Laparoscopic extravesical ureteral reimplantation (LEUR) of obstructed megaureters: STEP-BY-STEP video of a simplified approach

In this video we aim to describe step-by-step a simplified surgical technique for the treatment of primary and secondary obstructed megaureters in children by laparoscopic extravesical ureteral reimplantation (LEUR). A transperitoneal approach is used in all cases. The distal ureter is dissected and...

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Bibliographic Details
Published in:Journal of pediatric urology 2021-08, Vol.17 (4), p.581-582
Main Authors: Gander, Romy, Asensio, Marino, Royo, Gloria Fatou, López, Manuel
Format: Article
Language:English
Subjects:
Child, Preschool
Female
Humans
Infant
Laparoscopic ureteral reimplantation
Laparoscopy
Male
Minimally invasive surgery
Obstructed megaureter
Pediatrics
Replantation
Retrospective Studies
Treatment Outcome
Ureter - surgery
Ureteral Obstruction - surgery
Urologic Surgical Procedures
Vesico-Ureteral Reflux - surgery
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Summary:In this video we aim to describe step-by-step a simplified surgical technique for the treatment of primary and secondary obstructed megaureters in children by laparoscopic extravesical ureteral reimplantation (LEUR). A transperitoneal approach is used in all cases. The distal ureter is dissected and transected at the level of the stenosis. Detrusor fibers are divided to expose bladder mucosa and the distal ureter is introduced into the bladder to create a valve-like mechanism (modified-Shanfield technique). Between 2016 and 2020, 9 patients underwent LEUR (5 female, 4 male). Mean age at surgery was 31.6 months (SD:22.74) and indications were infection (2), obstruction (3), increase hydronephrosis (2) and decrease in renal differential function (2). The procedure was completed laparoscopically in all cases with a median operative time of 144 min (r: 120–160). The postoperative MAG-3 renogram revealed a non-obstructive pattern in 8/9 patients and MCUG demonstrated absence of VUR in all 8/9. With a mean follow-up of 2.4 years (SD:1.4) all are asymptomatic. LEUR by this new simplified technique is a feasible treatment of megaureters associated with good short and long-term results.
ISSN:1477-5131
1873-4898
DOI:10.1016/j.jpurol.2021.06.030