Transvesicoscopic Cohen Ureteric Reimplantation for Vesicoureteral Reflux in Children: A Pilot Study

Abstract

Abstract Background Cohen’s pneumovesicoscopic reimplantation technique (CPRT) is a minimally invasive procedure that resembles the surgical steps of the open cross-trigonal reimplantation technique with a similar success rate and the inherent benefits of a minimally invasive approach, like less need for analgesia and less morbidity. Aim of the Work to evaluate the efficacy and safety of CPRT in 20 pediatric patients with primary VUR presented to 2 pediatric surgery departments, in 2 tertiary centers. Patients and Methods a prospective interventional study on 20 children (13 girls, 7 boys, age ranged from 4 to 12 years) with primary vesicoureteral reflux (VUR), grades II-IV (6 bilateral, 9 RT and 5 LT) underwent a CPRT. Suprapubic ports were placed: a 5-mm camera port and two 3- mm working ports. After the ureter(s) have been dissected transvesically a submucosal tunnel is made for ureteric reimplantation to be carried out using 5/0 absorbable sutures. After the procedure, the urethral catheter was taken out two days later, and the patients were released on day three. Clinical evaluation, renal ultrasonography, and voiding cystourethrogram were used to Follow-up the patients. Results 198.5 min was the average operating time (range 90 – 240 min). Two cases developed postoperative complications (mild suprapubic emphysema-perivesical hematoma) managed conservatively. One case needed conversion to open technique because of intraoperative complications (port displacement- perivesical air leakage). All patients had renal US and VCUG between 3 and 6 months after surgery. All low-grade reflux patients (grade II & III) had their hydronephrosis disappear on postoperative US (13 out of 26 refluxing units), while persistence of grade I VUR on VCUG was in two cases (2 units). Conclusion Technically feasible, Cohen’s pneumovesicoscopic reimplantation technique can be carried out safely and effectively in children. It is advisable to select the patients carefully in the primary phase of this technique. Some technical modifications are suggested to overcome the technical obstacles faced, helping us to master this promising technique.