Category: Reconstruction: Pediatrics

MP14-20 - Transvesicoscopic Ureteral Reimplantation for VUR : A single center experience

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Transvesicoscopic ureteral reimplantation (TVUR) has been reported as an alternative procedure for vesicoureteral reflux (VUR). Many reports have suggested that TVUR can be performed safely and effectively with a high success rate and minimal invasiveness. But TVUR has not gained wide  popularity as a treatment for VUR because the procedure is  technically challenging. Although TVUR has been viewed as a difficult procedure with a steep learning curve, several studies suggest that the learning curve is shorter than might be expected. Accordingly, we aimed to review our initial experience of TVUR, to identify the critical aspects that might affect the surgical difficulty, and to evaluate the learning curve of this intervention.


Methods :

50 patients (23 male and 27 female) who underwent TVUR in our institution from Dec. 2013 to Mar. 2018 were retrospectively analyzed. Mean age at operation was 4.0 years (1-39 years). The Surgeries were performed by 3 surgeons, one had more than 100 experiences of TVUR in a previous institute, and the others had no experience before the term of the surveillance.  Three 5 mm ports were introduced through the bladder wall under cystoscopic vision. Having mobilized the ureter intravesically, a submucosal tunnel was created and ureterovesical anastomosis was performed with 5-0 absorbable monofilament sutures.


Results :

In total 86 ureters, including 36 bilateral cases, were treated. 5 patients (6 units) had ureteral duplication, 1 patient had an intravesical ureterocele after a spontaneous rupture, and 2(3 units) had undergone endoscopic treatment using deflux. 2 cases were converted due to difficulty with port access to the bladder and CO2 leakage into the peritoneal space. The median operating time was 188 minutes for the unilateral cases and 241 minutes for the bilateral cases.  The operation time was significantly longer for special cases as previously described. There was no significant difference between  cases aged 4 years or older and those under 4 years. 4 patients (5 units) had persistent VUR on postoperative cystograms. Grades of persistent VUR were under 2 in all cases. The recurrence of febrile UTI was observed in 2 patients (4.0%).


Conclusions :

Our results from this study indicate that TVUR appears to be an effective alternative for VUR. Although long operative times were needed during the early period of our TVUR experience, the operative times decreased with the increasing numbers of cases. Patient selection may be recommended in the initial phase of this procedure.


 

Kenichi Kobayashi

Research associate
The department of urology, Shiga university of medical science
Otsu City, Shiga, Japan

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Kazuyoshi Johnin

Lecturer
The department of urology, Shiga university of medical science
Otsu City, Shiga, Japan

Tetsuya Yoshida

Research associate
Shiga university of medical science
Otsu, Shiga, Japan

Susumu Kageyama

Lecturer
The department of urology, Shiga university of medical science
Otsu city, Shiga, Japan

Mitsushiro Narita

Associate Professor
Shiga university of medical science
Otsu, Shiga, Japan

Akihiro Kawauchi

Professor
The department of urology, Shiga university of medical science
Otsu, Shiga, Japan