Chennai Stone Clinic
LAPARASCOPIC UROLOGY

LAPARASCOPIC ANTIREFLUX REPAIR

Surgery (ureteral reimplantation or ureteroneocystostomy) is the definitive method of correcting primary reflux, especially in the setting of anatomic abnormalities. Surgical principles of successful reimplantation include (1) creating a long submucosal tunnel to provide a 5:1 tunnel-to-diameter ratio, (2) providing good detrusor muscle backing, (3) avoiding ureteric kinking, and (4) creating a tunnel in the fixed area of the bladder.

Standard antireflux ureteral reimplantation procedures include the transtrigonal (Cohen), intravesical (Leadbetter-Politano), and extravesical detrusorrhaphy (Lich-Gregoir) techniques. The common goal of these operations is to prevent VUR by creating an effective flap-valve mechanism at the ureterovesical junction.

Potential complications due to ureteral reimplantation of the ureters include bleeding in the retroperitoneal space, infections, ureteral obstruction, injury to adjacent organs, and persistent reflux. These occur in less than 1% of cases .

Of note, surgical correction of VUR has not been demonstrated to decrease the frequency of recurrent nonfebrile UTIs. These infections occur in the lower tract, thereby indicating that the risk to the kidneys may have been reduced by preventing ascent of the bacteria to the upper urinary tract. The antireflux does not completely prevent pyelonephritis, as a small percentage of patients who have undergone antireflux surgery re-present with pyelonephritis. These infections may be due to the host predisposition to infection rather than to anatomic factors .