Isolated laparoscopic extra-vesical ureteric reimplantation (I-LEVUR) for upper moiety ectopic ureter without lower moiety vesicoureteric reflux
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In brief
In brief
This study demonstrates that isolated laparoscopic extravesical ureteric reimplantation (I-LEVUR) successfully treats upper moiety ectopic ureters in duplex systems while preserving the normal lower moiety orifice. In 12 pediatric patients followed for a median of 78.5 months, the technique achieved excellent continence outcomes with minimal complications, offering a less invasive alternative to traditional en bloc reimplantation.
- I-LEVUR selectively reimplants only the ectopic upper moiety ureter, preserving the normal lower moiety orifice and reducing surgical trauma
- In 12 patients (median age 2.8 years), I-LEVUR achieved 100% continence improvement with no obstruction over 78.5-month median follow-up
- Only 2/12 patients developed mild VUR post-I-LEVUR, both managed conservatively without surgical intervention
- Mean operative time of 127.5 minutes with no intraoperative complications demonstrates technical feasibility of isolated reimplantation
- I-LEVUR offers effective alternative to en bloc reimplantation when lower moiety ureter is non-refluxing in duplex system ectopic ureter
Written by the GCMD Library team from the article.
Abstract
Purpose
To evaluate the feasibility and outcomes of isolated laparoscopic extra-vesical ureteric reimplantation (I-LEVUR) for upper moiety ectopic ureter in patients with non-refluxing lower moiety ureter and avoid reimplanting normal lower moiety orifice.
Methods
Between 2013 and 2024, 12 patients (8 females, 4 males) with ectopic ureter associated with a duplex system underwent I-LEVUR. Preoperative assessment included ultrasonography, voiding cystourethrography (VCUG), and magnetic resonance urography (MRU)/retrograde pyelogram (RGP). The procedure involved laparoscopic extravesical approach dissecting only the ectopic ureter in lower most part, preserving vascularity, and performing an isolated reimplantation without manipulating lower moiety ureter.
Results
Twelve patients, with a median age of 2.8 years, underwent I-LEVUR. The mean operative time was 127.5 min. No intraoperative complications occurred. Postoperative follow-up (median: 78.5 months) showed no cases of ureteral obstruction or significant complications. Urinary continence improved in all patients. Two patients developed mild vesicoureteral reflux, managed conservatively, and one patient had minor urine leak which resolved spontaneously.
Conclusion
I-LEVUR is a viable and effective alternative to traditional en bloc reimplantation for upper moiety ectopic ureter. It preserves the normal ureteric orifice, reduces surgical trauma, and offers excellent outcomes in terms of renal function and urinary continence. Further studies with larger cohorts, control group of common sheath reimplantation, randomization, robust statistical validation and longer follow-up are recommended.