Initial experience of a simplified modified Politano-Leadbetter technique for pneumovesicoscopic ureteral reimplantation in children.

Abstract

Background: Pneumovesicoscopic ureteral reimplantation (PVUR) has gained popularity due to its minimally invasive characteristics. Most reported PVUR procedures, however, have employed the Cohen technique. The Politano-Leadbetter (PL) technique offers distinct advantages, including the creation of a longer submucosal? Tunnel and preservation of the ureter's natural anatomical course postoperatively. Nevertheless, the technical complexity and steep learning curve associated with the PL technique have restricted its widespread adoption among urologists. In this study, we introduce modified surgical techniques to streamline and standardize the pneumovesicoscopic ureteral reimplantation using the Politano-Leadbetter (PVUR-PL) technique procedure.

Methods: We conducted a retrospective cohort study analyzing operative outcomes of PVUR-PL in pediatric patients between November 2021 and May 2024. Patients were stratified into two cohorts: (I) the traditional group (November 2021 to March 2023) receiving standard PVUR-PL; and (II) the modified group (April 2023 to May 2024) undergoing PVUR-PL with technical refinements incorporating anatomical landmarks and optimized surgical maneuvers to simplify procedural steps. Clinical data were retrospectively collected and analyzed.

Results: A total of 25 pediatric patients underwent PVUR-PL during the study period, including 10 patients in the traditional group and 15 patients in the modified group. All procedures were successfully completed laparoscopically, with no conversions to open surgery. The modified technique demonstrated significant improvements in operative efficiency. Specifically, the mean operative time for unilateral cases was significantly shorter in the modified group compared to the traditional group (157.73±15.33 vs. 188.90±26.55 min, P<0.01). Similarly, for bilateral cases, the modified group exhibited a significantly reduced mean operative time compared to the traditional group (230.00±27.07 vs. 280.25±16.46 min, P<0.05). In terms of intraoperative complications, peritoneal perforation occurred in 3 patients (30%) within the traditional group, whereas no such complications were encountered in the modified group. Postoperative outcomes also favored the modified technique, demonstrated by significantly lower postoperative pain scores (2.93±1.03 vs. 4.20±1.23, P<0.05) and a shorter duration of hematuria (2.97±0.74 vs. 5.15±1.29 days, P<0.01). Additionally, the modified technique accommodated patients with a smaller minimum bladder capacity (75 vs. 90 mL) and a higher maximum body mass index (26.9 vs. 21.4 kg/m2). All patients completed a 6-month follow-up with favorable recovery outcomes.

Conclusions: The modified PVUR-PL technique offers a standardized and easily implementable option for clinicians. By standardizing essential procedural steps and optimizing the use of anatomical landmarks, this refinement improves accessibility to the PL approach without compromising surgical outcomes. These improvements may facilitate wider adoption of PVUR-PL among pediatric urologists, especially for complex cases requiring extensive ureteral tunneling.