title: Minimally invasive extravesical ureteral reimplantation for vesicoureteral reflux.
abstract: OBJECTIVE
  We designed a new extravesical ureteral reimplantation technique with a minimally invasive approach from skin to ureterovesical junction with less perivesical tissue manipulation to avoid extensive bladder denervation.
  
  
  METHODS
  Between July 1996 and December 2000, 37 boys and 52 girls 1.2 to 10.8 years old (mean age plus or minus standard deviation 3.8 +/- 2.5) (113 ureters) were treated with minimally invasive extravesical ureteral reimplantation. Vesicoureteral reflux was graded I to V in 8, 12, 43, 29 and 21 cases, respectively. The technique involves an approximately 10 to 15 mm. incision passing through the small triangular gap of the aponeurosis of the external abdominal oblique muscle and transversalis fascia to the point of the ureterovesical junction. The surgical field was exposed with mini-retractors and fine dissecting instruments were used to avoid unnecessary tissue manipulation.
  
  
  RESULTS
  At postoperative followup 1 patient had persistent grade II reflux and 2 had moderate hydronephrosis and hydroureter, which resolved after 18 months. No patient returned due to voiding inefficiency or for pain control after discharge from the outpatient setting.
  
  
  CONCLUSIONS
  This new technique can be easily used for vesicoureteral reflux with the advantages of simple intervention for surgeons, especially those with inguinal herniorrhaphy and antireflux surgery experience, and less wound discomfort for patients. The whole procedure can be performed on an outpatient basis. However, the decision to use this technique should be based on individual consideration.
authors.affiliation: Division of Urology, Chang Gung Children Hospital, Taoyuan, Taiwan, Republic of China.
authors.forename: Hsiao-Wen
authors.initials: HW
authors.lastname: Chen
authors.forename: Ghi-Jen
authors.initials: GJ
authors.lastname: Lin
authors.forename: Ching-Horng
authors.initials: CH
authors.lastname: Lai
authors.forename: Sheng-Hsien
authors.initials: SH
authors.lastname: Chu
authors.forename: Cheng-Keng
authors.initials: CK
authors.lastname: Chuang
mesh_terms: D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*