- 作者：Stephen Griffin ; J. Lauron ; A.L. Fragoso ; P. Arnaud ; R. Lé ; culé ; e ; H. Steyaert ; J.S. Valla
- 刊名：Journal of Pediatric Urology
- 出版年：2009
- 出版时间：April 2009
- 年：2009
- 卷：5
- 期：Supplement 1
- 页码：S31
- 全文大小：36 K
Purpose
To evaluate our results with the method of intravesical ureteric reimplantation using laparoscopic pneumovesicum in children.Material and Methods
Seventy-two patients (mean age 4.2 years, range 0.5-20 years) with primary vesico-ureteral reflux (VUR) underwent a laparoscopic transtrigonal ureteric reimplantation with CO2 pneumovesicum. Ports were inserted suprapubically – 5 mm for the camera and two 3-5 mm working ports. Having mobilised the ureter(s) intravesically, a submucosal tunnel is created and ureteric reimplantation performed with 5/0 and 6/0 absorbable sutures. Bladder drainage was maintained for 2-3 days post-operatively. Patients were followed up with clinical assessment, renal ultrasonography ± voiding cystourethrogram.
Results
Ninety % had VUR greater than or equal to grade 3. A total of 113 ureters were re-implanted. The mean operative time was 82 minutes for unilateral re-implantation, 130 minutes for bilateral. Four cases (6 % ) were converted. Three patients (4 % ) presented with temporary ureteric dilatation without symptoms on follow-up renal ultrasound. Seven patients (10 % ) had post-operative urinary tract infection without persistent reflux on cystography. Follow-up cystogram was performed in 50 patients (81 ureters). Reflux persisted in 4 of these patients (8 % ). There was a trend towards increased persistent VUR and conversion in patients less than 2 years of age. In addition, failure was more common in patients with higher grades of reflux.
Conclusions
Laparoscopic ureteric remplantation with CO2 pneumovesicum is technically feasible with a high success rate (92 % ). However, the role of this technique, in the treatment of VUR, remains to be determined.