V578: Initial experience of transvesicoscopic ureteral reimplantation with ureteral plication in refluxing megaureter

Video

Introduction and Objectives
Main advantages of transvesicoscopic ureteral reimplantation are minimal postoperative pain, hospital stay and small scars.

However, disadvantage of the procedure will be limited space in pediatric patients, especially in cases of refluxing megaureter where transvesicoscopic ureteral plication can be more challenging and physically demanding.

We report our experience of transvesicoscopic ureteral reimplantation with ureteral plication in children with refluxing megaureter.

Methods
Between January, 2008 and December, 2011, we retrospectively reviewed 7 patients who underwent transvesicoscopic ureteral reimplantation with ureteral plication for refluxing megaureter. 4 patients were diagnosed with bilateral VUR and 6 patients were male.

Results
Median age of 7 patients at surgery was 39.4 (range 9.7-142.2) months. Mean maximal diameter of megaureter on VCUG was 1.4 (range 1.2-1.6) cm. Mean operative time was 243.5±28.8 (range 210-287) min. We underwent ureteral plication by Starr method and inserted 3Fr. ureteral catheter in plicated ureter. Mean duration of ureteral catheter indwelling was 5.8 (range 3-7) days. Mean hospital day after surgery 7.3 (range 5-11) days. There were no complications in perioperative and postoperative periods. We performed follow up VCUG after 6 months postoperatively. All patients represented no reflux on follow up VCUG.

Conclusions
Our initial experience indicates that transvesicoscopic ureteral reimplantation with ureteral plication is a feasible surgical technique in children with megaureter. The operation time is clearly longer than for open surgery. However, the benefits of this procedure are reduced bladder trauma, reduction of postoperative pain and excellent cosmesis. Transvesicoscopic ureteral reimplantation with plication can be a great alternative treatment option for those pediatric urologists who are skilled in open Cohen&[prime]s reimplantation.

Funding: none