Modified Lich-Gregoir Ureteral Reimplantation for the Treatment of Unilateral Primary Vesicoureteral Reflux in Pediatric Patients: A Comparative Analysis with Medium-Term outcomes
5 January 2019
Purpose: To present the medium-term results for the modified Lich-Gregoir (LG) reimplantation technique in the treatment of unilateral primary vesicoureteral reflux (VUR) by comparing patients under and over 12 months of age.
Material and Methods: Data for patients who underwent modified LG surgery between January 2006 and December 2018 were retrospectively reviewed from the hospital data-recording system and patients under the age of 18 years were included in the study. After exclusion criteria, 55 patients in total were included in advanced analysis. The patients were grouped as ≤12 months and >12 months. Demographic characteristics, operative, and postoperative follow-up data were comparatively analyzed.
Results: The mean age was 10.4 ± 2.8 (6-12) and 41.4 ± 18.5 (13-96) months in the ≤12 months and >12 months groups, respectively. Mean operation time and hospitalization time were not significant between the groups. Mean follow-up times were 39.5 ± 14.1 and 38.4 ± 13.2 months, in the ≤12 months and >12 months groups, respectively. There was no significance in terms of complications between the groups and all of the complications in both groups were in grade 1 category according to the Modified Clavien complication classification. One (6.6%) patient in the ≤12 months group and 3 (7.5%) patients in the >12 months group had late (>30 days) febrile UTI, but none of them had a recurrence of VUR. Febrile infection did not recur during the follow-up period in these patients. While recurrent VUR was not seen in any patient in the ≤12 months group (success: 100%), it was seen in 2 (5%) patients in the >12 months group (success rate: 95%) (p=0.38).
Conclusion: The open LG ureteral reimplantation technique is an effective procedure for the treatment of unilateral primary VUR in children both under 12 months and over 12 months of age with minor morbidity.
- ureteral reimplantation
- vesicoureteral reflux
Murugapoopathy V, Christine McCusker C, Gupta IR. The pathogenesis and management of renal scarring in children with vesicoureteric reflux and pyelonephritis. Pediatr Nephrol. 2019. doi: 10.1007/s00467-018-4187-9 [Epub ahead of print].
Harper L, Paillet P, Minvielle T, Dobremez E, Lefevre Y, Bouali O, et al. Long-Term (>10 Years) Results After Endoscopic Injection Therapy for Vesicoureteral Reflux. J Laparoendosc Adv Surg Tech A. 2018;28:1408-1411.
Radmayr C, Bogaert G, Dogan HS, Kočvara R, Nijman JM, Stein R, et al. European Urology Guidelines, Paediatric Urology. 2019. uroweb.org/guideline/paediatric-urology
Carrillo Arroyo I, Fuentes Carretero S, Gómez Fraile A, Morante Valverde R, Tordable Ojeda C, Cabezalí Barbancho D. Technical challenges of endoscopic treatment for vesicoureteral reflux after Cohen reimplantation.Actas Urol Esp. 2019;43:384-388.
Silay MS, Turan T, Kayalı Y, Basibuyuk I, Gunaydin B, Caskurlu T, 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;14:65.e1-65.e4.
Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE. International system of radiographic grading of vesicoureteric reflux. Pediatric Radiology. 1985;15:105–109.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg 2004;240:205-13.
Soulier V, Scalabre AL, Lopez M, Li CY, Thach S, Vermersch S, et al. Laparoscopic vesico-ureteral reimplantation with Lich-Gregoir approach in children: medium term results of 159 renal units in 117 children. World J Urol. 2017;35:1791-1798.
Esposito C, Masieri L, Steyaert H, Escolino M, Cerchione R, La Manna A, et al. Robot-assisted extravesical ureteral reimplantation (revur) for unilateral vesico-ureteral reflux in children: results of a multicentric international survey. World J Urol. 2018;36:481-488.
Deng, T., Liu B, Luo L, Duan X, Cai C, Zhao Zet al. Robot-assisted laparoscopic versus open ureteral reimplantation for pediatric vesicoureteral reflux: a systematic review and meta-analysis. World J Urol, 2018;36: 819.
Ravindra Sahadev, Katelyn Spencer, Arun K. Srinivasan, Christopher J. Long and Aseem Ravindra Shukla. The Robot-Assisted Extravesical Anti-reflux Surgery: How We Overcame the Learning Curve. Front. Pediatr 2019;7:93.
Sriram K, Babu R.Extravesical (modified Gregoir Lich) versus intravesical (Cohen's) ureteric reimplantation for vesicoureteral reflux in children: A single center experience. Indian J Urol. 2016 ;32:306-309.
Fadil Iturralde JL, Marani J, Contardi JC, Damiani HJ. Vesicoureteral antireflux surgery with Lich-Gregoir technique without vesical drainage: Long-term results. Actas Urol Esp. 2019;43:439-444.
Lich R, Howerton LW, Davis LA. Ureteral refux, its signifcance and correction. South Med J 1962;55:633–635
Gregoir W. The surgical treatment of congenital vesicoureteral refux. Acta Chir Belg 1964;63:431–439
Zaontz MR, Maizels M, Sugar EC, Firlit CF.Detrusorrhaphy: extravesical ureteral advancement to correct vesicoureteral reflux in children. J Urol. 1987;138:947-49
Fung LC, Mc Lorie GA, Jain U, Khoury AE, Churchill BM. Voiding efficiency after ureteral reimplantation: a comparison of extravesical and intravesical techniques. J Urol. 1995;153:1972–75.
David S, Kelly C, Poppas DP. Nerve-sparing extravesical repair of bilateral vesico-ureteral reflux. Description of technique and evaluation of urinary retention. J Urol. 2004;172:1617–20.
Leissner J, Allhoff W, Wolff W, Feja C, Höckel M, Black P, et al. . The pelvic plexus and antireflux surgery: topographical findings and clinical consequences. J Urol. 2001;165:1652–55.
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