title: Transvesicoscopic ureteral reimplantation in children with bilateral vesicoureteral reflux: surgical technique and results.
abstract: OBJECTIVE
  To report our initial experience with transvesicoscopic cross-trigonal ureteral reimplantation (TVUR), describing stepwise the surgical procedure and determining critical aspects of this surgery in the actual surgical field.
  
  
  METHODS
  Between September 2008 and April 2010, 48 patients with bilateral vesicoureteral reflux (VUR) underwent TVUR. To identify the critical aspects affecting the surgical difficulty, we divided our TVUR procedure into four steps: TVUR set-up, mobilization of ureters, creation of submucosal tunnels, and ureterovesical anastomosis. To evaluate the evolution of our TVUR, we analyzed changes in the operative time and complications versus increase in surgeon experience (dividing our cases into three groups: the first third, the second third, and the last third). Changes in operative time for all four steps of TVUR were analyzed separately, as well as change in overall operative time.
  
  
  RESULTS
  Of a total of 48 cases, 45 patients underwent TVUR successfully except for 3 cases of open conversion. Among the 45 cases, the mean overall operative time was 155.6 min. In 1 patient, proximal migration of the ureteral catheter occurred. No other perioperative complications were observed. The mean postoperative hospital stay was 1.6 days. The VUR resolution rate was 96.4%. Upon analysis of our results by step, Step 4 (ureterovesical anastomosis) required the largest portion of the overall operative time in most cases. During the early period of our TVUR, we encountered several technical difficulties. However, the operative times for all four steps were stabilized with increasing number of cases, without deteriorating surgical outcomes.
  
  
  CONCLUSIONS
  Our report demonstrates that TVUR might potentially be a safe and effective alternative to open ureteral reimplantation in children with VUR, with a shorter learning curve than expected.
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Mun Su
authors.initials: MS
authors.lastname: Chung
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Han
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Jung
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Im
authors.forename: Hyun Ho
authors.initials: HH
authors.lastname: Han
authors.forename: Joon Chae
authors.initials: JC
authors.lastname: Na
authors.forename: Chang Hee
authors.initials: CH
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*