The effect of pneumovesicoscopic Cohen surgery using a segmented submucosal tunnel and reduced intra-abdominal pressure for the treatment of vesicoureteral reflux in children

Hong Chen ¹, Xu Cui ¹, Chaoming Zhou ¹

⁰Department of Urology, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China.

Frontiers in Pediatrics +

|

December 29, 2025

View abstract on PubMed

Summary

Reducing intra-abdominal pressure and using segmented submucosal tunneling effectively manages CO2 leakage during pneumovesicoscopic Cohen surgery for vesicoureteral reflux (VUR) in infants. This approach simplifies the procedure and improves patient outcomes.

Area Of Science

Pediatric Urology
Minimally Invasive Surgery

Background

Vesicoureteral reflux (VUR) is a common condition in infants requiring surgical correction.
Pneumovesicoscopic Cohen surgery is a minimally invasive technique for VUR repair.
Carbon dioxide (CO2) leakage into the abdominal cavity can complicate this procedure.

Purpose Of The Study

To evaluate the efficacy of a segmented submucosal tunnel technique combined with reduced intra-abdominal pressure for managing CO2 leakage during pneumovesicoscopic Cohen surgery in VUR patients.
To compare the outcomes of this combined approach with direct submucosal tunnel establishment.

Main Methods

Retrospective analysis of 56 infants (0-1 years) with VUR undergoing pneumovesicoscopic Cohen surgery.
Patients were divided into two groups: Group A (direct submucosal tunnel) and Group B (segmented submucosal tunnel with reduced intra-abdominal pressure).
Intraoperative and postoperative outcomes, including complications and clinical efficacy, were compared.

Main Results

No significant differences in complications like bladder leakage, anastomotic stenosis, or urinary retention were observed between groups.
Group B showed significantly shorter operation times and lower pain scores at 2 hours post-surgery compared to Group A.
Two cases in Group A required conversion to open surgery, while none in Group B did.

Conclusions

The combination of reduced intra-abdominal pressure and segmented submucosal tunneling is a safe, simple, and effective method for managing CO2 leakage during pneumovesicoscopic Cohen surgery for VUR.
This technique is recommended for improving surgical outcomes in pediatric VUR patients.

Keywords:

children’s bladder surgery infants pneumovesicoscopic Cohen surgery retrospective studies vesicoureteral reflux

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