Minilaparoscopic nerve-sparing extravesical ureteral reimplantation for primary vesicoureteral reflux: a preliminary report

To validate its safety and efficacy, we evaluated our preliminary results of the three-port minilaparoscopic nerve-sparing extravesical ureteral reimplantation for patients with vesicoureteral reflux (VUR). Between July 2005 and February 2007, 9 consecutive patients (4 girls and 5 boys) with a mean age of 3.4 years (range, 7 months to 5 years) underwent a minilaparoscopic nerve sparing extravesical ureteral reimplantation for VUR. A 30-degree 3-mm telescope and two 3-mm trocars were used for the reimplantation. Minimal handling and dissection of the ureter and ureterovescial junction was adhered to spare the nerves. A total of 14 ureters were reimplanted (4 unilateral and 5 bilateral). Mean follow-up period was 8.7 months. The mean operative time was 170 minutes in unilateral reimplantations and 218 minutes in the bilateral one. There was no intraoperative complication. All patients resumed oral intake in the first postoperative morning. The Foley catheters were removed within 24-36 hours after surgery. None of them had urinary retention after catheter removal. Voiding cystourethrography was done 3-4 months after surgery. A complete resolution of reflux was identified in 11 of 14 units, a downgrading of reflux in 2 of 14 units, and ureterovesical junction stenosis in 1 of 14. Open reimplantation was done for the ureter with postoperative ureterovesical junction stenosis. The three-port minilaparoscopic nerve-sparing extravesical ureteral reimplantation was a safe, effective techinique for the treatment of VUR.