Laparoscopic extravesical ureteral reimplantation (LEVUR): a multicenter experience with 95 cases

Minimally invasive techniques have been used to treat vesicoureteral reflux (VUR) on pediatric patients. The aim of this study is to review the experience of the laparoscopic approach for VUR by the laparoscopic extravesical ureteral reimplantation (LEVUR) Lich-Gregoir technique.

We performed a multicentric retrospective study. From 2001 to 2009, 81 pediatric patients with VUR constituting 95 ureteral units underwent LEVUR. Reflux was grade II in 32%, grade III in 55%, and grade IV in 8%.

LEVUR was performed successfully on the 81 patients with 95 ureteral units. Mean operative time was 105 minutes for left-sided reimplants, 70 minutes for right sided, and 180 minutes for bilateral reimplants. Mean hospital stay was 1.6 days. Urinary catheter was kept in place for a mean time of 0.5 days. Follow-up was achieved for at least 1 year with regular clinic visits, urinalysis, ultrasound, and voiding cystourethrogram. Four patients (4.2%) had evidence of recurrent VUR in a follow-up of 6 to 36 months after antireflux surgery.

Although new endoscopic techniques have been widely available for VUR, they have a lower success rate and might require multiple attempts before success. We report that LEVUR has an acceptable success rate (95.8%) and durability compared with open and endoscopic procedures.