■ A minimally invasive approach may be used both for transvesical and extravesical ureteral reimplantation. In both cases, postoperative pain and duration of recovery seem to be reduced compared to open approaches.

■ The extravesical approach offers a technically easier ureteral dissection and reimplantation and avoids the need for postoperative catheter drainage. However, the risk of temporary urinary retention after bilateral extravesical reimplants is well documented. While retention is uncommon, even a short course of intermittent straight catheterization would seem to defeat the goal of minimal morbidity, and so one might limit this extravesical approach to patients with unilateral reflux.

■ The transvesical approach avoids the risks of a transperitoneal approach and dissection at the bladder base, but is technically more challenging and currently utilizes postoperative catheter drainage. To date, this approach has also only been employed in unilateral cases.

■ The availability of injection therapy for reflux-an even less invasive approach-will limit the utilization of laparoscopic/percutaneous approaches, particularly because they are technically more challenging.

■ Laparoscopic/percutaneous approaches do not have the long track record of success seen with standard open techniques, and the morbidity of the open approach is relatively mild because it is an extraperitoneal operation with a relatively quick recovery. Nonetheless, the laparoscopic/percutaneous approaches offer some marginal advantage in postoperative morbidity compared with open techniques while holding out the promise of greater success than injection therapy.

0 0

Post a comment