUER) and to evaluate the efficacy and security of this procedure. Materials and Methods: From January 2011 to January 2018 a retrospective study was carried out by reviewing the clinical records of 26 patients diagnosed with POM. All patients underwent laparoscopic ureteral reimplantation following Lich Gregoir technique. In cases of ureteral tapering, an EUTR was performed with Hendren technique. Results: In all patients LUER and EUTR were performed without conversion. No ureteral tapering was necessary in six patients. There were no intraoperative complications. At 3 months in postoperative, 1 patient presented a febrile UTI, and subsequently, a vesicoureteral reflux (VUR) grade III was diagnosed by voiding cystourethrogram. In this case, a redo laparoscopic surgery was performed. After long-term follow-up, all patients were asymptomatic without recurrence of POM or VUR. Conclusion: Laparoscopic-assisted EUTR and LUER following Lich Gregoir technique for POM constitutes a safe and effective option, with a success rate similar to that of open procedure. Nevertheless, larger randomized prospective trials and long-term follow-up are required to validate this technique.
Collapse
Affiliation(s)
- Manuel Lopez
- Department of Pediatric Surgery & Urology, University Hospital of Vall d'Hebron, Barcelona, Spain.,Department of Pediatric Surgery & Urology, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Eduardo Perez-Etchepare
- Department of Pediatric Surgery & Urology, University Hospital Nuestra Senora de Candelaria, Tenerife, Spain
| | - Nasser Bustangi
- Department of Pediatric Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Oleg Godik
- Department of Pediatric Surgery & Urology, National Medical University and Clinic Oberig, Kiev, Ukraine
| | - Michel Juricic
- Service de Chirurgie Pédiatrique et Urologie Toulouse, Clinique Rive du Gauche, Toulouse, France
| | - Francois Varlet
- Department of Pediatric Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - Rocio Gutierrez
- Department of Pediatric Surgery, University Hospital of Arnaud de Villanova, Lleida, Spain
| | - Mario Gomez Culebras
- Department of Pediatric Surgery & Urology, University Hospital Nuestra Senora de Candelaria, Tenerife, Spain
| | - Romy Gander
- Department of Pediatric Surgery & Urology, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Gloria Royo
- Department of Pediatric Surgery & Urology, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Marino Asensio
- Department of Pediatric Surgery & Urology, University Hospital of Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
6
|
Gander R, Asensio M, Royo GF, López M. Laparoscopic extravesical ureteral reimplantation for correction of primary and secondary megaureters: Preliminary report of a new simplified technique. J Pediatr Surg 2020; 55:564-569. [PMID: 31326110 DOI: 10.1016/j.jpedsurg.2019.05.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/07/2019] [Accepted: 05/31/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE To describe a simplified surgical technique for the treatment of primary and secondary obstructed megaureters in children by laparoscopic extravesical ureteral reimplantation (LEUR) and evaluate the short-term outcomes. METHODS Prospective study of children with primary and secondary megaureters treated at our institution between 2016 and 2018 by LEUR. A transperitoneal approach was used in all cases. The distal ureter was transected at the level of the stenosis. Detrusor muscle fibers were divided to expose bladder mucosa. The distal ureter was introduced into the bladder to create a valve-like mechanism. The ureter was fixed to the bladder mucosa by four stitches. We analyzed indications for surgery, complications and outcomes. Definition of success was relieved of obstruction and absence of VUR. RESULTS Six patients with a mean age of 28.83 months (SD: 21.4) underwent LEUR. Indications for surgery were: infection [2], obstruction [2], decrease in renal differential function [1] and increase in hydronephrosis [1]. There were no intraoperative complications. Resolution of hydronephrosis, obstruction and VUR was achieved in all cases. Mean follow-up was 13 months (SD: 6.67). CONCLUSION LEUR for the correction of primary and secondary megaureters by this new technique is safe. The most important advantage is that this technique is simpler and more easily reproducible than conventional LEUR. However, long-term follow-up is required. TYPE OF STUDY Prospective, observational. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Romy Gander
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Passeig de la Vall d'Hebrón 119-129, 08035 Barcelona, Spain.
| | - Marino Asensio
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Passeig de la Vall d'Hebrón 119-129, 08035 Barcelona, Spain
| | - Gloria Fatou Royo
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Passeig de la Vall d'Hebrón 119-129, 08035 Barcelona, Spain
| | - Manuel López
- Department of Pediatric Surgery, University Hospital Vall d'Hebron, Hospital Vall d'Hebron, Passeig de la Vall d'Hebrón 119-129, 08035 Barcelona, Spain; Universitat Autónoma de Barcelona, Hospital Vall d'Hebron, Passeig de la Vall d'Hebrón 119-129, 08035, Barcelona, Spain
| |
Collapse
|
7
|
Neheman A, Kord E, Koucherov S, Kafka I, Gaber J, Noh PH, Zisman A, Chertin B. A Novel Surgical Technique for Obstructed Megaureter: Robot-Assisted Laparoscopic Dismembered Extravesical Cross-Trigonal Ureteral Reimplantation—Short-Term Assessment. J Endourol 2020; 34:249-254. [DOI: 10.1089/end.2019.0192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amos Neheman
- Department of Urology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Kord
- Department of Urology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Stanislav Koucherov
- Departments of Urology and Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Ilan Kafka
- Departments of Urology and Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Jaudat Gaber
- Departments of Urology and Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Paul H. Noh
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Amnon Zisman
- Department of Urology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Boris Chertin
- Departments of Urology and Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| |
Collapse
|
8
|
Szavay PO. Applications of Laparoscopic Transperitoneal Surgery of the Pediatric Urinary Tract. Front Pediatr 2019; 7:29. [PMID: 30805327 PMCID: PMC6378287 DOI: 10.3389/fped.2019.00029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/23/2019] [Indexed: 12/23/2022] Open
Abstract
Application of laparoscopy in pediatric urology has evolved over more than 30 years coming from a merely diagnostic use for non-palpable testes to "interventional" laparoscopy to extirpative surgery and finally to the era of reconstructive pediatric laparoscopic urology, when in 1995 Peters described the first laparoscopic pyeloplasty in a child. Laparoscopic surgery in pediatric urology became implemented increasingly in the twenty-first century with now present-day applications including the complete variety of all kind of indications for surgery for pediatric urological pathology. This article aims to provide a comprehensive overview of current indications, techniques, and outcomes of laparoscopic transperitoneal surgery of the upper as well as of the lower urinary tract for urological pathology in the pediatric patient population.
Collapse
Affiliation(s)
- Philipp O Szavay
- Department of Pediatric Surgery, Lucerne Children's Hospital, Lucerne, Switzerland
| |
Collapse
|
9
|
Videourology Abstracts. J Endourol 2018; 32:989-993. [PMID: 30188190 DOI: 10.1089/end.2018.29045.vid] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|