Chung Mun Su, Han Sang Won, Jung Hyun Jin, Im Young Jae, Han Hyun Ho, Na Joon Chae, Hong Chang Hee
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
J Laparoendosc Adv Surg Tech A. 2012 Apr;22(3):295-300. doi: 10.1089/lap.2011.0318. Epub 2012 Feb 22.
To report our initial experience with transvesicoscopic cross-trigonal ureteral reimplantation (TVUR), describing stepwise the surgical procedure and determining critical aspects of this surgery in the actual surgical field.
Between September 2008 and April 2010, 48 patients with bilateral vesicoureteral reflux (VUR) underwent TVUR. To identify the critical aspects affecting the surgical difficulty, we divided our TVUR procedure into four steps: TVUR set-up, mobilization of ureters, creation of submucosal tunnels, and ureterovesical anastomosis. To evaluate the evolution of our TVUR, we analyzed changes in the operative time and complications versus increase in surgeon experience (dividing our cases into three groups: the first third, the second third, and the last third). Changes in operative time for all four steps of TVUR were analyzed separately, as well as change in overall operative time.
Of a total of 48 cases, 45 patients underwent TVUR successfully except for 3 cases of open conversion. Among the 45 cases, the mean overall operative time was 155.6 min. In 1 patient, proximal migration of the ureteral catheter occurred. No other perioperative complications were observed. The mean postoperative hospital stay was 1.6 days. The VUR resolution rate was 96.4%. Upon analysis of our results by step, Step 4 (ureterovesical anastomosis) required the largest portion of the overall operative time in most cases. During the early period of our TVUR, we encountered several technical difficulties. However, the operative times for all four steps were stabilized with increasing number of cases, without deteriorating surgical outcomes.
Our report demonstrates that TVUR might potentially be a safe and effective alternative to open ureteral reimplantation in children with VUR, with a shorter learning curve than expected.
报告我们经膀胱镜跨三角区输尿管再植术（TVUR）的初步经验，逐步描述手术过程，并确定该手术在实际手术领域的关键要点。
2008年9月至2010年4月，48例双侧膀胱输尿管反流（VUR）患者接受了TVUR。为确定影响手术难度的关键要点，我们将TVUR手术分为四个步骤：TVUR准备、输尿管游离、黏膜下隧道创建及输尿管膀胱吻合。为评估我们TVUR的进展情况，我们分析了手术时间和并发症的变化与术者经验增加的关系（将我们的病例分为三组：前三分之一、中间三分之一和后三分之一）。分别分析了TVUR四个步骤的手术时间变化以及总手术时间的变化。
48例患者中，除3例转为开放手术外，45例患者成功接受了TVUR。45例患者中，平均总手术时间为155.6分钟。1例患者输尿管导管近端移位。未观察到其他围手术期并发症。术后平均住院时间为1.6天。VUR解决率为96.4%。按步骤分析结果时，在大多数情况下，步骤4（输尿管膀胱吻合）占总手术时间的比例最大。在我们TVUR的早期，我们遇到了一些技术困难。然而，随着病例数的增加，所有四个步骤的手术时间都趋于稳定，且手术效果并未恶化。
我们的报告表明，对于患有VUR的儿童，TVUR可能是开放输尿管再植术的一种安全有效的替代方法，其学习曲线比预期的要短。
