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Inicio Actas Urológicas Españolas (English Edition) Vesicoureteral antireflux surgery with Lich–Gregoir technique without vesical ...
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Vol. 43. Issue 8.
Pages 439-444 (October 2019)
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Vol. 43. Issue 8.
Pages 439-444 (October 2019)
Original article
Vesicoureteral antireflux surgery with Lich–Gregoir technique without vesical drainage: Long-term results
Resultados a largo plazo de cirugía antirreflujo vesicoureteral con técnica de Lich-Gregoir sin drenaje vesical
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J.L. Fadil Iturralde
Corresponding author
jlfi68@yahoo.com.ar

Corresponding author.
, J. Marani, J.C. Contardi, H.J. Damiani
Servicio de Urología Pediátrica, Hospital Municipal de Niños Víctor J. Vilela, Rosario, Provincia de Santa Fe, Argentina
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Tables (3)
Table 1. Patients’ characteristics.
Table 2. Surgical indication of the studied population.
Table 3. Reflux grade of the studied population.
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Abstract
Objective

To describe our long-term experience with patients with vesicoureteral reflux (VUR) who underwent conventional surgery without postoperative bladder drainage.

Material and methods

Retrospective review of 45 patients surgically treated by extravesical Lich–Gregoir's ureterovesical reimplantation without postoperative bladder drainage between 2010 and 2013.

Results

37 women (82.2%) and 8 men (17.8%). 28 patients with unilateral reflux, and 17 patients with bilateral reflux with a total of 62 operated kidneys. The mean age at surgery was 6 years (2–11 years).

The main cause of surgical indication was the persistence of reflux in patients older than 6 years (73.3%); with grade III VUR (75.6%) being the most frequent. The mean surgical time was 44min (35–70) for unilateral reimplantation, and 70min (53–98) for bilateral ones.

All patients presented spontaneous urination in the immediate postoperative period, without pain, no hematuria, full incontinence, and without a bladder balloon. None required bladder catheter placement, and hospital discharge was indicated between 7 and 36h postoperatively (mean 11h).

All continued with spontaneous micturitions, without postvoid residual or voiding dysfunction during the 5-year follow-up.

Conclusion

The thorough selection of the patients, the detailed surgical gestures, the bladder emptying without instrumentation of the urethra, together with a correct use of analgesics and early ambulation allowed excellent outcomes obtained in these patients managed with a short hospital stay and without bladder drainage, also demonstrating the safety of the procedure at 5 years of follow-up.

Keywords:
Vesicoureteral reflux
Ureteral reimplantation
Lich–Gregoir
Ambulatory
Bladder catheter
Resumen
Objetivo

Describir nuestra experiencia a largo plazo de pacientes portadores de reflujo vesicoureteral (RVU) operados a cielo abierto sin drenaje vesical postoperatorio.

Material y método

Revisión retrospectiva de 45 pacientes intervenidos quirúrgicamente durante el periodo 2010-2013, a quienes se les realizó reimplante ureterovesical extraperitoneal tipo Lich-Gregoir por vía convencional, sin drenaje vesical durante el postoperatorio.

Resultados

Treinta y siete mujeres (82,2%) y 8 varones (17,8%), con 62 unidades renales operadas. Veintiocho pacientes con reflujo unilateral y 17 pacientes con reflujo bilateral. La edad media en el momento de la cirugía fue de 6 años (2 a 11 años).

La principal causa de indicación quirúrgica fue la persistencia del reflujo en paciente mayor a 6 años (73,3%), siendo el RVU grado iii (75,6%) el más frecuente. El tiempo quirúrgico medio fue de 44 min (35-70) para los reimplantes unilaterales y de 70 min (53-98) para los bilaterales.

Todos los pacientes presentaron micciones espontáneas en el postoperatorio inmediato, sin dolor, sin hematuria, sin incontinencia y sin globo vesical. Ninguno requirió colocación de sonda vesical y se indicó alta hospitalaria entre las 7 y 36 h del postoperatorio (media 11h).

Todos continuaron con micciones espontáneas, sin residuo posmiccional ni disfunción miccional en los 5 años de seguimiento.

Conclusión

La selección minuciosa de los pacientes, lo detallista de los gestos quirúrgicos, el vaciado vesical sin instrumentación de la uretra, sumado a un correcto uso de analgésicos y a la deambulación temprana, permitieron obtener excelentes resultados en estos pacientes manejados con una corta estancia hospitalaria y sin drenaje vesical, demostrando además la seguridad del procedimiento a 5 años de seguimiento.

Palabras clave:
Reflujo vesicoureteral
Reimplante ureteral
Lich-Gregoir
Ambulatorio
Sonda vesical

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