Surgical Management of Pediatric Vesicoureteral Reflux: A Comparative Study Between Endoscopic, Laparoscopic, and Open Surgery.
OBJECTIVE
Our retrospective study compared the results of three surgical procedures for correction of pediatric vesicoureteral reflux (VUR): open Cohen, laparoscopic Lich-Gregoir reimplantation (LEVUR), and endoscopic subureteric injection (STING) procedure.


METHODS
We analyzed 90 patients (50 girls, 40 boys, average age 4.86 years) operated in two centers of pediatric surgery for VUR. Exclusion criteria were Grade 1 VUR, Grade 5 VUR with megaureters requiring ureteral tapering, secondary VUR, and patients already operated for VUR. Thirty patients underwent Cohen, 30 LEVUR, and 30 STING procedure. Follow-up included renal ultrasonography and voiding cystourethrography 6 months postoperatively. The statistical analysis was performed using χ(2) Pearson and Fisher tests.


RESULTS
Operative time was shorter using STING either for unilateral or bilateral correction (P = .001). Hospitalization was statistically shorter using STING and LEVUR compared to Cohen (P = .001). The pain scores were worse after Cohen (P = .001). Analgesic requirements were higher after Cohen (P = .001). Reflux persistence was higher after STING (10 cases versus 5 Cohen and 4 LEVUR). Cohen presented more complications compared to LEVUR and STING (P = .001). Intraoperative costs were higher for STING procedure (P = .001), while hospitalization costs were significantly higher for Cohen procedure (P = .001).


CONCLUSIONS
In children affected by VUR, open Cohen and LEVUR reported a higher success rate than STING procedure. However, Cohen procedure had a very long and painful hospital stay, more complications, more analgesic requirements compared to STING and LEVUR. Comparing the three techniques, it seems that LEVUR presents a high success rate similar to the Cohen procedure, but in addition, it presents the same advantages of STING procedure with no postoperative pain and a lower postoperative morbidity.
1 Department of Translational Medical Sciences, Federico II University of Naples , Naples, Italy .
Ciro
C
Esposito
1 Department of Translational Medical Sciences, Federico II University of Naples , Naples, Italy .
Maria
M
Escolino
2 Department of Pediatric Surgery, Centre Hospitalier Universitaire , Hopital Nord, Saint-Etienne, France .
Manuel
M
Lopez
1 Department of Translational Medical Sciences, Federico II University of Naples , Naples, Italy .
Alessandra
A
Farina
1 Department of Translational Medical Sciences, Federico II University of Naples , Naples, Italy .
Mariapina
M
Cerulo
1 Department of Translational Medical Sciences, Federico II University of Naples , Naples, Italy .
Antonio
A
Savanelli
3 Department of Pediatrics, Second University of Naples , Naples, Italy .
Angela
A
La Manna
1 Department of Translational Medical Sciences, Federico II University of Naples , Naples, Italy .
Maria Grazia
MG
Caprio
1 Department of Translational Medical Sciences, Federico II University of Naples , Naples, Italy .
Alessandro
A
Settimi
2 Department of Pediatric Surgery, Centre Hospitalier Universitaire , Hopital Nord, Saint-Etienne, France .
Francois
F
Varlet
D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007558:Italy; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D010149:Postoperative Pain; D011183:Postoperative Complications; D012092:Replantation; D012189:Retrospective Studies; D016896:Treatment Outcome; D018666:Ureteroscopy; D013520:Urologic Surgical Procedures; D014718:Vesico-Ureteral Reflux / Q000601:surgery*