Initial experience with laparoscopic transvesical ureteral reimplantation at the Children's Hospital of Philadelphia

Laparoscopic transvesical ureteral reimplantation with or without robotic assisted surgical devices is being developed as an alternative to open surgery. We review our experience with laparoscopic transvesical ureteral reimplantation.A total of 32 patients underwent laparoscopic transvesical reimplantation by the same surgeon. Of the patients 5 had primary obstructing megaureters and 27 had vesicoureteral reflux. Transvesical laparoscopic cross-trigonal ureteral reimplantation was performed in patients with reflux, and a Glenn-Anderson reimplantation was used in patients with a primary obstructing megaureter. A pure laparoscopic approach using two 3 mm working ports and a 5 mm camera port was used.The operative success rates were 92.6% and 80% for vesicoureteral reflux and primary obstructing megaureter cases, respectively. Complications included a postoperative urinary leak in 4 patients (12.5%) and ureteral stricture at the neoureterovesical anastomosis in 2 (6.3%). All but 1 complication occurred in patients 2 years or younger with bladder capacity less than 130 cc.Laparoscopic intravesical reimplantation is in its infancy and appears to have higher complication rates in young patients with small bladder capacity.