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  • Title: Laparoscopic-Assisted Extravesical Ureteral Reimplantation and Extracorporeal Ureteral Tapering Repair for Primary Obstructive Megaureter in Children.
    Author: Lopez M, Gander R, Royo G, Varlet F, Asensio M.
    Journal: J Laparoendosc Adv Surg Tech A; 2017 Aug; 27(8):851-857. PubMed ID: 28594594.
    Abstract:
    BACKGROUND: Open surgery is a preferred treatment for primary obstructive megaureter (POM) in cases where the conservative treatment fails, with reported success rates of 90%-96%. OBJECTIVE: To describe our initial experience in the treatment of POM by laparoscopic-assisted extracorporeal ureteral tapering repair (EUTR) and laparoscopic ureteral extravesical reimplantation (LUER) by following Lich Gregoir technique as an alternative to open surgery. DESIGN, SETTING, AND PARTICIPANTS: A total of 7 patients with POM underwent laparoscopic-assisted extracorporeal ureteral tapering repair and ureteral extravesical reimplantation by following Lich Gregoir technique between 2011 and 2014. Postoperative follow-up included the following: Renal and bladder ultrasound, voiding cystourethrogram (VCUG), and mercaptoacetyltriglycine (MAG3) renogram were done at 6 months. Outcome Measurements and Statistical Analysis: Statistical analysis was performed by using the SPSS software package (version 15.0; SPSS, Chicago, IL), and P < .05 was considered statistically significant. Paired tests and Wilcoxon test were performed to compare pre- and post-measures. RESULTS: LUER and EUTR were completed successfully in all patients without conversion. A postoperative MAG3 renogram showed nonobstructive pattern in all patients. Statistical analysis revealed significant differences before and after surgery in the average time of elimination on the MAG3 renogram (T½ 59.10 minutes versus 13.57 minutes, P < .0001). After medium-term follow-up, the overall POM resolution was 100%. One case of vesicoureteral reflux (VUR) was found during VCUG control. A total of 7 patients were asymptomatic without recurrence of POM. CONCLUSION: Laparoscopic-assisted extracorporeal ureteral tapering repair and ureteral extravesical reimplantation by following Lich Gregoir technique for POM constitutes a safe and good option when the first line of treatment fails, with a success rate similar to the open procedure. Nevertheless, larger randomized prospective trials and long-term follow-up are required to validate this technique.
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