Bilateral Transvesicoscopic Cross-trigonal Ureteric Reimplantation in Children: Surgical Subtleties and a Prospective Summary

Abstract

Objective: To prospectively evaluate the surgical technique and results of bilateral transvesicoscopic cross-trigonal ureteric reimplantation (TVUR) in children with vesicoureteric reflux (VUR) and compare the results and surgical subtleties with the existing literature.

Materials and methods: From January 2010 to December 2015, children between 2 and 14 years of age with bilateral primary VUR grades II-IV underwent bilateral TVUR at a tertiary referral center in Northern India. The grade of VUR was II in 12 patients, III in 19 patients, and IV in 3 patients. All surgeries were performed by a single surgeon. Success was defined as the absence of VUR on direct radionuclide cystogram at 8 weeks.

Results: Seventeen patients (34 refluxing ureters) underwent bilateral TVUR during the study period. They included 13 girls and 4 boys. The median age was 4.6 years (range: 2-14 years). Two patients required conversion to open surgery. Resolution of VUR was seen in 16 patients (32 out of 34 ureters). Hydronephrosis resolved on postoperative ultrasonography in all patients with low-grade reflux (lower than grade IV) and all except one patient with grade IV reflux.

Conclusion: TVUR is a feasible method with success rate equal to that of open technique if patient selection is good. Success rate is low in high-grade reflux, and dilated and tortuous ureter. Subtle modifications in the surgical steps can make significant contribution toward learning this minimally invasive technique.