BERKELEY, CA (UroToday Inc.) - Nephropathy due to renal scarring continues to be the most concerning issue about vesicoureteral reflux. Surgical correction to eliminate reflux is an important part of its management. Different techniques have been successfully used, including transvesical procedures such as those described by Cohen or Leadbetter-Politano, and an extravesical procedure described by Zaontz in 1987. In addition, an endoscopic, and now a minimally invasive extravesical technique, are available for the treatment of vesicoureteral reflux. Few studies have compared the various techniques to determine differences in efficacy or morbidity.

H.W. Chen et al, from Taiwan, completed a study designed to compare the different antireflux procedures performed in one center in terms of outcome and morbidity. The results were reported in the February 2004, issue of Urology. The study group was comprised of 218 patients (305 ureters) who underwent surgical correction for vesicoureteral reflux. The mean age was 3.5 years. Mean follow-up was 4.8 years. The first 92 cases (143 ureters) were performed transvesically with the technique of Cohen (group 1), the next 37 cases (49 ureters) were performed with a conventional extravesical technique (group 2).

The last 89 cases (113 ureters) were performed with the new minimally invasive extravesical technique (group 3). In this procedure, an inguinal incision is used (as opposed to a Pfannenstiel incision), and the dissection proceeds through the floor of the inguinal canal to reach the ureterovesical junction. An extravesical reimplant is then performed by incising the detrussor muscle and laying the ureter within the trough that is created. The detrussor muscle is then brought together over the ureter, effectively lengthening the submucosal tunnel.

Analysis showed that all three techniques had similar efficacy with only two patients having persistent reflux. Four patients had some degree of hydronephrosis postoperatively, with each of the groups having at least one obstructed ureter. Necessity for catheter drainage was 100% for the transvesical approach and none for the minimally invasive extravesical approach. Four patients undergoing the standard extravesical approach had urinary retention requiring a catheter.

Operative time and hospital stay was markedly less in the minimally invasive group. Mean OR times were 61 minutes for the bilateral minimally invasive extravesical repair versus 181 minutes for a bilateral Cohen transvesical repair. The conventional bilateral extravesical technique took 158 minutes on average. Mean hospital stay was 4.9 days, 3.0 days and 0 days for groups 1, 2 and 3 respectively. Analgesia requirements also showed similar decreasing trends for the groups.

The authors conclude that the minimally invasive extravesical technique for the repair of vesicoureteral reflux is an effective and less morbid treatment for patients who require surgical correction for the condition.

Urology 2004;63:364-7.