Bilateral Transvesicoscopic Cross-Trigonal Ureteric Reimplantation in Children: Surgical Subtleties and a Prospective Summary

Abstract Objective To prospectively evaluate the surgical technique and results of bilateral transvesicoscopic cross-trigonal ureteric reimplantation (TVUR) in children with vesicoureteric reflux (VUR) and compare the results and surgical subtleties with the existing literature. Materials and Methods From January 2010 to December 2015, children between 2-14 years of age with bilateral primary VUR grade II-IV underwent bilateral TVUR at a tertiary referral centre in Northern India. The grade of VUR was II in 12 patients, III in 19 patients, and IV in 3 patients. All surgeries were performed by a single surgeon. Success was defined as absence of VUR on direct radionuclide cystogram at eight weeks. Results Seventeen patients (34 refluxing ureters) underwent bilateral TVUR during the study period. They included 13 girls and 4 boys. Median age was 4.6years (range 2-14 years). Two patients required conversion to open surgery. Resolution of VUR was seen in sixteen patients (32/34 ureters). Hydronephrosis resolved on postoperative ultrasonography in all patients with low grade reflux (< grade IV) and all except one patient with grade IV reflux. Conclusion TVUR is feasible method with success rate equal to that of open technique if patient selection is good. Success rate is low in high grade reflux, dilated and tortuous ureter. Subtle modifications in the surgical steps can make significant contribution towards learning this minimally invasive technique.