title: Unilateral extravesical ureteral reimplantation via inguinal incision for the correction of vesicoureteral reflux: a 10-year experience.
abstract: OBJECTIVE
  Multiple options exist for the surgical management of vesicoureteral reflux (VUR). We report on our 10-year experience using the inguinal approach to extravesical ureteral reimplantation (EVR).
  
  
  METHODS
  Patient characteristics of age, gender, and reflux grade were obtained and outcomes of operative time, hospital stay, and radiographic resolution were assessed.
  
  
  RESULTS
  71 girls and 20 boys with a mean age of 74 months (range 14-164) underwent inguinal EVR via a 3.5-cm inguinal mini-incision. Mean follow up was 10.9 months (range 0.4-69.7). Average grade of reflux was 2.80. Average operative time was 91 minutes (range 51-268). The procedure was successful in 87 of 91 patients (95.6%). The 3 cases of reflux that persisted were all grade 1 and managed expectantly. Contralateral reflux developed in 9 cases, all of which resolved after treatment with either Deflux or ureteral reimplant. There were 4 case of urinary retention that resolved after a brief period of CIC or indwelling catheterization. There were no cases of ureteral obstruction. Most patients were discharged on post-operative day 1 (85/91) and no hospitalization extended beyond 3 days.
  
  
  CONCLUSIONS
  The inguinal approach to extravesical ureteral reimplantation should be considered as a potentially minimally invasive alternative to endoscopic and robotic treatment of VUR with a success rate more comparable to traditional open approaches. We feel it is the method of choice in cases of unilateral VUR requiring surgical correction.
authors.affiliation: Rady Children's Hospital, San Diego, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Yap
authors.affiliation: Rady Children's Hospital, San Diego, CA, USA.
authors.forename: Unwanabong
authors.initials: U
authors.lastname: Nseyo
authors.affiliation: Rady Children's Hospital, San Diego, CA, USA.
authors.forename: Hena
authors.initials: H
authors.lastname: Din
authors.affiliation: Rady Children's Hospital, San Diego, CA, USA.
authors.forename: Madhu
authors.initials: M
authors.lastname: Alagiri
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
keywords: Minimally Invasive Surgical Procedures; Urinary Incontinence ; Vesico-Ureteral Reflux