Department of Pediatric Surgery, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, 482003, India.
Department of Pediatric Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, 600116, India.
Pediatr Surg Int. 2024 Nov 1;40(1):284. doi: 10.1007/s00383-024-05876-w.
To evaluate the feasibility and outcomes of isolated laparoscopic extra-vesical ureteric reimplantation (I-LEVUR) for upper moiety ectopic ureter in patients with non-refluxing lower moiety ureter and avoid reimplanting normal lower moiety orifice.
Between 2013 and 2024, 12 patients (8 females, 4 males) with ectopic ureter associated with a duplex system underwent I-LEVUR. Preoperative assessment included ultrasonography, voiding cystourethrography (VCUG), and magnetic resonance urography (MRU)/retrograde pyelogram (RGP). The procedure involved laparoscopic extravesical approach dissecting only the ectopic ureter in lower most part, preserving vascularity, and performing an isolated reimplantation without manipulating lower moiety ureter.
Twelve patients, with a median age of 2.8 years, underwent I-LEVUR. The mean operative time was 127.5 min. No intraoperative complications occurred. Postoperative follow-up (median: 78.5 months) showed no cases of ureteral obstruction or significant complications. Urinary continence improved in all patients. Two patients developed mild vesicoureteral reflux, managed conservatively, and one patient had minor urine leak which resolved spontaneously.
I-LEVUR is a viable and effective alternative to traditional en bloc reimplantation for upper moiety ectopic ureter. It preserves the normal ureteric orifice, reduces surgical trauma, and offers excellent outcomes in terms of renal function and urinary continence. Further studies with larger cohorts, control group of common sheath reimplantation, randomization, robust statistical validation and longer follow-up are recommended.
评估孤立性腹腔镜下肾盂外输尿管再植入术（I-LEVUR）治疗无反流下部分输尿管的上部分异位输尿管的可行性和结果，避免再植入正常下部分输尿管口。
2013 年至 2024 年间，12 例（8 名女性，4 名男性）伴有双输尿管系统的异位输尿管患者接受了 I-LEVUR 治疗。术前评估包括超声检查、排尿性膀胱尿道造影（VCUG）和磁共振尿路成像（MRU）/逆行肾盂造影（RGP）。该手术采用腹腔镜下肾盂外入路，仅在下极部分解剖异位输尿管，保留血供，并进行孤立性再植入，而不操作下部分输尿管。
12 例患者，中位年龄 2.8 岁，接受了 I-LEVUR 治疗。平均手术时间为 127.5 分钟。术中无并发症发生。术后随访（中位数：78.5 个月）显示无输尿管梗阻或明显并发症病例。所有患者的尿控均得到改善。2 例患者出现轻度的输尿管反流，保守治疗后得到缓解，1 例患者出现轻微尿漏，自行缓解。
对于上部分异位输尿管，I-LEVUR 是传统整块再植入术的可行且有效的替代方法。它保留了正常的输尿管口，减少了手术创伤，并在肾功能和尿控方面提供了出色的结果。建议进一步开展更大样本量的研究，包括与常规鞘管再植入术的对照研究、随机化、强有力的统计学验证和更长时间的随访。
