To report our experience with the laparoscopic pneumovesical approach for Politano-Leadbetter ureteric reimplantation and to compare the results to those obtained using a traditional open approach.

We retrospectively reviewed the medical records of 52 patients who underwent Politano-Leadbetter ureteral reimplantation between 2012 and 2017. The peri-operative parameters, postoperative outcomes, and complication rates of patients who underwent the open approach for the Politano-Leadbetter procedure and those who underwent the laparoscopic pneumovesical approach were compared.

During the study period, 52 ureteric reimplantation procedures were analyzed. Among these, 28 and 24 patients underwent surgery using the open and pneumovesical approaches, respectively. The mean operative time did not differ between the groups (143.64 min vs. 128.12 min, P = 0.092). However, the pneumovesical group had a shorter duration of hospital stay (5.08 days vs 7.43 days, P = 0.001) and required less morphine analgesic for pain than did the open group (7.7% vs 32.1%, P = 0.027). No significant differences in the success rates (94.9% vs 92.5%, P = 0.512) or procedure-related complications were noted between the pneumovesical and open techniques.

The pneumovesical laparoscopic approach has been reported to yield outcomes comparable with their open counterparts in terms of successful reflux resolution. After the first report of transvesicoscopic ureteral reimplantation using pneumovesicum by Yeung et al., several studies have been published; however, most have reported the results of the Cohen technique. To date, reports of transvesicoscopic Politano-Leadbetter ureteral reimplantation using pneumovesicum include those published by Soh et al. [1] and our institution [2]. The Cohen technique has the potential disadvantage of difficulty in retrograde catheterization of the superolaterally positioned ureteral orifice for radiographic studies, stent insertion, and ureterolithiasis management. Alternatively, the neo-orifice position is less restricted by the Politano-Leadbetter technique. In addition, the submucosal tunnel length can be increased by advancing the ureter orifice to create a new orifice in various physiological positions by incising rather than tunneling into the more distal epithelium and closing it over the ureter [1]. Nevertheless, transvesicoscopic Politano-Leadbetter ureteral reimplantation using pneumovesicum has not been adopted by many surgeons because of the difficulty in creating a neo-hiatus. We stated in our initial report that the Politano-Leadbetter technique using pneumovesicum is effective and easy to master. We previously reported that the mean operative time (125 min) showed a decreasing tendency in eight bilateral cases [2]. In this case series, the mean total operation time was 125.67 min (110.25 min for unilateral reimplantation, 141.00 min for bilateral reimplantation). This case series showed acceptable clinical results in terms of the resolution rate as compared to the open approach and other studies of laparoscopic ureteral reimplantation using pneumovesicum [1, 3].

The transvesicoscopic Politano-Leadbetter technique with pneumovesicum is safe and effective for ureteric reimplantation and comparable to the open approach. This may be a useful option for future treatment of vesicoureteral reflux, especially for overcoming the potential limitations of the Cohen technique.

S. Soh, Y. Kobori, T. Shin, K. Suzuki, T. Iwahata, Y. Sadaoka, et al. Transvesicoscopic ureteral reimplantation: Politano-Leadbetter versus Cohen technique Int J Urol: Off J Jpn Urol Assoc, 22 (2015), pp. 394-399
H. Choi, J.Y. Park, J.H. Bae Initial experiences of laparoscopic intravesical detrusorraphy using the Politano-Leadbetter technique J Pediatr Urol, 12 (2016), pp. 110.e1-110.e7
M.S. Ansari, P. Yadav, S. Arora, P. Singh, V. Sekhon Bilateral transvesicoscopic cross-trigonal ureteric reimplantation in children: surgical subtleties and a prospective summary Urology, 101 (2017), pp. 67-72