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Extravesical reimplantation

William R Boysen, Jonathan S Ellison, Christina Kim, Chester J Koh, Paul Noh, Benjamin Whittam, Blake Palmer, Aseem Shukla, Andrew Kirsch, Mohan S Gundeti
PURPOSE: Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) has been proposed as a minimally invasive alternative to open ureteral reimplantation for correcting primary vesicoureteral reflux (VUR) in children. However, in the current literature there are conflicting data regarding the safety and efficacy of this approach. Amidst ongoing debate, we analyzed outcomes and complications from this procedure in a large, multi-institutional cohort. MATERIALS AND METHODS: We reviewed the records of children who underwent RALUR-EV at 9 academic centers from 2005 to 2014...
January 24, 2017: Journal of Urology
Michael Yap, Unwanabong Nseyo, Hena Din, Madhu Alagiri
INTRODUCTION AND OBJECTIVE: Multiple options exist for the surgical management of vesicoureteral reflux (VUR). We report on our 10-year experience using the inguinal approach to extravesical ureteral reimplantation (EVR). MATERIALS AND METHODS: Patient characteristics of age, gender, and reflux grade were obtained and outcomes of operative time, hospital stay, and radiographic resolution were assessed. RESULTS: 71 girls and 20 boys with a mean age of 74 months (range 14-164) underwent inguinal EVR via a 3...
January 27, 2017: International Braz J Urol: Official Journal of the Brazilian Society of Urology
Martin A Koyle, Hissan Butt, Armando Lorenzo, Gerald C Mingin, Jack S Elder, Grahame H H Smith
OBJECTIVE: Transient urinary retention has been recognized as a complication of bilateral ureteroneocystostomy (UNC), when performed extravesically. The objective of this study was to review a collective surgeons' experiences of unilateral extra- and unilateral and/or bilateral intra-vesical ureteral reimplanation, where urinary retention greater than 6 weeks, or what we have termed, "prolonged urinary retention" (PUR), occurred. MATERIALS AND METHODS: We retrospectively reviewed charts to identify PUR after any open or robotic reimplant, other than bilateral extravesical, between 1998 and 2015 as reported by five surgeons...
January 20, 2017: Pediatric Surgery International
Bing-Sheng Li, Yao He, Zhi Chen, Zhao-Hui Wang, Zhi-Qiang Wen, Xiang Chen
OBJECTIVE: To describe a newly developed transperitoneal intravesical technique for laparoscopic ureteral reimplantation in patients with terminal ureteral stenosis. METHODS: Between July 2009 and May 2015, laparoscopic transperitoneal intravesical ureteral reimplantation was performed in 16 patients with terminal ureteral stenosis without vesicoureteral reflux (VUR). An incision was made in the superior bladder wall of the affected side with an electric hook. The bladder mucosa was then circumferentially cut away from the ureteral orifice to a distance of 0...
January 4, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Huijie Gong, Yiqin Lu, Yongji Yan, Zhenqi Wu, Wenfeng Gao, Haisheng Cheng, Yabing Wu, Yanfeng Li, Xuetao Ma, Jingbo Liu, Linfeng Dai
OBJECTIVE: This study aims to describe the technique and feasibility of laparoscopic submucosal tunneling ureteroneocystostomy in combination with psoas hitch to restore urinary tract continuity in patients showing medium-length distal ureteral defects. MATERIALS AND METHODS: From January 2012 to April 2016, a total of 13 patients (4 males and 9 females) with a mean age of 37 years were performed with the laparoscopic operation of ureteral submucosal tunneling reimplantation combined with psoas hitch...
December 17, 2016: Urologia Internationalis
Alessandra Farina, Ciro Esposito, Maria Escolino, Manuel Lopez, Alessandro Settimi, François Varlet
BACKGROUND: Laparoscopic ureteral reimplantation is a feasible method for treating ureteral pathology with good preliminary results in the literature. In this study, we review medium term results for laparoscopic ureteral reimplantation and discuss current developments of this procedure. METHODS: Medline and Embase databases were searched using relevant key terms to identify reports of paediatric laparoscopic extravesical ureteral reimplantation (LEVUR). Literature reviews, case reports, series of <3 children and adult studies (age >20 years) were excluded...
October 2016: Translational pediatrics
Krishnamoorthy Sriram, Ramesh Babu
INTRODUCTION: There are multiple techniques for surgical correction of vesicoureteral reflux (VUR). We compared the outcomes of extravesical versus Cohen's reimplantation for VUR in children. METHODS: Records of all children (n = 118) who underwent reimplantation for VUR between 2003 and 2014 were analyzed (male: female = 43:75). Children with secondary VUR, duplication anomalies, and ectopic ureter were excluded from our study. Extravesical reimplantation (EVR) was performed bilateral in 32 children (Group 1a) and unilateral in 19 (Group 1b), while bilateral Cohen's reimplantation was performed in 67 (Group 2)...
October 2016: Indian Journal of Urology: IJU: Journal of the Urological Society of India
Matthew D Timberlake, Craig A Peters
PURPOSE OF REVIEW: Although open ureteral reimplantation remains the gold standard for surgical correction of vesicoureteral reflux (VUR), robotic-assisted laparoscopic ureteral reimplantation (RALUR) holds promise and is becoming more widely utilized. The present article outlines primary operative techniques for RALUR, summarizes the current literature with respect to surgical outcomes and costs, and discusses early applications of RALUR to complex and reoperative cases. RECENT FINDINGS: Intravesical and extravesical techniques for RALUR have been described...
January 2017: Current Opinion in Urology
Daniel Herz, Molly Fuchs, Andrew Todd, Daryl McLeod, Jennifer Smith
BACKGROUND: Published reports of outcomes of robot assisted laparoscopic ureteral reimplantation (RALUR) show mixed results that, on average, are inferior to open ureteral reimplant. We present a retrospective analysis of a prospective series of children who had RALUR from 2013 to June 2015. We hypothesized that surgical outcomes are based on identifiable risk variables. We provide a critical analysis of the relationship between patient characteristics and several surgical and non-surgical outcomes...
December 2016: Journal of Pediatric Urology
Mohan S Gundeti, William R Boysen, Anup Shah
BACKGROUND: Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) is being adopted at large pediatric urology centers in the United States, but currently there is not consensus on surgical technique to facilitate the best possible outcomes. OBJECTIVE: To describe technique modifications that may lead to improved radiographic vesicoureteral reflux (VUR) resolution. DESIGN, SETTING, AND PARTICIPANTS: Between December 2008 and February 2015, a single surgeon performed RALUR-EV at an academic medical center...
November 2016: European Urology
Angela M Arlen, Kristin M Broderick, Curtis Travers, Edwin A Smith, James M Elmore, Andrew J Kirsch
INTRODUCTION AND OBJECTIVE: While open ureteral reimplantation remains the gold standard for surgical treatment of vesicoureteral reflux (VUR), minimally invasive approaches offer potential benefits. This study evaluated the outcomes of children undergoing complex robot-assisted laparoscopic ureteral reimplantation (RALUR) for failed previous anti-reflux surgery, complex anatomy, or ureterovesical junction obstruction (UVJO), and compared them with patients undergoing open extravesical repair...
June 2016: Journal of Pediatric Urology
B K Komjakov, B G Guliev
The aim of the paper was to evaluate the efficacy of laparoscopic uretero-cysto-anastomosis (UCA) in patients with lower ureteral strictures of various etiologies. Over the period from 2010 to 2014, 12 patients (8 females and 4 males) aged 19 to 64 years (mean age 35.6 ± 8.5 years) underwent laparoscopic UCA. In all females, iatrogenic ureteral injury occurred during gynecological surgery. Types of gynecological surgeries were an open or laparoscopic hysterectomy (5), excision of endometriosis nodules (2), and resection of the ovaries (1)...
May 2015: Urologii︠a︡
Xing Liu, Jun-Hong Liu, De-Ying Zhang, Yi Hua, Tao Lin, Guang-Hui Wei, Da-Wei He
INTRODUCTION: Primary obstructive ureter (POM) is an upper urinary tract malformation in children. Transvesicoscopic ureteral reimplantation is increasingly being used as the first choice to correct POM, replacing the open extravesical approach. Although several procedures have been reported, there is no universally accepted technique for endoscopic ureteral reimplantation. OBJECTIVE: To report on several modifications of the Glenn-Anderson ureteral advancement technique to make it suitable for a laparoscopic pneumovesical approach to treatment of POM...
October 2015: Journal of Pediatric Urology
V V S Chandrasekharam
PURPOSE: We describe a novel technique of laparoscopic undiversion and reimplantation of end ureterostomy in children. METHODS AND TECHNIQUE: Three children (mean age 2.1 y, two girls) underwent laparoscopic undiversion and reimplantation of unilateral end ureterostomy during early infancy for symptomatic primary obstructive megaureter. The procedure consisted of laparoscopic dismantling of stoma, mobilization and medial rerouting of ureter, and extravesical ureteric reimplantation...
June 2015: Journal of Pediatric Urology
M Harel, K W Herbst, R Silvis, J H Makari, F A Ferrer, C Kim
INTRODUCTION: While open ureteral reimplantation is the gold standard of surgical intervention for vesicoureteral reflux (VUR), minimally invasive approaches offer the potential benefits of decreased postoperative pain, improved cosmesis, and shorter hospital stay and convalescence. Studies comparing open and minimally invasive surgery with respect to postoperative pain in children have been inconclusive. OBJECTIVE: We sought to compare postoperative pain in children undergoing open versus robotic ureteral reimplantation by using age-appropriate, validated pain assessment scales...
April 2015: Journal of Pediatric Urology
Jason P Joseph, Mohan S Gundeti
INTRODUCTION: Here we describe our technique for robot-assisted, extravesical, anterior wall ureteral reimplantation for select patients with obstructive megaureter or high grade VUR with paraureteral diverticulum. We performed anterior wall reimplantation, extrapolating our experience with anterior wall appendicovesicostomy [Famakinwa et al., Eur Urol 2013;64(5):831-6] METHODS: We applied this technique at our institution for a total of 6 patients: 4 pediatric, 2 adult...
February 2015: Journal of Pediatric Urology
Mesrur Selcuk Silay, Minki Baek, Chester J Koh
Extravesical robotic-assisted laparoscopic ureteral reimplantation in children is a challenging procedure. Our top-down suturing technique facilitates this reconstructive surgery. After mobilization of the ureter without the use of ureteral stent placement, the detrusor muscle is divided. Once adequate muscle flaps are raised, the ureter is placed into its new muscle tunnel. Unlike previously described techniques, the top-down suturing approach involves placement of the first detrusor stitch at the superior aspect...
August 2015: Journal of Endourology
Ranjit Rao, Rishi Nayyar, S Panda, Ashok K Hemal
Bladder diverticulectomy is a surgical operation for symptomatic or large bladder diverticula. Typically, bladder diverticula are because of infravesical obstruction, although congenital diverticula can occur that may be large and symptomatic. The ability to excise the diverticulum completely, avoid important adjacent structures, and close the bladder defect in a watertight fashion are key fundamentals to this operation. Traditionally done via an open extravesical, intravesical, or combined approach, bladder diverticulectomy can now be done in a minimally invasive fashion...
2007: Journal of Robotic Surgery
Dana A Weiss, Aseem R Shukla
The development of the robotic-assisted laparoscopic ureteral reimplantation has tracked a path searching for the optimal method of providing outcomes on par with the gold standard of open intravesical ureteral reimplantation combined with fewer complications and decreased discomfort for the patient. With this in mind, pioneers in pediatric urology minimally invasive surgery have put limits to the test with laparoscopic transvesicoscopic Cohen reimplants and laparoscopic extravesical Lich-Gregoir reimplants and then used the da Vinci platform to fine-tune and bring these skills into the 21st century...
February 2015: Urologic Clinics of North America
Hasan Serkan Dogan, Serdar Tekgul
Vesicoureteral reflux is one of the most important pediatric urology topics. The correction of this pathology by means of open and endoscopic surgery has been well established. The laparoscopic approaches are evolved with the aim of combining the minimally invasive nature of endoscopic treatments with the high success rates of open surgeries. The first applications of laparoscopic ureteral reimplantation techniques started in mid 1990s. However, it did not gain wide acceptance as the latter endoscopic trigonoplasties could not...
October 2014: Archivos Españoles de Urología
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