EXTRAVESICAL VERSUS INTRAVESICAL URETERIC REIMPLANTATION IN CHILDREN

Abstract

Objectives: The objective of our study is to compare the extravesical andintravesical ureteric reimplantation for the treatment of bilateral vesicoureteral reflux in children.Period: April 2013 and July 2016. Setting: Urology Department of Mayo Hospital, Lahore.Methodology: 66 children diagnosed with primary vesicoureteral reflux and undergoingureteric reimplantation. The Cohen cross-trigonal reimplantation (intravesical) and modifiedLich-Gregoir procedure (extravesical) were performed on two separate groups Group IRand group ER. The following parameters were compared: postoperative duration of stay inthe hospital, hematuria and bladder spasm. Frequency of hematuria, bladder spasm andaverage duration of stay in the hospital were compared in both group. Mean and standarddeviation was calculated for age, gender and duration of surgery in both groups.). Chi squaretest was applied to check the association of outcome variables with demographical variablesand duration of surgery. Results: These 100% (n=66) patients were divided into 2 groupsequally, 33 in each, i.e. group ER and group IR. The mean age and duration of surgery ofthe patients of group ER were 13.78±2.83 years, 102.45±4.13 minutes respectively. Whilethe mean age and duration of surgery of the patients of group IR was 30.33±4.58 years and119.7±10.70 minutes respectively (Table-II).The main outcome variables of this study werethe hospital stay, postoperative bladder spasm and hematuria. The mean hospital stay of thepatients of group ER and group IR was 4.30±1.35 days and 5.84±1.0 respectively (Table-II).It was observed that bladder spasm in group ER and group IR was 39.4% (n=13) and 54.5%(n=18) respectively (Figure-1). It was also observed that hematuria in group ER and group IRwas 36.4% (n=12) and 48.5% (n=16) respectively (Figure-2). Conclusion: The observation ofthis study concludes that extravesical ureteric reimplantation has an edge over conventionalprocedure of intravesical ureteric approach. Intravesical procedure has disadvantages of morefrequency of postoperative complications like, hospital stay, bladder spasms and hematuria.