Minimally invasive ureteral reimplantation: trends in regions of the Russian Federation and The Republic of Belarus. Multi-center study

Abstract

Introduction. Until recently, open ureteral reimplantation was considered the gold standard for the surgical treatment of ureterovesical junction (UVJ) pathologies. The introduction of minimally invasive ureteral reimplantation (MIUR) for the treatment of vesicoureteral reflux (VUR) and primary obstructive megaureter (POM) in children started in the 1990s. However, studies describing national trends in the use of minimally invasive and open approaches in the surgical treatment of UVJ pathology in children are limited.Objective. To describe changes in the use of MIUR and open ureteral reimplantation (OUR) between 2007 and 2022 in some regions of the Russian Federation and the Republic of Belarus and compare the results and complication rates of the two surgical approaches. Materials & methods. The study includes 1273 patients (1793 ureters), operated on for UVJ pathology in the period from 2007 to 2022. MIR was performed in 1356 (75.6%) ureters (913 for VUR and 443 for POM). The studied parameters included an annual amount of reimplantation, the age of patients, the frequency of intra- and postoperative complications, as well as the medium-term results of operations.Results. The use of MIUR techniques has increased significantly over time, and in 2022, seventy-five percent of surgeries were performed using MIUR. Analysis of the rate of adoption of MIUR by clinics showed that those that began using it first experienced a significant increase in frequency of use after 4 to 6 years, while those that started later took 2 to 3 years to achieve a significant positive trend. There were 5 (0.4%) intraoperative complications in the MIUR group. All these complications were classified as grade I according to the Satava grading system. There was no significant difference between MIUR and OUR in terms of postoperative complication rates (6.6% vs. 7.6%, p = 0.8). The efficiency of reimplantation was 96.6% in the MIUR group compared to 95.9% in the OUR group for POM and 96.2% in the MIR group compared to 94.6% in the OUR for VUR.Conclusion. In the regions of Russia involved in the study, there has been a trend towards completely replacing open surgery with minimally invasive techniques. Regarding complication rates and efficacy, MIUR is not significantly different from OUR.