Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “REIMPLANTATION”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources
PubMed2001

Cochlear reimplantation: surgical techniques and functional results.

OBJECTIVES/HYPOTHESIS: The most common indication for cochlear reimplantation is device failure. Other, less frequent indications consist of "upgrades" (e.g., single to multichannel), infection, and flap breakdown. Although the percentage of failures has decreased over time, an occasional patient requires reimplantation because of device malfunction. The varying designs of internal receiver/stimulators and electrode arrays mandate an examination of the nature and effects of reimplantation for the individual designs. The purpose of the current study was to investigate the reimplantation of several implant designs and to determine whether differences in surgical technique, anatomical findings, and postoperative performance exist. STUDY DESIGN: Retrospective chart review. METHODS: The subjects were 33 of 618 severely to profoundly deaf adults and children who had implantation at the New York University Medical Center (New York, NY) between February 1984 and December 2000. The subjects had previously had implantation with either a single-channel 3M/House (House Ear Institute, Los Angeles, CA) or 3M/Vienna (Technical University of Vienna, Vienna, Austria) device or with one of the multichannel Clarion (Advanced Bionics, Sylmar, CA), Ineraid (Smith & Nephew Richards, TN), or Nucleus (including the Contour) devices (Cochlear Corp., Englewood, CO) before reimplantation. RESULTS: Length of use before reimplantation ranged from 1 month to 13 years and included traumatic and atraumatic (electronic) failures, as well as device extrusion or infection. Results indicated that postoperative performance was either equal to or better than scores before failure. None of the devices explanted caused damage that precluded the implantation of the same or an upgraded device. These findings support the efficacy and safety of internal implant designs as related to the maintenance of a functional cochlea for the purpose of reimplantation. CONCLUSIONS: Cochlear reimplantation can be performed safely and without decrement to performance. The number of implanted electrodes at reinsertion were either the same or greater in all cases.

Adult↗
PubMed2003

Orthotopic and heterotopic lower leg reimplantation. Evaluation of seven patients.

Reimplantation is a well-established procedure in reconstructive surgery. This is especially so after amputation of the upper limb since prostheses provide limited function. In unilateral amputation of the lower leg orthotopic reimplantation is the treatment of choice. With bilateral amputation, in which orthotopic reimplantation is not possible because of the complexity of the trauma, heterotopic reimplantation is an option. We report five patients who received orthotopic and two who received heterotopic reimplantations of the lower leg. We assessed the functional outcomewith reference to cutaneous sensation, mobility, pain, and the cosmetic result. The functional outcome was good, as was the patients' satisfaction. Their mobility, stability, and psychological state were satisfactory. Patients with heterotopic reimplantations preferred the reimplanted leg to a prosthesis. Although reimplantation of the lower leg requires prolonged hospitalisation, delayed mobilisation and secondary operations, we conclude that there is an indication for this operation in order to improve the patient's quality of life.

Adolescent↗
PubMed2003

[Two-stage reimplantation using spacers--the method of choice in treatment of hip joint prosthesis-related infections. Comparison with methods used from 1979 to 1998].

PURPOSE OF THE STUDY: Several therapies are available for the treatment of deep infection in total hip arthroplasty but none is completely successful; there is no consensus on an optimal method. The aim of this study was to evaluate the treatment used in our institution and its outcomes over the last 20 years. In each method, the success of treatment was evaluated in terms of both infection control and restoration of function in the treated joint. MATERIAL: A total of 172 patients with infected total hip replacements were treated at the First Orthopedic Clinic of the First Faculty of Medicine, Charles University, Prague, between 1979 and 1998. Our sample consisted of 132 patients, 92 men and 40 women. Resection arthroplasty was performed in 62 patients. Two-stage reimplantation was used in 64 patients. Two-stage reimplantation involving skeletal traction was applied in 35 and a block spacer was used in 29 patients. The remaining patients were treated by other techniques. METHODS: The type of infection was classified according to the Coventry system. The outcome of surgery was assessed on the basis of the Tsukayma rating system, radiographic findings and the Harris hip score. RESULTS: The average follow-up time from the definitive operation was 70.8 months. In the patients who had resection arthroplasty only, the cure rate of infection was 91.9%. However, an increase in the Harris hip score, as compared with the condition before surgery, was low (9.7 points). In the patients treated by the two-stage reimplantation without a spacer but with skeletal traction, the cure rate of infection was 94.3% and the Harris score increased by 20 points. The patients who were treated by two-stage reimplantation with a spacer showed an infection cure rate of 96.5% and an increase in the Harris score by 29 points. This increase was higher by 9 points in comparison with the patients who had reimplantation without the use of a spacer. An even greater difference (28.2 points) was found when the outcomes of this technique were compared with those of resection arthroplasty. The incidence of spacer dislocation in 21% of the cases was an unexpected finding. DISCUSSION: No great differences in outcome in terms of infection cure rate were found among the methods used, i.e., two-stage reimplantation facilitated a better function for the hip joint than Girdlestone's operation. The use of a spacer in two-stage reimplantation ensured a greater comfort for the patient during treatment and gave better results in terms of joint function than treatment without a spacer. The use of a cemented spacer is an optimal method that not only ensures the stability of a limb during the period necessary for infection control but also provides conditions for the prospective implantation of a new prosthesis. The spacer also permits delivery of high-dose local antibiotics released from the cement as well as makes space for a long-term application of antibiotic-containing lavage. CONCLUSIONS: The rate of success in the treatment of an infected hip arthroplasty and the possibility of preserving the implant and thus enabling the patient to move comfortably are currently high. The prerequisite is early diagnosis and a radical surgical approach that involves the use of a method leading to the most effective eradication of infection and the maintenance of a good function for the joint. The reimplantation of a new prosthesis, after removal of the previous one and debridement of all infected tissue and material, combined with a targeted antibiotic therapy, is the method of choice for both the patient and the surgeon.

Adult↗
PubMed1998

[Management of the complications of ureterointestinal reimplantation in urinary diversion].

OBJECTIVE: To analyze our experience in the management of complications of ureteroenteric reimplantation in patients undergoing urinary diversion by endourological techniques or open surgery, in order to identify a useful algorithm that takes the oncologic prognosis into account, as well as the probability of success. METHODS: A retrospective study was conducted on 136 patients who had undergone urinary diversion from 1987-1998. Of these, 126 had transitional cell carcinoma, two had infiltrating carcinoma, two had a benign condition and 6 had undergone urinary diversion for patient comfort without cystectomy. The following techniques were utilized: cutaneous ureteroileostomy or Bricker technique (104 patients), Mainz neobladder (10 patients), ileal neobladder (15 patients), colonic conduit (5 patients) and cutaneous ureter (2 patients). RESULTS: Overall, 56 patients (41%) had some type of alteration at the ureteroenteric reimplantation site, but only 36 (26%) required intervention. The reimplantation techniques utilized were: the Bricker direct ureteroileostomy (26 patients), Le Duc (6 patients), Leadbetter (3 patients), and the direct cutaneous technique (1 patient). Patient mean age was 67 years (range 53-80). There were 35 males and one female. Seven patients required immediate reimplantation due to a persistent urinary fistula and 29 had late obstruction (more than 3 months), accounting for 21.3% of the cases undergoing urinary diversion. The antegrade endourological approach was utilized in 24 patients (5 nephrostomy alone and 19 stent or balloon dilatation). Dilatation was performed palliatively in 6 cases with extensive tumor spread. Permanent success was achieved in 5 cases (38%) and in spite of the initial success, there were 4 reobstructions. Open surgery was performed in 24 patients (66% of the complicated reimplantations); 5 of these patients had another pathology that warranted laparotomy, 7 required reimplantation early due to a fistula and two patients with a nonfunctioning kidney underwent nephrectomy. Ureteral replacement using the ileum was performed in 4 patients and direct reimplantation to the primary loop was performed in 6 patients. Good surgical results were consistently achieved. CONCLUSIONS: The complication rate of ureteral reimplantation is high in patients undergoing urinary diversion. Endourology has an important role in these cases, particularly in patients with a poor prognosis. Surgery achieves the best results. Although they may entail difficulty, complex cases such as extensive ureteral necrosis can be managed successfully.

Aged↗
PubMed1983

An electrophysiological study of the reinnervation of reimplanted and autotransplanted teeth in the cat.

There is evidence to suggest that some reimplanted and autotransplanted teeth are reinnervated, but the time-course of reinnervation and the properties and source of the reinnervating axons are not known. This reinnervation has been investigated using electrophysiological techniques in 6 adult cats. In each cat, one lower canine and three incisor teeth were extracted and immediately reimplanted. Three other lower incisor teeth were transplanted into an edentulous area. The teeth were splinted in position for 6 weeks. Bipolar electrical stimulation of 22 of the 38 successfully reimplanted or autotransplanted teeth evoked a jaw-opening reflex within 9-24 weeks of the surgery. The reflex had a raised threshold and increased latency. Twenty-four weeks after reimplantation or autotransplantation, 32 of the 38 teeth contained nerve fibres travelling in the ipsilateral inferior alveolar nerve but, compared with normal, the fibres had decreased conduction velocities and produced small amplitude compound action potentials in the teeth when stimulated. Seven of the reimplanted teeth contained nerve fibres travelling in the contralateral inferior alveolar nerve. These results suggest that reimplanted and autotransplanted teeth may be reinnervated but the axons are small in diameter, and either few in number or mainly located near to the apices of the teeth. Reimplanted teeth may be reinnervated by axons from the nerve which supplied them originally or by sprouting and ingrowth of axons from nerves supplying adjacent tissues.

Action Potentials↗
PubMed2004

Evaluation of native valve-sparing aortic root reconstruction with direct imaging--reimplantation or remodeling?

BACKGROUND: Aortic root reimplantation and remodeling have been used to preserve the native aortic valve. However, direct observation of valve motions with these techniques has not been performed. METHODS: Mongrel dogs were studied. The beating heart model was created using modified Tyrode's solution. Normal aortic valves and aortic valves preserved with the remodeling or reimplantation procedure were observed with an endoscope, and behavior was recorded on a high-speed video (200 frames/s). The aortic valve orifice area was measured at 11 data points per beat. A predictable maximum valve orifice area was defined as an area encircled by the three commissures. A ratio of each aortic valve orifice area to the predictable maximum valve orifice area was calculated. The control group, the reimplantation group, and the remodeling group were compared. RESULTS: The preserved aortic valve with reimplantation showed bending and asymmetric motion. The ratio of aortic valve orifice area and predictable maximum valve orifice area in the reimplantation group was significantly smaller compared with the control and remodeling groups. CONCLUSIONS: The opening and closing behavior of the aortic valve preserved with the reimplantation procedure was impaired. It was speculated that the remodeling procedure may preserve more physiologic root function compared with the reimplantation procedure.

Animals↗
PubMed2005

Survival, regeneration and functional recovery of motoneurons after delayed reimplantation of avulsed spinal root in adult rat.

We have established that extensive reinnervation and functional recovery follow immediate reimplantation of avulsed ventral roots in adult rats. In the present study, we examined the consequences of reimplantation delayed for 2 weeks after avulsion of the C6 spinal root. Twelve and 20 weeks after delayed reimplantation, 57% and 53% of the motoneurons in the injured spinal segment survived. More than 80% of surviving motoneurons regenerated axons into the reimplanted spinal root. Cholinesterase-silver staining revealed axon terminals on endplates in the denervated muscles. The biceps muscles in reimplanted animals had atrophied less than those in animals with avulsion only, as indicated by muscle wet weight and histological appearance. After electrical stimulation of the motor cortex or the C6 spinal root, typical EMG signals were recorded in biceps of reimplanted animals. The latency of the muscle potential at 20 weeks was similar to that of sham-operated controls. Behavioral recovery was demonstrated by a grooming test and ipsilateral forepaw movements were well coordinated in both voluntary and automatic activities. These results demonstrate that ventral root reimplantation can protect severed motoneurons, enable the severed motoneurons to regenerate axons, and enhance the recovery of forelimb function even when it is delayed for 2 weeks after avulsion.

Action Potentials↗
PubMed1999

Cystography after the Cohen ureterovesical reimplantation: is it necessary at a training center?

PURPOSE: Reimplantation by the Cohen procedure has a low rate of recurrent reflux, although postoperative cystography is done routinely at most centers. According to the French training program for pediatric surgery and urology residents, reimplantation is the main pediatric urology procedure performed during residency. We determine whether it is necessary to perform postoperative cystography routinely and whether the fact that the procedure is done by a junior surgeon modifies management. MATERIALS AND METHODS: A total of 268 children with primary vesicoureteral reflux underwent ureteral reimplantation by the Cohen transtrigonal technique. Bilateral reimplantation was done in 97% of the cases. Reimplantation was performed by a surgery resident assisted by a clinical fellow or senior consultant surgeon in 37% of the cases. Routine cystography and renal ultrasound were done in all patients postoperatively. Followup ranged from 6 months to 5 years (mean 10 months). RESULTS: In 2 children (0.7%) with recurrent reflux surgery was not performed by a resident. One of the 2 children had asymptomatic persistent reflux and no further surgery was done. In the other child postoperative cystography was normal at 6 months. One year later she had acute pyelonephritis with recurrent unilateral reflux and underwent repeat reimplantation. CONCLUSIONS: Routine cystography is not necessary after bilateral Cohen reimplantation. Reflux recurrence is low even at a training center where surgery may be performed by junior surgeons.

Child↗
PubMed1997

Versatility of the adult psoas hitch ureteral reimplantation.

PURPOSE: The psoas hitch ureteral reimplant has been described in the literature as an excellent method to restore ureterovesical continuity in patients with ureteral defects of various etiologies. However, long-term data on the durability of this procedure are lacking. We retrospectively reviewed patients who underwent ureteral reconstruction using the psoas hitch reimplantation to determine long-term efficacy. MATERIALS AND METHODS: Ureteral reimplantation in the adult is frequently performed in the setting of ureteral tissue loss secondary to resection or injury. The psoas hitch reimplantation is a simple, versatile technique that avoids the inclusion of intestinal segments and can be used in most patients requiring reimplantation. Indications for surgery and the long-term followup were examined in 20 patients undergoing reimplantation using the psoas hitch. RESULTS: The indications for ureteral reconstruction included surgical injury in 13 cases, recurrent pyelonephritis with reflux in 1, obstruction secondary to cancer in 2, trauma in 1, retroperitoneal fibrosis in 1 and ureteral stricture in 2. At followup of 1 to 14 years (mean 6) 17 patients have not required further intervention for urological problems and have retained normal renal function. In the 2 patients with cancer ileal conduit was performed later and in 1 flank pain persisted despite negative urological evaluation. CONCLUSIONS: Psoas hitch ureteral reimplantation can be used successfully for bridging various ureteral defects in difficult clinical situations. Adequate renal and bladder mobilization will allow reconstruction despite long ureteral defects.

Adolescent↗
PubMed1993

Direct (nontunneled) ureterocolonic reimplantation in association with continent reservoirs.

A total of 190 patients underwent continent urinary diversion using the Florida pouch. Direct mucosa-to-mucosa ureterocolonic reimplantation was used in 165 patients (326 ureters). Of the first 30 ureters in patients who underwent antireflux tunneled reimplantation obstruction occurred in 4 (13.3%). Obstruction developed directly in 16 of the ureters reimplanted (4.9%), and 3 of the 6 plicated and reimplanted megaureters (50%). Among the obstructed units 3 (13%) were treated unexpectedly by autonephrectomy, while the other 20 units (87%) were treated with percutaneous balloon dilation and internal stenting for 6 to 8 weeks. In the latter group 12 units (60%) recovered function, 3 (15%) had pyelonephritis requiring nephrectomy and 5 (25%) stabilized following a new reimplantation. Reflux was demonstrated in 23 units (7%). All units with reflux are being followed conservatively and renal deterioration has not been demonstrated. The incidence of ureteral obstruction with direct reimplantation is lower compared to a tunneled technique. This reimplantation procedure is technically simpler than others and is safe in adults when performed in association with a large volume, continent colonic reservoir.

Colon↗
PubMed2002

Inferior mesenteric artery reimplantation does not guarantee colon viability in aortic surgery.

Reimplantation of the inferior mesenteric artery (IMA) at the time of aortic surgery has been advocated to prevent colon ischemia in patients deemed to have inadequate perfusion of the left colon. The purpose of this study was to determine whether IMA reimplantation is globally protective against colon necrosis. We reviewed the medical records of all patients who were diagnosed with colon ischemia after aortic surgery during a 10-year period. Cases were indexed from the institution's operative database and from the vascular morbidity and mortality registry. Ten patients (eight men, two women; mean age 71 +/- 9 years) were identified during the study period. Five patients (50%) underwent successful IMA reimplantation for inadequate Doppler signals on the antimesenteric border of the sigmoid colon. Five other patients (50%) did not undergo IMA reimplantation because they were deemed to have adequate colon perfusion. Transmural colon necrosis occurred in 6 of the 10 study patients, 4 of whom had IMA reimplantation. Five of the six patients had intraoperative hypotension. Three of the four patients with colon ischemia presenting less than 24 hours after aortic revascularization survived (mortality 25%), but both patients with late colon ischemia died of multisystem organ failure (mortality 100%). Four patients developed mucosal ischemia and did not undergo colectomy. Only one of these had IMA reimplantation. Colon ischemia was detected more than 1 week postoperatively in three patients. All four patients were treated with supportive therapy and antibiotics, and all four survived to discharge after a mean length of stay of 14 +/- 10 days. These data show that IMA reimplantation does not ensure colon viability in aortic surgery. Transmural colon necrosis tends to present sooner than mucosal ischemia and may be attributable to nonanatomic variables such as intraoperative hypotension. Although transmural necrosis is a highly morbid complication after aortic surgery, timely colectomy may lead to survival in some patients.

Aged↗
PubMed2002

Ureteral reimplantation in infants and children: effect on bladder function.

PURPOSE: We investigate whether early ureteral reimplantation in infants damages the urodynamic behavior of the bladder compared to ureteral reimplantation after age 1 year. We also evaluate changes in bladder behavior after ureteral reimplantation. MATERIALS AND METHODS: We compared 2 groups of 25 children each who underwent ureteral reimplantation. Group 1 included children younger than 12 months at surgery, and group 2 children were between 1 and 10 years old. All patients had grade III or greater reflux in 1 or 2 ureters, or obstructed megaureters. All patients underwent a complete urodynamic study before and after surgery. We analyzed preoperative and postoperative differences in urodynamic studies in both groups concerning bladder instability, capacity and compliance. RESULTS: Our analysis of urodynamic data showed that bladder instability was reduced more in group 1 than group 2, although not statistically significant. Parameters for bladder capacity and compliance were comparable for both groups. No statistically significant difference was noted between the urodynamic results in both groups preoperatively and postoperatively. CONCLUSIONS: No difference in urodynamic parameters could be found between children younger than 12 months compared to those older who underwent ureteral reimplantation. The urodynamic data do not provide any contraindication to ureteral reimplantation performed in early infancy. Moreover, except for a minor reduction in bladder instability, ureteral reimplantation does not alter the urodynamic behavior of the bladder.

Age Factors↗
PubMed2001

Outcome analysis of cochlear implant reimplantation in children.

OBJECTIVES: We review our experience gained in performing cochlear reimplantation in 25 children who have had multichannel cochlear implant device failure at the Cochlear Implant Center of the Manhattan Eye, Ear and Throat Hospital and Lenox Hill Hospital (New York, NY), to assess the feasibility of cochlear reimplantation in children and the effect of reinsertion on audiological performance. STUDY DESIGN: We retrospectively analyzed the outcome of 27 consecutive multichannel cochlear implant reinsertions performed in 25 children at the Manhattan Eye, Ear and Throat Hospital and Lenox Hill Hospital. These reimplantations were performed between 1990 and 1999, with a minimum follow-up of 6 months for both surgical and audiological performance. METHODS: Charts were reviewed for patient factors, findings at the time of initial operation and repeat operation, and results of audiological testing both before and after reimplantation. RESULTS: Surgical complications of reimplantation included two intraoperative cerebral spinal fluid leaks and two late postoperative flap breakdowns with implant extrusions. For the most part, depth of electrode insertion was unchanged. Open-set speech recognition scores and speech perception abilities remained stable or improved compared with results before reimplantation. CONCLUSION: Our results confirm that cochlear implant reimplantation is technically feasible and allows for continued auditory development for the child who has a cochlear implant device failure.

Cerebrospinal Fluid↗
PubMed2002

Does cochlear reimplantation affect speech recognition?

Although cochlear implantation has been proven to be a very effective method of rehabilitation for post-lingually deaf adults and pre-lingually deaf children, as electronic devices, cochlear implants are occasionally subject to damage or breakdowns. In these cases, reimplantation would be necessary. The aim of this study was to find out whether or not there are any negative effects on speech abilities after reimplantation with the same type of multichannel digital implant in the same ear. Seven patients were provided with a digital multi-channel cochlear implant. One subject suffered manipulative damage to the implant, and in six subjects an implant failure was observed. All reimplantations were performed on the same ear as the initial implantation. with the same implant type. Parameters such as insertion depth and number of active channels were the same in all subjects before and after reimplantation. Immediately following the revision surgery, three patients attained the same level of hearing that they had with their original implants. Three months following reimplantation, five subjects achieved almost the same scores that they had before reimplantation. The results showed that cochlear implant patients undergoing re-implantation can anticipate achieving nearly the same level of speech recognition as they had with their original implant. Nevertheless, patients need to be aware of potential problems before undergoing reimplantation so that expectations are not too high.

Aged↗
PubMed2005

Salvage of suboptimal prostate seed implantation: Reimplantation of underdosed region of prostate base.

PURPOSE: To demonstrate how a suboptimal (125)I prostate implant can be salvaged by reimplantation. METHODS AND MATERIALS: A (125)I implant was preplanned to deliver 150 Gy to the prostate of a patient with early stage prostate cancer. A CT scan at 35 days postimplant indicated that V(100) and D(90) were 46% and 49 Gy, respectively. The cause was a systematic source placement error that left the base significantly underdosed. A reimplantation of the underdosed region was planned by superimposing a template grid onto the 35-day postimplant CT scan images and digitizing them into the treatment planning computer as if they were TRUS images. The reimplantation was carried out under fluoroscopy guidance so that the initial implant was visible. RESULTS: The reimplantation increased V(100) and D(90) to 98% and 201 Gy, respectively. The misplaced seeds resulted in a high dose to the apical region and urethra, which was further increased by the reimplantation. The patient experienced increased urinary morbidity, which was relieved by medication. CONCLUSION: It is feasible to salvage a suboptimal prostate seed implant by reimplanting the underdosed regions under fluoroscopy guidance based on a plan generated from the postimplant CT scan.

Adenocarcinoma↗
PubMed2004

125I reimplantation in patients with poor initial dosimetry after prostate brachytherapy.

PURPOSE: In this case report, we describe 7 patients with suboptimal dosimetry after (125)I prostate brachytherapy who underwent a second implant procedure to improve the dosimetric coverage of the prostate. METHODS AND MATERIALS: Seven patients underwent second (125)I implants for suboptimal dosimetry after their initial implant for prostate cancer. The pretreatment characteristics (clinical stage, Gleason score, initial prostate-specific antigen level, location of positive cores, International Prostate Symptom Score, potency, use of androgen suppression, initial implant planning characteristics) were noted. The "Day 30" CT-based dosimetry parameters after the first implant and "Day 0" CT-based dosimetry after the reimplant were recorded (volumes of prostate and rectum covered by 100% and 150% of the dose and dose covering 90% of the prostate volume). The toxicity of the second procedure, International Prostate Symptom Scores before and after reimplantation, the clinical course, and prostate-specific antigen outcomes after reimplant were examined. We described our reimplant planning and intraoperative procedure. RESULTS: In all 7 patients, we were able to achieve very favorable dosimetry after the second procedure. The acute toxicity of the reimplant procedure was reasonably low, and the short-term prostate-specific antigen outcome has been favorable. CONCLUSION: It is possible to add more seeds safely to the dosimetrically cool area after the initial brachytherapy procedure and achieve excellent postimplant dosimetry with acceptable acute toxicity. The ultimate benefits and long-term toxicity of reimplantation are unknown.

Aged↗
PubMed2006

Initial experience with laparoscopic transvesical ureteral reimplantation at the Children's Hospital of Philadelphia.

PURPOSE: Laparoscopic transvesical ureteral reimplantation with or without robotic assisted surgical devices is being developed as an alternative to open surgery. We review our experience with laparoscopic transvesical ureteral reimplantation. MATERIALS AND METHODS: A total of 32 patients underwent laparoscopic transvesical reimplantation by the same surgeon. Of the patients 5 had primary obstructing megaureters and 27 had vesicoureteral reflux. Transvesical laparoscopic cross-trigonal ureteral reimplantation was performed in patients with reflux, and a Glenn-Anderson reimplantation was used in patients with a primary obstructing megaureter. A pure laparoscopic approach using two 3 mm working ports and a 5 mm camera port was used. RESULTS: The operative success rates were 92.6% and 80% for vesicoureteral reflux and primary obstructing megaureter cases, respectively. Complications included a postoperative urinary leak in 4 patients (12.5%) and ureteral stricture at the neoureterovesical anastomosis in 2 (6.3%). All but 1 complication occurred in patients 2 years or younger with bladder capacity less than 130 cc. CONCLUSIONS: Laparoscopic intravesical reimplantation is in its infancy and appears to have higher complication rates in young patients with small bladder capacity.

Child↗
PubMed2003

Subureteral polydimethylsiloxane injection versus extravesical reimplantation for primary low grade vesicoureteral reflux in children: a comparative study.

PURPOSE: We compare the outcome of extravesical ureteral reimplantation to endoscopic polydimethylsiloxane (Macroplastique, Uroplasty, Inc., Minneapolis, Minnesota) subureteral injection for primary low grade vesicoureteral reflux in children. MATERIALS AND METHODS: Between 1997 and 2000, 180 patients underwent polydimethylsiloxane injection (74, 108 ureters) or extravesical ureteral reimplantation (106, 166 ureters) for low grade vesicoureteral reflux. Low grade reflux was defined as grades I to III. Outcome analysis included success rates, de novo hydronephrosis, voiding efficiency, urinary tract infections and complications. RESULTS: Mean patient age at surgery for the injection and surgery groups was 60 and 77 months, and mean followup was 12 and 15 months, respectively. Of the patients who underwent single injection 80.6% were cured of reflux at 3 months and 91.6% were cured at last followup. Success rate after reimplantation was 95.8% at 3 months which improved to 98.8% 1 year later. The success rate was significantly different between the injection and reimplantation groups at 3 and 12 months (p <0.01). Postoperative complications in the reimplantation group included transient urinary retention after bilateral surgery in 2 patients (3.3%), suprapubic fluid collections in 2 and wound seroma in 1. No complications occurred in the polydimethylsiloxane group. CONCLUSIONS: Extravesical ureteral reimplantation has near perfect success with a low but definite complication rate. Polydimethylsiloxane offers high success rates for reflux in an ambulatory setting with no short-term complications. Currently, endoscopic polydimethylsiloxane injection is our preferred mode of therapy for low grade vesicoureteral reflux in children when surgical correction is indicated.

Adolescent↗