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Comparative study of open, laparoscopic and endoscopic treatments of intermediate grade vesicoureteral reflux in children

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Abstract

Background

Low-grade vesicoureteral-reflux (VUR) are rather treated by endoscopic injection, whereas open or laparoscopic procedures are mainly performed for high-grade VURs. Management of intermediate grades is controversial and no study focused on grade III to date. This study aims to compare the results of open, laparoscopic, and endoscopic approaches in children with grade III VUR.

Methods

A multicenter comparative retrospective study included children with grade III VUR operated for febrile urinary tract infections (UTIs) from 2007 to 2016. Children without UTI, with reflux of other grades, neurological bladder, duplex system, posterior urethral valves, and bladder exstrophy were excluded. Success was defined as no recurrence of febrile UTI and was presented as event-free survival curves.

Results

Out of 806 children operated of VUR, 171 met the inclusion criteria (114 females). Seventy-seven children (45%) underwent an open Cohen procedure, 35 (21%) a laparoscopic Lich-Gregoir and 59 (34%) a submucosal endoscopic injection according to the centers’ preference. The mean follow-up was 64 months (24–132). Groups were not different for age, sex, and circumcision status. Compared to Cohen procedure, recurrences of febrile UTI were more frequent after laparoscopic treatment (p = 0,02, 8/35) and endoscopic treatment (p = 0.001, 16/59). Redosurgery was also more frequent after laparoscopy (n = 2) and endoscopic injection (n = 14) than after open surgery (n = 0, p < 0.001).

Conclusion

Recurrent febrile UTIs and redosurgery are more frequent after endoscopic and laparoscopic procedures in grade III VUR than open reimplantation. Whether the lower morbidity of laparoscopic or endoscopic approaches balances the risk of recurrent febrile UTI remains to be determined for intermediate grade reflux.

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Authors and Affiliations

  1. Département de Chirurgie Infantile, Service de Chirurgie Viscérale et Urologie Pédiatrique, CHU de Montpellier Et Université de Montpellier, 371 Av Giraud, 34295 cedex 5, Montpellier, France

    B. Tessier, S. Garnier, C. Lopez, A. Cazals & N. Kalfa

  2. Service de Chirurgie et Urologie Pédiatrique, CHU de Saint Etienne, Saint Etienne, France

    A. Scalabre, S. Vermesch & F. Varlet

  3. Service de Chirurgie et Urologie Pédiatrique, CHU de Bordeaux, Bordeaux, France

    L. Harper

  4. Service de Néphrologie Pédiatrique, CHU de Montpellier Et Université de Montpellier, Montpellier, France

    M. Fila & D. Morin

  5. Institut Debrest de Santé Publique IDESP, UMR INSERM – Université Montpellier, Montpellier, France

    N. Kalfa

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  1. B. Tessier
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Correspondence to N. Kalfa.

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Disclosures

Benoit Tessier, Aurélien Scalabre, Luke Harper, Sarah Garnier, Sophie Vermesch, Christophe Lopez, Aurélie Cazals, Marc Fila, Denis Morin, François Varlet, Nicolas Kalfa have no conflicts of interest or financial ties to disclosure.

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Tessier, B., Scalabre, A., Harper, L. et al. Comparative study of open, laparoscopic and endoscopic treatments of intermediate grade vesicoureteral reflux in children. Surg Endosc 37, 2682–2687 (2023). https://doi.org/10.1007/s00464-021-08985-y

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