Minimally invasive reimplantation of the ureter for obstructive megaureter in children: a multicenter study

Abstract

BACKGROUND: Open reimplantation has been considered the gold standard treatment for pathologies of the ureterovesical segment. In 2000, studies that presented results of the use of laparoscopic and vesicoscopic techniques for ureteral reimplantation in children began to emerge.

AIM: This study aimed to retrospectively analyze the results and complications of minimally invasive interventions in children with obstructive megaureter using various ureteral reimplantation techniques.

MATERIALS AND METHODS: Data from 369 patients (385 ureters) operated on in 12 clinics were included. The median age of the patients was 6 months (4; 7.8), and 39 (10.7%) patients had concomitant pathology of the ureter and bladder. Cohen’s vesicoscopic operation, extravesical transverse reimplantation, Lich–Gregoir dissection, and psoas-hitch reimplantation were conducted on 189, 148, 27, and 21 ureters, respectively, and ureteral diameter remodeling was performed in 23.6% of patients. The Mann–Whitney U-test, Kruskal–Wallis test, Fisher’s exact test, and binary logistic regression model were used to assess the statistical significance of the studied variables.

RESULTS: The median operation time was 140 minutes (110; 170). Obstruction was eliminated in 375 of 385 ureters (97.4%), regardless of the type of reimplantation, and vesicoureteral reflux developed in 35 (9.1%) ureters. Intraoperative (3) and postoperative complications (22) were present in 0.8% and 6% of cases, respectively. Reoperations were performed in 31 patients (8%). The statistically significant predictors of reimplantation outcome were tunnel orientation, infant age, and ureteral diameter.

CONCLUSIONS: Minimally invasive ureteral reimplantation for obstructive megaureter is safe for children, with efficacy comparable to open surgery, and with few complications.

Keywords

primary obstructive megaureter / minimally invasive reimplantation / laparoscopy / pneumovesicoscopy / children

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