Vesicoureteral Reflux and Ureteral Reimplantation

Abstract

Vesicoureteral reflux (VUR) affects 1 % of children and predisposes to clinical pyelonephritis. The purpose of surgical correction is to minimize the risk of upper urinary tract infection, which can result in reflux-related renal scarring. Most children are managed initially with medical therapy, which includes assessment of bladder and bowel habits, determination of reflux risk to the child, behavioral modification, and selective antibiotic prophylaxis. Surgical options include open ureteral reimplantation (extravesical or intravesical), subureteral injection therapy using dextranomer/hyaluronic acid, and robotic-assisted laparoscopic surgical correction, either extravesical or intravesical. The reported success rates with the robotic procedures for standard ureteral reimplantation show longer operative times than with the open approach but trend toward less need for analgesia and a shorter length of stay. There are more reports of the robotic extravesical approach compared with the intravesical approach. It is an effective minimally invasive surgical approach for the repair of VUR.