Simplified technique for laparoscopic extravesical ureteral reimplantation in the porcine model.
OBJECTIVE
Laparoscopic intravesical and standard Lich-Gregoir repair have been reported but are technically challenging. Herein, we present our experience with a simplified laparoscopic reimplantation of the ureter to correct vesicoureteral reflux (VUR).


METHODS
Bilateral VUR was created cystoscopically in six minipigs, as confirmed by a static cystogram 6 weeks later. The laparoscopic extravesical correction of VUR was performed utilizing a full-thickness cystotomy. The ureter was transposed inside the bladder, and a full-thickness bladder closure was performed. No attempt was made to cover the ureter with urothelium. No stents or catheters were utilized postoperatively. Three months after reimplantation, the animals were evaluated with serology, a static cystogram, an intravenous urogram (IVU), and gross pathologic and histopathologic examination.


RESULTS
The postoperative cystograms confirmed no reflux in all the reimplanted ureters and residual grade 1 to 3 reflux in the non-reimplanted ureters. All pigs voided normally and were completely continent. Cystoscopic evaluation revealed complete epithelialization over the reimplanted ureter. One surgical complication occurred: the ureter was incorporated into the bladder closure and became obstructed. The IVU in all other pigs demonstrated patent ureters with prompt function.


CONCLUSIONS
Laparoscopic reimplantation of the ureter utilizing this modified Lich-Gregoir approach corrected reflux in all animals. The full-thickness bladder incision and intravesical transposition of the ureter greatly simplifies the laparoscopic procedure. This laboratory experience encourages further clinical evaluation in the pediatric population with VUR.
Baldwin
D Duane
DD
Division of Urologic Surgery, Loma Linda University School of Medicine, Loma Linda, California 92354, USA.
Pope
John C
JC
Alberts
Gregory L
GL
Herrell
S Duke
SD
Dunbar
Jennifer A
JA
Roberts
Richard L
RL
Maynes
Lincoln J
LJ
Brock
John W
JW
Adams
Mark C
MC
McDougall
Elspeth M
EM
D000818:Animals; D003558:Cystoscopy; D004848:Epithelium / Q000473:pathology; D005260:Female; D010535:Laparoscopy / Q000379:methods*; D023421:Models, Animal; D011859:Radiography; D012092:Replantation / Q000379:methods*; D013536:Suture Techniques; D013552:Swine; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000601:surgery; D014718:Vesico-Ureteral Reflux / Q000601:surgery*