title: The inguinal approach to extravesical ureteral reimplantation is safe, effective, and efficient.
abstract: BACKGROUND
  Minimally invasive surgery implies a percutaneous or endoscopic approach rather than an incision, regardless of size. However, open approaches to various procedures using a mini-incision should assume the same appellation. We report our experience with extravesical ureteral reimplant (EVR) performed through an inguinal mini-incision.
  
  
  METHODS
  Patient characteristics of age, gender, and reflux grade were obtained, and outcomes of recurrent urinary tract infection, time of surgery, time of hospitalization and radiographic resolution were assessed. The technique involved a 2 cm incision made in the lowest inguinal skin crease, standard hernia exposure, opening of the floor of the inguinal canal to isolate the ureter, detrussorhaphy.
  
  
  RESULTS
  30 girls and 15 boys with a mean age of 64 months (range 20-180), and mean followup of 18 months (range 3-36) underwent unilateral inguinal mini-incision EVR. Reflux grades represented were 7, 13, 18, 5, and 2 for Grades I through V respectively. Common sheath reimplantations were performed in twelve duplicated systems, and tapering performed in three patients. The average time of surgery was 75 min. All but 2 patients were discharged within 24 h; postoperative imaging was normal in all cases. Three patients had febrile UTIs following discontinuation of prophylactic antibiotics.
  
  
  CONCLUSIONS
  The inguinal approach to EVR is safe, effective, efficient, and well-tolerated. Through several maneuvers learned as the experience with EVR grew, we present a realizable approach to minimally invasive ureteral reimplantation with application in most pediatric urologic practice.
authors.affiliation: Division of Pediatric Urology, Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, Long Island, 1999 Marcus Avenue, M18, Lake Success, NY 11042, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Wiygul
authors.forename: Lane S
authors.initials: LS
authors.lastname: Palmer
mesh_terms: D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006119:Groin / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012092:Replantation / Q000379:methods*; D013536:Suture Techniques; D014552:Urinary Tract Infections / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*