Isolated laparoscopic extra-vesical ureteric reimplantation (I-LEVUR) for upper moiety ectopic ureter without lower moiety vesicoureteric reflux.

IF 1.5 3区 医学 Q2 PEDIATRICS
Vikesh Agrawal, Ramesh Babu
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引用次数: 0

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

针对上段异位输尿管且无下段膀胱输尿管反流的孤立腹腔镜膀胱外输尿管再植术(I-LEVUR)。
目的:评估孤立腹腔镜下输尿管外再植术(I-LEVUR)治疗下段输尿管无反流的上段异位输尿管的可行性和效果,避免再植正常的下段输尿管口:2013年至2024年期间,12例(8女4男)输尿管异位患者接受了I-LEVUR手术。术前评估包括超声波检查、排尿膀胱尿道造影(VCUG)和磁共振尿路造影(MRU)/逆行肾盂造影(RGP)。手术采用腹腔镜膀胱外入路,仅解剖异位输尿管的最下端,保留血管,在不操作下段输尿管的情况下进行孤立再植:12 名患者接受了 I-LEVUR 手术,中位年龄为 2.8 岁。平均手术时间为 127.5 分钟。术中未出现并发症。术后随访(中位数:78.5 个月)显示无输尿管梗阻或重大并发症。所有患者的尿失禁情况都有所改善。两名患者出现了轻微的膀胱输尿管反流,保守治疗,一名患者出现轻微漏尿,但已自行缓解:结论:对于上段异位输尿管,I-LEVUR 是替代传统的整体再植术的一种可行而有效的方法。结论:I-LEVUR 是治疗上段异位输尿管的一种可行、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,在肾功能和排尿功能方面都有很好的疗效。建议进行更大规模的研究,以普通鞘管再植术为对照组,采用随机方法,进行可靠的统计验证,并进行更长时间的随访。
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来源期刊
CiteScore
3.00
自引率
5.60%
发文量
215
审稿时长
3-6 weeks
期刊介绍: Pediatric Surgery International is a journal devoted to the publication of new and important information from the entire spectrum of pediatric surgery. The major purpose of the journal is to promote postgraduate training and further education in the surgery of infants and children. The contents will include articles in clinical and experimental surgery, as well as related fields. One section of each issue is devoted to a special topic, with invited contributions from recognized authorities. Other sections will include: -Review articles- Original articles- Technical innovations- Letters to the editor
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