Laparoscopic extravesical transverse ureteral reimplantation in children with obstructive megaureter

Background and purpose: In contemporary practice the application of a laparoscopic approach for repairing congenital ureterovesical junction obstruction in children is rare. We report our experience with laparoscopic dismembered extravesical transverse ureteral reimplantation in children with unilateral primary ureterovesical junction obstruction. Patients and methods: Ten children (all male, aged 6 months to 5 years) underwent laparoscopic dismembered extravesical transverse ureteral reimplantation. The postoperative follow up included abdomino-pelvic ultrasound at 3 months after surgery, and a voiding cystourethrogram and intravenous urogram at 6 months and 1 year after surgery. Results: In all patients surgery was completed laparoscopically without conversion to open procedure; there were no major intraoperative complications. The mean operative time was 180 min (range 150-210 min). The postoperative intravenous urogram demonstrated improvement of the dilatation of the pelvicalyceal system and ureters in all patients; in one case grade IV vesicoureteral reflux developed and was successfully treated by endoscopic injection. Conclusions: We could consider this technique as an eventual option in pediatric minimally invasive urologic surgery. However, larger series with long-term follow up are necessary to validate the results.