title: Bilateral Transvesicoscopic Cross-trigonal Ureteric Reimplantation in Children: Surgical Subtleties and a Prospective Summary.
abstract: OBJECTIVE
  To prospectively evaluate the surgical technique and results of bilateral transvesicoscopic cross-trigonal ureteric reimplantation (TVUR) in children with vesicoureteric reflux (VUR) and compare the results and surgical subtleties with the existing literature.
  
  
  METHODS
  From January 2010 to December 2015, children between 2 and 14 years of age with bilateral primary VUR grades II-IV underwent bilateral TVUR at a tertiary referral center in Northern India. The grade of VUR was II in 12 patients, III in 19 patients, and IV in 3 patients. All surgeries were performed by a single surgeon. Success was defined as the absence of VUR on direct radionuclide cystogram at 8 weeks.
  
  
  RESULTS
  Seventeen patients (34 refluxing ureters) underwent bilateral TVUR during the study period. They included 13 girls and 4 boys. The median age was 4.6 years (range: 2-14 years). Two patients required conversion to open surgery. Resolution of VUR was seen in 16 patients (32 out of 34 ureters). Hydronephrosis resolved on postoperative ultrasonography in all patients with low-grade reflux (lower than grade IV) and all except one patient with grade IV reflux.
  
  
  CONCLUSIONS
  TVUR is a feasible method with success rate equal to that of open technique if patient selection is good. Success rate is low in high-grade reflux, and dilated and tortuous ureter. Subtle modifications in the surgical steps can make significant contribution toward learning this minimally invasive technique.
authors.affiliation: Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. Electronic address: ansarimsa@hotmail.com.
authors.forename: Mohd S
authors.initials: MS
authors.lastname: Ansari
authors.affiliation: Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Priyank
authors.initials: P
authors.lastname: Yadav
authors.affiliation: Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Sohrab
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Prempal
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Virender
authors.initials: V
authors.lastname: Sekhon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D012092:Replantation / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter / Q000000981:diagnostic imaging / Q000601:surgery*; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000601:surgery*; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000601:surgery*