1. Surgical Management of Pediatric Vesicoureteral Reflux: A Comparative Study Between Endoscopic, Laparoscopic, and Open Surgery.
- Author
-
Esposito, Ciro, Escolino, Maria, Lopez, Manuel, Farina, Alessandra, Cerulo, Mariapina, Savanelli, Antonio, La Manna, Angela, Caprio, Maria Grazia, Settimi, Alessandro, and Varlet, Francois
- Subjects
CHILD health services ,COMPARATIVE studies ,UROLOGICAL surgery ,LENGTH of stay in hospitals ,LAPAROSCOPY ,RESEARCH methodology ,MEDICAL cooperation ,POSTOPERATIVE pain ,REIMPLANTATION (Surgery) ,RESEARCH ,SURGICAL complications ,VESICO-ureteral reflux ,EVALUATION research ,TREATMENT effectiveness ,RETROSPECTIVE studies ,URETEROSCOPY - Abstract
Aim: Our retrospective study compared the results of three surgical procedures for correction of pediatric vesicoureteral reflux (VUR): open Cohen, laparoscopic Lich-Gregoir reimplantation (LEVUR), and endoscopic subureteric injection (STING) procedure.Methods: We analyzed 90 patients (50 girls, 40 boys, average age 4.86 years) operated in two centers of pediatric surgery for VUR. Exclusion criteria were Grade 1 VUR, Grade 5 VUR with megaureters requiring ureteral tapering, secondary VUR, and patients already operated for VUR. Thirty patients underwent Cohen, 30 LEVUR, and 30 STING procedure. Follow-up included renal ultrasonography and voiding cystourethrography 6 months postoperatively. The statistical analysis was performed using χ(2) Pearson and Fisher tests.Results: Operative time was shorter using STING either for unilateral or bilateral correction (P = .001). Hospitalization was statistically shorter using STING and LEVUR compared to Cohen (P = .001). The pain scores were worse after Cohen (P = .001). Analgesic requirements were higher after Cohen (P = .001). Reflux persistence was higher after STING (10 cases versus 5 Cohen and 4 LEVUR). Cohen presented more complications compared to LEVUR and STING (P = .001). Intraoperative costs were higher for STING procedure (P = .001), while hospitalization costs were significantly higher for Cohen procedure (P = .001).Conclusions: In children affected by VUR, open Cohen and LEVUR reported a higher success rate than STING procedure. However, Cohen procedure had a very long and painful hospital stay, more complications, more analgesic requirements compared to STING and LEVUR. Comparing the three techniques, it seems that LEVUR presents a high success rate similar to the Cohen procedure, but in addition, it presents the same advantages of STING procedure with no postoperative pain and a lower postoperative morbidity. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF