V574: Experience with the Vesicoscopic Ureteral Reimplantation by Politano-Leadbetter technique
VideoIntroduction and Objectives
We present a initial report with the vesicoscopic ureteral reimplan
tation by Politano-Leadbetter (P-L) technique under pneumovesicum
We attempted vesicoscopic ureteral reimplantation with the P-L technique for total 14 ureters, 9 girls with more than grade III vesicoureteral reflux (VUR) and 1 girl with vesico-ureteral stricture. To provide intravesical vision by 5 mm endoscope 5-mm Step port was placed on bladder dome under the cystoscopic guidance. Two 3 mm Step ports were placed on the lateral bladder wall subsequently. The bladder was drained and insufflated with CO2 to 8 mm Hg pressure. To assist intravesical surgical manipulation a 3-mm port was placed from the urethral meatus. All the endoscopic transvesical manipulations that was mobilization of ureter, was creation of 2.5 cm length new submucosal tunnel along with Politano-Leadbetter technique were performed under videoscopic guidance. Ureteral catheter was used for bilateral cases by next morning. Urethral catheter was removed on day 2 postoperatively. After confirmed voiding, the patients were discharged same day afternoon.
Results: There was no serioous complication after surgery. No patients required any narcotic analgesics postoperatively. After removal of the urethral catheter bladder spasm was minimal. At 8 weeks postoperatively, the patients had a repeat VCUG that showed no reflux in 12 uretes of 13 ureters. Of these patients VUR was persisted in a girl. In the first case, vesicoscopic ureteral reimplantation was converted to open surgery after finish the surgery of other ureter, because peumovesicum was unable to maintain.
This technique is very useful for female patients with high grade VUR.