Laparoscopic ureteral reimplantation - Comparison of intravesical versus extravesical techniques in the management of unilateral primary vesicoureteral reflux in children: Does approach matter?

Abstract

Aims/introduction: Laparoscopic extravesical and intravesical (transvesicoscopic) ureteral reimplantation are widely accepted procedures but there is limited literature on comparison of these techniques. This study compares the efficacy and outcomes of laparoscopic intravesical and extravesical ureteral reimplantation for unilateral primary vesicoureteral reflux (VUR) in children.

Materials and methods: We retrospectively analysed the case records of 62 children between ages of 1 and 18 years who underwent laparoscopic unilateral ureteral reimplantation at our institute between January 2019 and January 2023. Patients divided into two groups; those who underwent laparoscopic intravesical ureteric reimplantation were Group A and those who underwent laparoscopic extravesical ureteric reimplantation were Group B. We analysed the blood investigations, pre- and post-operative grade of reflux, operative time, complications, analgesic requirements, and pre- and post-operative nuclear scans. The success of surgery was defined as the resolution of VUR on voiding cystourethrography (VCUG) performed 6 months post operatively.

Results: 24 patients were in Group A and 38 patients in Group B. The mean age and grades of reflux were comparable in the groups. The difference in operative time was statistically significant (Group A: 131.3 ± 30.4 min and Group B: 96 ± 20.4 min, p = 0.009). The success rate (95.8% vs 94.7%), complication rate (16.7% vs 15.7%), time to discharge (2.6 vs 3.3 days) of both group was comparable. Less analgesics were needed in intravesical group (186 vs 204 mg/kg) though it was not statistically significant (p = 0.22).

Conclusion: Laparoscopic ureteric reimplantation by both extravesical and intravesical route is equally safe and effective with similar efficacy, outcome and comparable acceptable complication rate.

Keywords: EVUR: extravesical ureteric reimplant; IVUR: intravesical ureteric reimplant; USG: ultrasound; UTI: urinary tract infection; VCUG: voiding cystourethrogram; VUR: vesicoureteral reflux.