title: Contemporary open ureteral reimplantation without morphine: assessment of pain and outcomes.
abstract: OBJECTIVE
  The recent literature places significant emphasis on decreased pain and length of stay after endoscopic treatment of vesicoureteral reflux compared to historical open ureteroneocystostomy. We documented postoperative pain and outcomes of a contemporary series of minimally invasive ureteral reimplantation.
  
  
  METHODS
  For 100 consecutive patients who underwent ureteroneocystostomy we examined the association of the variables patient age, weight, gender, reflux grade, year of surgery, extravesical or intravesical approach and operative time with the outcomes length of hospital stay and pain score (0 to 10), with univariate linear and multivariate regression analyses.
  
  
  RESULTS
  Mean patient age was 5.5 years and median followup was 16 months. All patients received ketorolac and acetaminophen with codeine for pain, and early in the series 7 patients received morphine. Average pain scores were mean 1.2, median 0.9 and maximum 3.4. Mean length of stay was 24.4 hours. Multiple regression analyses demonstrated that date of surgery, lower weight, intravesical approach and operative time were independently associated with greater length of stay. A total of 26 patients underwent voiding cystourethrography postoperatively. There was 1 case of recurrent (from bilateral grade V to unilateral grade I) and 1 case of de novo (contralateral grade I) reflux.
  
  
  CONCLUSIONS
  Open ureteroneocystostomy can be performed in a minimally invasive manner. A small incision combined with administration of ketorolac is associated with a short length of stay and low pain scores. When comparing endoscopic and open treatment of reflux investigators should consider the high success rate and low morbidity of contemporary, minimally invasive open series.
authors.affiliation: Department of Urology, University of California, Davis, Children's Hospital and School of Medicine, Sacramento, California, USA.
authors.forename: Karim
authors.initials: K
authors.lastname: Chamie
authors.forename: Andrew
authors.initials: A
authors.lastname: Chi
authors.forename: Brian
authors.initials: B
authors.lastname: Hu
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Keegan
authors.forename: Eric A
authors.initials: EA
authors.lastname: Kurzrock
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000627:therapeutic use*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009020:Morphine / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D012092:Replantation; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
chemical_list: D000700:Analgesics; D009020:Morphine; D020910:Ketorolac