Skip to main content
SpringerLink
Log in

Minimal invasive surgery of the distal ureter: indications, advantages and technical considerations from a single-center preliminary experience

  • Original Research
  • Published:
Journal of Pediatric Endoscopic Surgery Aims and scope Submit manuscript

Abstract

Purpose

The management of vesicoureteric junction (VUJ) diseases is a common and controversial problem in pediatric urology. Minimal invasive approaches were described for vesicoureteric reflux (VUR), obstructive megaureter (POM) and complicated duplex systems treatments. The aim of this paper is to describe our experience with minimal invasive approach focusing on technical considerations and preliminary outcomes.

Materials and methods

Data about patient aged between 0 and 18 years who underwent minimal invasive surgery for VUR, POM or complicated duplex system, were prospectively collected. Complications were classified according to Clavien–Dindo classification. One senior surgeon, trained in laparoscopy, performed surgeries (Lich Gregoir reimplantation, dismembered reimplantation and ureteroureterostomy).

Results

Seventeen patients were included in the study; thirteen had an extravesical reimplantation (nine non-dismembered, four dismembered) and four had an ureteroureterostomy. No complications were described. Median operating time was 98.5 min and median hospital stay was 4.1 days. Median follow-up was 7.5 months. Success rate for VUR was 78%; for dismembered reimplantation, one case showed post-operative VUR. Functional studies showed an improvement in split renal function on the pathologic moieties in patients treated by ureteroureterostomy for complicated ectopic ureters.

Conclusion

This preliminary experience in minimal invasive surgery of the distal ureter shows that this approach is feasible and safe, reduces hospitalization and gives better cosmetic. Results may be impacted by the surgeon’s learning curve and technical modifications. As robotic procedures are described to be more effective and safe, less technical demanding and associated with good results, switching from laparoscopic to robot-assisted surgery could be useful to improve results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Atala A et al (1993) Laparoscopic correction of vesicoureteral reflux. J Urol 150:748–751

    Article  CAS  Google Scholar 

  2. Peters CA (2004) Robotically assisted surgery in pediatric urology. Urol Clin North Am 31:743–752

    Article  Google Scholar 

  3. Radmayr C et al (2019) EAU Guidelines: pediatric urology. https://uroweb.org/guideline/paediatric-urology/

  4. Peters CA et al (2017) Management and screening of primary vesicoureteral reflux in children (2010, amended 2017). https://www.auanet.org/guidelines/vesicoureteral-reflux-guideline

  5. Bowen DK et al (2016) Use of pediatric open, laparoscopic and robot-assisted laparoscopic ureteral reimplantation in the United States: 2000 to 2012. J Urol 196:207–212

    Article  Google Scholar 

  6. Lendvay T (2008) Robotic-assisted laparoscopic management of vesicoureteral reflux. Adv Urol 732942

  7. Chalmers D et al (2012) Robotic-assisted laparoscopy extravesical ureteral reimplantation: an initial experience. J Pediatr Urol 8:268–271

    Article  Google Scholar 

  8. Smith RP et al (2011) Pediatric robotic extravesical ureteral reimplantation: comparison with open surgery. J Urol 185:1876–1881

    Article  Google Scholar 

  9. Casale P et al (2008) Nerve sparing robotic extravesical ureteral reimplantation. J Urol 179:1987–1990

    Article  Google Scholar 

  10. Akhavan A et al (2014) Robot-assisted extravesical ureteral reimplantation: outcomes and conclusions from 78 ureteres. J Pediatr Urol 10:864–868

    Article  Google Scholar 

  11. Grimsby G et al (2015) Multi-institutional review of outcomes of robotic assisted extravesical ureteral reimplantation. J Urol 193:1791–1795

    Article  Google Scholar 

  12. Marchini GS et al (2011) Robotic assisted laparoscopic ureteral reimplantation in children: case matched comparative study with open surgical approach. J Urol 185:1870–1875

    Article  Google Scholar 

  13. Gundeti MS et al (2016) Robot-assisted laparoscopic extravesical ureteral reimplantation: technique modifications contribute to optimized outcomes. Eur Urol 70:818–823

    Article  Google Scholar 

  14. Deng T et al (2018) Robot-assisted laparoscopic versus open ureteral reimplantation for pediatric vesicoureteral reflux: a systematic review and meta-analysis. World J Urol 36:819–828

    Article  Google Scholar 

  15. Bustangi N et al (2018) Extravesical ureteral reimplantation following Lich–Gregoir technique for the correction of vesico-ureteral reflux retrospective comparative study open vs laparoscopy. Front Pediatr 18(6):388

    Article  Google Scholar 

  16. Rodriguez MV et al (2018) Robot-assisted laparoscopic common sheath ureteral reimplantation in duplex ureters: LUAA technique tips for optimal outcomes. J Pediatr Urol 14:353–355

    Article  Google Scholar 

  17. Esposito C et al (2019) Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot-assisted approach: results of a multicentre international survey. BJU Int 124:820–827

    Article  Google Scholar 

  18. Chertin B et al (2008) Long-term follow up of antenatally diagnosed megaureters. J Pediatr Urol 4:188–191

    Article  Google Scholar 

  19. Garcia-Aparicio L et al (2012) High pressure balloon dilatation of the ureterovesical junction. First line approach to treat primary obstructive megaureter? J Urol 187:1834–1838

    Article  CAS  Google Scholar 

  20. Kutikov A et al (2006) Initial experience with laparoscopic transvesical ureteral reimplantation at the Children’s Hospital of Philadelphia. J Urol 176:2222–2225

    Article  Google Scholar 

  21. Kalicinski Z et al (1977) Surgery of megaureters—modification of Hendren’s operation. J Pediatr Surg 12:183–188

    Article  CAS  Google Scholar 

  22. Starr A (1979) Ureteral plication. A new concept in ureteral tailoring for megaureter. Invest Urol 17:153–158

    CAS  PubMed  Google Scholar 

  23. Hendren W (1969) Operative repair of megaureter in children. J Urol 101:491–507

    Article  CAS  Google Scholar 

  24. Lopez M et al (2017) Laparoscopic-assisted extravesical ureteral reimplantation and extracorporeal ureteral tapering repair for primary obstructive megaureter in children. J Laparoendosc Adv Surg Tech A 27:851–857

    Article  Google Scholar 

  25. Bondarenko S (2013) Laparoscopic extravesical transverse ureteral reimplantation in children with obstructive megaureter. J Pediatr Urol 9:437–441

    Article  Google Scholar 

  26. Silay MS et al (2015) Robot-assisted laparoscopic extravesical ureteral reimplantation in children: top-down suturing technique without stent placement. J Endourol 29:864–866

    Article  Google Scholar 

  27. Landa-Juarez S et al (2016) Plastia ureterovesical laparoscopica para el tratamiento del megaureter. Cirugia y cirujanos. https://doi.org/10.1016/J.circir.2016.08.003

    Article  PubMed  Google Scholar 

  28. Neheman A et al (2019) Robot-assisted laparoscopic extravesical cross-trigonal ureteral re-implantation with tailoring for primary obstructive megaureter. Urology pii: S0090-4295(19)30816-7

  29. Siomou E et al (2006) Duplex collecting system diagnosed during the first 6 years of life after a first urinary tract infection: a study of 63 children. J Urol 175:678–681

    Article  Google Scholar 

  30. Bolduc S et al (2002) Histology of upper pole is unaffected by prenatal diagnosis in duplex system ureteroceles. J Urol 168:1123–1126

    Article  Google Scholar 

  31. Michaud JE et al (2017) Upper pole heminephrectomy versus lower pole ureteroureterostomy for ectopic upper pole ureters. Curr Urol Rep 18:21

    Article  Google Scholar 

  32. Husmann DA (1998) Renal dysplasia: the risks and consequences of leaving dysplastic tissue in situ. Urology 52:533–536

    Article  CAS  Google Scholar 

  33. Levy JB et al (1989) Hypertension after surgical management of renal duplication associated with an upper pole ureterocele. J Urol 158:1241–1244

    Article  Google Scholar 

  34. Kawal T et al (2019) Ipsilateral ureteroureterostomy: does function of the obstructed moiety matter? J Pediatr Urol 15:50

    Article  Google Scholar 

  35. Herz D et al (2016) Robot-assisted laparoscopic management of duplex renal anomaly: comparison of surgical outcomes to traditional pure laparoscopic and open surgery. J Pediatr Urol 12(44):e1–e7

    Google Scholar 

  36. Wong MCY et al (2019) Surgical validation of functional magnetic resonance urography in the study of ureteropelvic junction obstruction in a pediatric cohort. J Pediatr Urol 15:168–175

    Article  CAS  Google Scholar 

  37. Boysen WR et al (2018) Prospective multicentre study on robot-assisted laparoscopic extravesical reimplantation (RALUR-EV): outcomes and complications. J Pediatr Urol 14:262.e1–262.e6

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, IRCCS G. Gaslini, Genoa, Italy

    M. Carlucci & G. Mattioli

  2. DINOGMI, University of Genova, Genoa, Italy

    V. Fiorenza, M. C. Y. Wong & G. Mattioli

  3. Department of Pediatric Radiology, IRCCS G. Gaslini, Genoa, Italy

    M. B. Damasio

Authors
  1. M. Carlucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Fiorenza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. C. Y. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. B. Damasio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Mattioli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Carlucci.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carlucci, M., Fiorenza, V., Wong, M.C.Y. et al. Minimal invasive surgery of the distal ureter: indications, advantages and technical considerations from a single-center preliminary experience. J Ped Endosc Surg 2, 1–9 (2020). https://doi.org/10.1007/s42804-020-00047-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s42804-020-00047-9

Keywords

Search

Navigation