Vesicoureteral reflux (VUR) is a common pathological condition that may lead to renal scarring, and therefore, the treatment approach for VUR is focused on avoiding renal damage.Open ureteral reimplantation with a submucosal tunnel has long been the gold standard surgical treatment. However, minimally invasive surgical correction has been recently developed for VUR management.Of these, the transvesicoscopic cross-trigonal ureteral reimplantation (Cohen) technique with the bladder filled with CO2 was first introduced by Yeung et al. Many previous studies demonstrated that the current techniques are safe with low complication rates and excellent success rates (90-98%) 
The Politano-Leadbetter technique has the theoretical advantages of a long tunnel and retrograde catheterization through the normal ureteral orifice. The transvesicoscopic Cohen technique has been frequently described, whereas few reports have detailed the transvesicoscopic Politano-Leadbetter technique using pneumovesicum. We previously presented our initial experience with the transvesical laparoscopic technique for Politano-Leadbetter ureteric reimplantation using pneumovesicum. Here, we report our experience with the current technique for the treatment of VUR and compare our results with those from the traditional open approach.

We retrospectively reviewed the medical records of 52 patients who underwent Politano-Leadbetter ureteral reimplantation between 2012 and 2017. The perioperative 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 present laparoscopic Politano-Leadbetter procedure using pneumovesicum has several advantages over other procedures. First, the present pneumovesical laparoscopic procedure can overcome the disadvantage of making future retrograde endourological procedures practically difficult in the Cohen procedure. Second, the pneumovesical laparoscopic approach can minimize the risk of postoperative ileus or injury to adjacent organs compared with the transperitoneal laparoscopic approach. Third, the pneumovesical laparoscopic approach has the advantage of early postoperative recovery, a shorter catheterization period, and superior cosmesis than the open approach.

The transvesicoscopic Politano-Leadbetter technique with pneumovesicum is safe and effective for ureteric reimplantation and is comparable to the open approach.

Laparoscopy
Vesicoureteral reflux
Ureteral reimplantation