Lich-Gregoir reimplantation causes less discomfort than Politano-Leadbetter technique: Results of a prospective, randomized, pain scale-oriented study in a pediatric population.
OBJECTIVE
There is a consensus that transvesical reimplantation is more appropriate in cases of bilateral vesicoureteral reflex (VUR). In contrast to that it is not yet clear which approach should be used in unilateral VUR. This prospective, randomized trial compared the benefits and drawbacks of the intravesical and extravesical techniques in terms of operative comorbidity.


METHODS
Forty-four children (29 girls, 15 boys, mean age, 67.23 mo) with unilateral VUR were assigned to two groups: 22 patients underwent Lich-Gregoir reimplantation and 22 underwent the intravesical Politano-Leadbetter technique. Follow-up evaluation included renal ultrasonography and voiding cystourethrography (VCUG) 6 mo postoperatively. The groups were compared for operative time, duration of hematuria, upper tract dilation, discomfort and pain, analgesic requirements, voiding dysfunction, and reflux persistency.


RESULTS
No child had persistent VUR. Contralateral degrees II VUR was noted in five patients without significant difference regarding the treatment (p = 0.345). It was transient in all cases. Operative time was shorter using the extravesical technique (66.73 min versus 79.28 min; p < 0.0001). Gross hematuria occurred only after intravesical reimplantation lasting 4.19 d (p < 0.00001). The objective pain score was worse after intravesical surgery (p = 0.002). Analgesic requirements were higher after the Politano reimplantation (p = 0.039).


CONCLUSIONS
Both unilateral extravesical and intravesical reimplantation definitively correct VUR. The mean operative time was significantly shorter using the Lich-Gregoir technique, which underlines its simplicity; additionally, gross hematuria can be avoided. Postoperative pain and bladder spasms were reduced using the extravesical approach. Consequently, it represents an effective surgical technique to correct reflux while operative morbidity is low. Therefore it is the method of choice in cases of unilateral VUR requiring correction.
Schwentner
C
C
Department of Pediatric Urology, Medical University, Innsbruck, Austria.
Oswald
J
J
Lunacek
A
A
Deibl
M
M
Koerner
I
I
Bartsch
G
G
Radmayr
Christian
C
D000700:Analgesics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D011446:Prospective Studies; D011859:Radiography; D012092:Replantation / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014521:Urethra / Q000000981:diagnostic imaging / Q000503:physiopathology; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000503:physiopathology; D014554:Urination; D013520:Urologic Surgical Procedures / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
D000700:Analgesics