Laparoscopic transuretheroureterostomy in children: multicenter study results

Introduction. Transureteroureteroanastomosis (TUUA) is rarely used in pediatric urology. The literature describes isolated cases of performing TUUA with laparoscopic access. The objective of this study is to present a multicenter experience of laparoscopic TUUA. Material and methods. A retrospective study included 11 patients (7 boys and 4 girls). The age of children ranged from 9 months to 11 years (median 72 months. All patients underwent laparoscopic TUUA in the period from 2013 to 2019. In 8 (72.7%) patients, TUUA was used in the presence of obstructive megaureter or vesicoureteral reflux after ureteral reimplantation. In 3 (27.3%) cases, the indication for TUUA was the presence of a neurogenic bladder with a capacity reduction, resistant to anticholinergic drugs and botulinum toxin, and complicated by a megaureter with significant dilation of the distal ureter. Implementation of TUUA allowed to use the dilated distal part of the ureter to ureterocystoplasty. In all patients, the donor ureter was dilated during TUUA. The recipient ureter had a normal diameter in 4 (36.4%) cases, 7 (63.6%) children had its dilatation. Results. All surgical interventions were performed with laparoscopic access, without conversions, the mean operating time was 165.4±28.9 minutes for isolated TUUA and 326±41.0 minutes for simultaneous TUUA and ureterocystoaugmentation. There were no intraoperative complications, and blood loss was insignificant in all cases. Postoperative course was uneventful except for a transient urinary leak during 8 days in 1 (9.1%) patient, which stopped spontaneously. Median follow-up was 12.4 months. There were no late postoperative complications, all patients had a decrease of hydronephrosis, children with neurogenic bladder after ureterocystoplasty had sufficient capacity without hyperactivity. Conclusion. Laparoscopic TUUA is a safe and effective method of surgical treatment that can be used in pediatric urology.