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Pneumovesicoscopic correction of primary vesicoureteral reflux (VUR) in children. - Our Initial experience.

Purpose The main objective of our prospective,descriptive,monocentric,longitudinal study is to demonstrate the feasibility of vesicoscopic cross-trigonal ureteral reimplantation under CO2 pneumovesicum in treatment on primary vesicoureteral reflux,analyze results and specify the age limit of this approach.


METHODS
A total of 60 patients underwent transvesicoscopic ureteral reimplantation (33 boys, 27 girls) by the same surgeon from Mai 2011 to Mai 2015. All patients had primary vesicoureteral reflux,and surgery was performed because of breakthrough urinary tract infection despite antibiotic prophylaxis, persistent high grade of vesicoureteral reflux especially in association with significant renal scarring, mean age at operation was 47.47month (6 month-12 years). Of the 60 patients, 34 had bilateral reflux and 26 had unilateral reflux. The reflux grade in the total of 94 ureters was grade IV, V in 59.57%, grade III in 35.11% and grade II in 5.32% in association with contralateral high grade vesicoureteral reflux.


RESULTS
The transvesicoscopic procedure was successfully completed in all patients without perioperative complication except one case of pneumoperitoneum that required exsufflation by open laparoscopy. The mean overall operative time decreased significantly with an average of 58.43 +/- 11.26 minutes for unilateral reimplantation and 101.18+/- 26.5 minutes for bilateral reimplantation.The postoperative hospital stay was 3 days for all patients.The mean follow-up period was 03 years.Cystography was performed 3 month after surgery in all patients and showed the disappearance of vesicoureteral reflux in 57/60 patients (95%) or 91/94 of ureters (97%). Persistent vesicoureteral reflux was documented in 3 of 94 ureters and had resolved spontaneously at 12 month after reimplantation.


CONCLUSION
Our preliminary results indicate that vesicoscopic ureteral reimplantation is safe and effective procedure with minimal morbidity when compared to traditional open method. It can be apply in children under 12 months. Key words: Primary vesicoureteral reflux, surgical treatment of primary vesicoureteral reflux,vesicoscopic Cross-Trigonal Ureteral Reimplantation, childre.