Department of Urology, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama 232-8555, Japan.
Department of Urology, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama 232-8555, Japan.
J Pediatr Urol. 2023 Jun;19(3):322.e1-322.e7. doi: 10.1016/j.jpurol.2023.02.018. Epub 2023 Feb 26.
Vesicoureteral reflux (VUR), commonly referred to as urinary reflux, is one of the most common congenital urological anomaly to occur during childhood. Historically, open vesicoureteral reimplantation has been the gold standard in the surgical treatment of VUR. Currently, vesicoscopic ureteral reimplantation is used as a minimally invasive alternative to open ureteral reimplantation. Most vesicoscopic procedures are performed using the transtrigonal Cohen technique. As a non-transtrigonal technique, the vesicoscopic Politano-Leadbetter technique is also performed, but requires dissection outside the bladder under a narrow surgical field, and in boy carries a risk of vas deferens injury.
This study evaluated surgical outcomes and perioperative findings for vesicoscopic ureteral reimplantation using a modified Glenn-Anderson technique in children with VUR.
Eighteen consecutive children who underwent vesicoureteral ureteral reimplantation using a modified Glenn-Anderson technique were included in this study. The surgical procedure was explained and surgical outcomes and perioperative findings were evaluated.
Patients comprised 9 boys and 9 girls with 29 cases of ureteral reflux (7 unilateral cases, 11 bilateral cases). All procedures were performed laparoscopically, with no cases requiring conversion to open surgery. Median operative time was 143 min for unilateral VUR and 194 min for bilateral VUR. Only one case showed a complication (Clavien-Dindo grade 1). The remaining 17 cases showed no complications, with removal of the urethral catheter and discharge 2 days postoperatively. Seventeen of the 18 cases underwent postoperative voiding cystourethrography, showing no VUR in all cases.
Vesicoscopic ureteral reimplantation is a minimally invasive alternative to open surgery, with most procedures performed using a transtrigonal Cohen technique. Regardless of whether the surgery is open or laparoscopic, a disadvantage of the Cohen technique is that postoperative transureteral treatment may not be possible. The Politano-Leadbetter technique has been reported as a non-transtrigonal technique. However, this requires dissection outside the bladder under a narrow surgical field, and carries a risk of vas deferens injury in boys. In this study, vesicoscopic ureteral reimplantation using a modified Glenn-Anderson technique provided good surgical outcomes with minimal perioperative complications and easy manipulation under a wide field of view.
Although many minimally invasive treatments are available, vesicoscopic ureteral reimplantation using a modified Glenn-Anderson technique is safe and effective for patients with VUR 4 years old. To demonstrate the further utility of this procedure, long-term outcomes and safety evaluations are needed in a larger number of cases.
膀胱输尿管反流（VUR），通常称为尿反流，是儿童时期最常见的先天性泌尿科异常之一。历史上，开放的膀胱输尿管再植术一直是 VUR 手术治疗的金标准。目前，膀胱镜下输尿管再植术被用作开放输尿管再植术的微创替代方法。大多数膀胱镜手术采用跨三角区 Cohen 技术进行。作为一种非跨三角区技术，膀胱镜下 Politano-Leadbetter 技术也被使用，但需要在狭窄的手术视野下在膀胱外进行解剖，在男孩中存在输精管损伤的风险。
本研究评估了使用改良 Glenn-Anderson 技术在 VUR 儿童中进行膀胱镜下输尿管再植术的手术结果和围手术期发现。
本研究纳入了 18 例连续接受改良 Glenn-Anderson 技术行膀胱镜下输尿管再植术的儿童。解释了手术过程，并评估了手术结果和围手术期发现。
患者包括 9 名男孩和 9 名女孩，共 29 例输尿管反流（7 例单侧，11 例双侧）。所有手术均经腹腔镜完成，无一例需要转为开放手术。单侧 VUR 的中位手术时间为 143 分钟，双侧 VUR 的中位手术时间为 194 分钟。只有 1 例出现并发症（Clavien-Dindo 分级 1）。其余 17 例无并发症，术后 2 天拔除尿道导管出院。18 例中有 17 例在术后进行了排尿性膀胱尿道造影，所有病例均无 VUR。
膀胱镜下输尿管再植术是开放手术的微创替代方法，大多数手术采用跨三角区 Cohen 技术进行。无论手术是开放还是腹腔镜，Cohen 技术的一个缺点是术后经尿道治疗可能不可行。Politano-Leadbetter 技术已被报道为一种非跨三角区技术。然而，这需要在狭窄的手术视野下在膀胱外进行解剖，并且在男孩中存在输精管损伤的风险。在本研究中，使用改良 Glenn-Anderson 技术的膀胱镜下输尿管再植术提供了良好的手术结果，围手术期并发症少，在宽视野下操作简单。
尽管有许多微创治疗方法，但对于 4 岁的 VUR 患者，使用改良 Glenn-Anderson 技术的膀胱镜下输尿管再植术是安全有效的。为了证明该手术的进一步应用价值，需要在更大的病例数量中进行长期结果和安全性评估。
