Login to Access Video or Poster Abstract: MP61-19
Sources of Funding: none

Introduction

The modified Lich-Gregoir extravesical technique (EVR) via a Pfannenstiel incision avoids opening the bladder and dissection of the trigone, and carries exceptional success. Minimally invasiveness endoscopic injections and laparoscopic/robotic approaches carry inferior results and are uncommonly used in more complex cases (megaureter, duplex systems). Consistent with the goal of minimizing invasiveness, we previously reported our positive experience with EVR through a 2 cm inguinal incision. Herein, we report our experience applying this approach to complex cases of ureteral reimplantation.

Methods

We reviewed the records of all patients who underwent common sheath and/or tapered EVR through an inguinal incision by a single surgeon. Patient characteristics of age, gender, and reflux grade were obtained, and outcomes were assessed. The technique involved a 2 cm incision made in the lowest inguinal skin crease, standard cord exposure and lateral retraction, opening the floor of the inguinal canal to isolate the ureter. Excisional tapering was performed with the ureter dismembered from the bladder and then reimplanted via detrussorhaphy while the common sheath reimplantation was performed with advancement fixation sutures and the ureters in situ.

Results

There were 28 patients (15 males and 13 females) with a median age of 1.7 years (range 0.9-4.8 yr) included in the series. 15 patients had ureteral tapering, 12 underwent common sheath reimplantation, and 1 child had both. Indications for surgery were VUR in 19 (average - grade IV), UVJ obstruction in 8, and both in 1 patient. The majority of cases were left-sided (22, 78.6%). One case was a redo surgery from a prior failed reimplantation. Mean hospital length of stay was 1.8 days. Success was seen in 93% (two patients had persistent VUR, one required re-operation). There were no postoperative obstructions, urinary leaks, or wound infections.

Conclusions

Extravesical ureteral tapering and common sheath reimplantation can safely and effectively be performed through a 2 cm inguinal approach.

Funding

none