Laparoscopic Extravesical Reimplantation in Children with Primary Obstructive Megaureter

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Urologic Oncology

Background:

• Primary obstructive megaureter (POM) often requires surgical intervention when conservative management fails.
• Traditional open surgery for POM involves ureteral reimplantation with or without tapering.
• Evaluating minimally invasive alternatives is crucial for improving patient outcomes.

Purpose of the Study:

• To report outcomes of laparoscopic-assisted Extracorporeal Ureteral Tapering Repair (EUTR) and Laparoscopic Ureteral Extravesical Reimplantation (LUER) for POM.
• To assess the efficacy and safety of these laparoscopic techniques compared to open procedures.

Main Methods:

• Retrospective review of 26 patients with POM treated between January 2011 and January 2018.
• All patients underwent LUER (Lich Gregoir technique); EUTR (Hendren technique) was performed when ureteral tapering was necessary.
• Data collected included intraoperative findings, postoperative complications, and long-term follow-up outcomes.

Main Results:

• Laparoscopic EUTR and LUER were successfully performed in all patients without conversion to open surgery.
• No intraoperative complications were reported.
• One patient developed a febrile urinary tract infection (UTI) postoperatively, diagnosed with VUR grade III, and successfully treated with redo laparoscopic surgery. Long-term follow-up showed all patients remained asymptomatic.

Conclusions:

• Laparoscopic-assisted EUTR and LUER represent a safe and effective treatment for POM.
• This minimally invasive approach achieves success rates comparable to open surgery.
• Further large-scale randomized trials are needed to validate these findings and establish long-term efficacy.