Laparoscopic Ureteral Reimplantation after Failed Open Surgery: Incorporating the Psoas Hitch Maneuver for Sufficient Tunnel Length

 

 Buy Article Permissions and Reprints

Abstract

Background Failure after open ureteral reimplantation has been reported to occur in 2 to 7% of cases. While a second open reconstructive surgery is appropriate in most cases, there are data suggesting similar outcomes utilizing the laparoscopic approach. The objective of this study is to describe a modification and report our experience with laparoscopic ureteral reimplantation after failed open reimplantation reinforced with a psoas hitch.

Materials and Methods A retrospective review of pediatric patients who underwent laparoscopic ureteral reimplantation after failed open surgery between September 2012 and April 2018 at three different academic centers was performed. Patient demographics, surgical indications, complications, and outcomes were reviewed. Either ipsilateral ureteral reimplantation with a combined intravesical and extravesical approaches or a cross-trigonal extravesical approach was utilized, depending on the length of the ureter. In all cases, a psoas hitch was performed to gain a longer submucosal tunnel and relieve tension, thus facilitating an efficient antireflux mechanism.

Results Seventeen patients underwent a laparoscopic ureteral reimplantation after failed open surgery. Median age at second surgery was 106 months (interquartile range [IQR]: 53–122.5). Ipsilateral ureteral reimplantation with a combined intravesical and extravesical approaches was performed in 11 cases and cross-trigonal extravesical approach in 6 cases. Median ureteral diameter before the redo surgery was 16 mm (IQR: 14.5–18.5) and after surgery was 6 mm (IQR: 3.5–8.5) (p < 0.001). Postoperative mercaptoacetyltriglycine renal scan showed a nonobstructive pattern and stable renal function in all cases.

Conclusion Laparoscopic ureteral reimplantation with incorporation of a psoas hitch after failed open reimplantation is safe and effective.

Publication History

Received: 31 May 2022

Accepted: 18 July 2022

Accepted Manuscript online:
20 July 2022

Article published online:
18 October 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Silay MS, Turan T, Kayalı Y. et al. Comparison of intravesical (Cohen) and extravesical (Lich-Gregoir) ureteroneocystostomy in the treatment of unilateral primary vesicoureteric reflux in children. J Pediatr Urol 2018; 14 (01) 65.e1-65.e4
  CrossrefPubMedGoogle Scholar
• 2 Esposito C, Escolino M, Lopez M. et al. Surgical management of pediatric vesicoureteral reflux: a comparative study between endoscopic, laparoscopic, and open surgery. J Laparoendosc Adv Surg Tech A 2016; 26 (07) 574-580
  CrossrefPubMedGoogle Scholar
• 3 Boysen WR, Ellison JS, Kim C. et al. Multi-institutional review of outcomes and complications of robot-assisted laparoscopic extravesical ureteral reimplantation for treatment of primary vesicoureteral reflux in children. J Urol 2017; 197 (06) 1555-1561
  CrossrefPubMedGoogle Scholar
• 4 Afshar K, Mirbagheri A, Scott H, MacNeily AE. Development of a symptom score for dysfunctional elimination syndrome. J Urol 2009; 182 (4, Suppl): 1939-1943
  CrossrefPubMedGoogle Scholar
• 5 O'Donnell LJ, Virjee J, Heaton KW. Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. BMJ 1990; 300 (6722): 439-440
  CrossrefPubMedGoogle Scholar
• 6 Rappaport YH, Kord E, Noh PH. et al. Minimally invasive dismembered extravesical cross-trigonal ureteral reimplantation for obstructed megaureter: a multi-institutional study comparing robotic and laparoscopic approaches. Urology 2021; 149: 211-215
  CrossrefPubMedGoogle Scholar
• 7 Paquin Jr AJ. Ureterovesical anastomosis: the description and evaluation of a technique. J Urol 1959; 82: 573-583
  CrossrefPubMedGoogle Scholar
• 8 DeFoor W, Minevich E, Reddy P. et al. Results of tapered ureteral reimplantation for primary megaureter: extravesical versus intravesical approach. J Urol 2004; 172(4 Pt 2):1640–1643, discussion 1643
  PubMedGoogle Scholar
• 9 Kumar R, Puri P. Endoscopic correction of vesicoureteric reflux in failed reimplanted ureters. Eur Urol 1998; 33 (01) 98-100
  CrossrefPubMedGoogle Scholar
• 10 Perez-Brayfield M, Kirsch AJ, Hensle TW, Koyle MA, Furness P, Scherz HC. Endoscopic treatment with dextranomer/hyaluronic acid for complex cases of vesicoureteral reflux. J Urol 2004; 172 (4 Pt 2): 1614-1616
  CrossrefPubMedGoogle Scholar
• 11 Lopez M, Gander R, Royo G, Varlet F, Asensio M. Laparoscopic-assisted extravesical ureteral reimplantation and extracorporeal ureteral tapering repair for primary obstructive megaureter in children. J Laparoendosc Adv Surg Tech A 2017; 27 (08) 851-857
  CrossrefPubMedGoogle Scholar
• 12 Greenbaum LA, Mesrobian HG. Vesicoureteral reflux. Pediatr Clin North Am 2006; 53 (03) 413-427 , vi
  CrossrefPubMedGoogle Scholar
• 13 Mesrobian HG, Kramer SA, Kelalis PP. Reoperative ureteroneocystostomy: review of 69 patients. J Urol 1985; 133 (03) 388-390
  CrossrefPubMedGoogle Scholar
• 14 Bondarenko S. Laparoscopic extravesical transverse ureteral reimplantation in children with obstructive megaureter. J Pediatr Urol 2013; 9 (04) 437-441
  CrossrefPubMedGoogle Scholar
• 15 Dubrov V, Shmyrov O, Kagantsov I. et al. Laparoscopic extravesical transverse ureteral reimplantation for megaureter in children: results from a multi-institutional study. Journal of Pediatric Endoscopic Surgery 2020; 2: 21-27 . Available at: https://link.springer.com/article/10.1007/s42804-019-00034-9
  CrossrefPubMedGoogle Scholar
• 16 Middleton RG. Routine use of the psoas hitch in ureteral reimplantation. J Urol 1980; 123 (03) 352-354
  CrossrefPubMedGoogle Scholar