Laparoscopic ureteral reimplantation in the recurrent vesicoureteral reflux in a 12-year-old child

Abstract

Introduction. The antireflux reimplantation of the ureter may be performed using different surgical approaches with the known techniques. Despite the high efficiency of these surgical interventions, there are cases of reflux relapses even after several surgical interventions on the ureterovesical junction (UVJ). The range of ways for laparoscopic reconstruction of the upper urinary tract is increasingly expanding what allows toperform a successful correction of the defect even in technically difficult positions. The main purpose of the present clinical demonstration is to illustrate a successful application of laparoscopic access in the correction of recurrent forms of vesicoureteral reflux (VUR).Material and methods. The authors present a clinical case and management of a patient with Grade 4 VUR on the right (classification by P.E. Heikel et K.V. Parkkulainen, 1966). Previously, a 12-year-old boy had four surgical interventions, both open traditional correction and endovesical implantations of volume-forming drugs. The reflux persisted and was accompanied with constant recurrences of pyelonephritis and progressive deterioration of the kidney function on the right.Results. Despite technical difficulties associated with cicatricial changes in UVJ, an antireflux surgery with laparoscopic access was performed. The follow-up control within one year revealed no recurrences of urinary tract infection. Findings of VUR control examination demonstrated that the renal function was stabilized.Conclusions. A rational approach and justified surgical access have given good outcomes in this patient.