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Paediatric Surgery

Surgical Treatment of Vesicoureteric Reflux

Built from Puri — Pediatric Surgery and Pediatric Urology

What’s inside

11 sections · 70 slides

  1. 01

    Overview

    • What this deck will teach you

    1 slide

  2. 02

    The Problem

    What reflux is and why it needs fixing

    • First, the plumbing in plain terms
    • Why a leaky valve endangers the kidney
    • Two ways the valve fails: primary vs secondary
    • The treatment ladder: surgery is the last rung
    • The exact indication for an operation
    • Ureteric re-implantation by the numbers

    6 slides

  3. 03

    The Core Principle

    Why a tunnel makes the valve work

    • The single idea behind every re-implantation
    • How long must the tunnel be
    • General principles of any anti-reflux operation
    • Tapering, stenting and drainage decisions

    4 slides

  4. 04

    Open Surgery: The Approach

    Still the commonest operation

    • Why open surgery remains the workhorse
    • Two broad families: intravesical vs extravesical
    • Opening and exposing the bladder (intravesical)
    • Mobilising the ureter: the critical first step
    • Choosing among the three intravesical techniques

    5 slides

  5. 05

    The Intravesical Operations

    Politano-Leadbetter, Glenn-Anderson, Cohen

    • The Politano-Leadbetter re-implant
    • Politano-Leadbetter: the long vertical tunnel
    • The Glenn-Anderson advancement
    • Glenn-Anderson: advancement toward the bladder neck
    • The Cohen cross-trigonal re-implant
    • Cohen cross-trigonal: the popular default
    • Why can a Cohen re-implant make future ureteroscopy difficult, and how is that solved?

    7 slides

  6. 06

    The Extravesical Operation

    Lich-Gregoir, without opening the bladder

    • The Lich-Gregoir extravesical technique
    • Lich-Gregoir: reshaping the valve from outside
    • The catch: nerves and voiding after Lich-Gregoir
    • The extravesical trade-off

    4 slides

  7. 07

    Difficult Anatomy

    Tapering and the psoas hitch

    • Tapering a widely dilated ureter
    • Ureteric tapering: making a fat ureter fit
    • The psoas hitch
    • The psoas hitch: a straight, kink-free ureter

    4 slides

  8. 08

    Minimally Invasive Surgery

    Keyhole and robotic re-implantation

    • How minimally invasive re-implantation evolved
    • Laparoscopic vs robotic: what each offers
    • The honest downsides of going minimally invasive
    • Vesicoscopic re-implant: first steps
    • Vesicoscopic re-implant: completing it
    • Vesicoscopic (intravesical) re-implantation
    • Why vesicoscopic surgery is so demanding
    • Laparoscopic Lich-Gregoir re-implant
    • RALUR-EV: the robotic extravesical operation

    9 slides

  9. 09

    Does It Work?

    Outcomes across the techniques

    • Open surgery: the benchmark to beat
    • Reported success by surgical approach
    • Minimally invasive intravesical results
    • Minimally invasive extravesical results
    • Head-to-head: minimally invasive versus open

    5 slides

  10. 10

    What Changes the Odds

    Factors affecting outcome

    • Prior endoscopic injection and grade of VUR
    • Bilateral robotic repair, age, and bladder function
    • A child with VUR and untreated dysfunctional voiding is booked for re-implantation. What should happen first?

    3 slides

  11. 11

    When Things Go Wrong

    Complications and their management

    • Persistent reflux on the operated side
    • New reflux on the opposite side
    • Obstruction of the re-implanted ureter
    • Urinary leak and bowel injury
    • A simplified VUR surgical pathway
    • The essentials to remember
    • References (1/4)
    • References (2/4)
    • References (3/4)
    • References (4/4)
    • Pediatric Surgery and Pediatric Urology

    11 slides