Unilateral extravesical ureteral reimplantation via inguinal incision for the correction of vesicoureteral reflux: a 10-year experience

Abstract

Introduction and Objective:Multiple options exist for the surgical management of vesicoureteral reflux (VUR). We report on our 10-year experience using the inguinal approach to extravesical ureteral reimplantation (EVR).Materials and Methods:Patient characteristics of age, gender, and reflux grade were obtained and outcomes of operative time, hospital stay, and radiographic resolution were assessed.Results:71 girls and 20 boys with a mean age of 74 months (range 14-164) underwent inguinal EVR via a 3.5-cm inguinal mini-incision. Mean follow up was 10.9 months (range 0.4-69.7). Average grade of reflux was 2.80. Average operative time was 91 minutes (range 51-268). The procedure was successful in 87 of 91 patients (95.6%). The 3 cases of reflux that persisted were all grade 1 and managed expectantly. Contralateral reflux developed in 9 cases, all of which resolved after treatment with either Deflux or ureteral reimplant. There were 4 case of urinary retention that resolved after a brief period of CIC or indwelling catheterization. There were no cases of ureteral obstruction. Most patients were discharged on post-operative day 1 (85/91) and no hospitalization extended beyond 3 days.Conclusions:The inguinal approach to extravesical ureteral reimplantation should be considered as a potentially minimally invasive alternative to endoscopic and robotic treatment of VUR with a success rate more comparable to traditional open approaches. We feel it is the method of choice in cases of unilateral VUR requiring surgical correction.

Robot-assisted extravesical ureteral reimplantation (REVUR) for bilateral vesico-ureteral reflux in children: Results of a multicentric international survey

“…We also reviewed the available literature published on open extravesical reimplantation (Table 3) and we found that many authors have performed this intervention as an outpatient procedure without increased morbidity or rehospitalization [31][32][33][34][35]. Schomberg et al [36] reported a single-surgeon experience of open and initial experience with robot-assisted laparoscopic ureteral reimplantation (RALUR) performed with the same surgical technique on consecutive cohorts with identical post-surgical care protocol and they concluded that RALUR reduces postoperative analgesic requirements while yielding similar clinical outcomes as the open technique.…”