Lich-Gregoir vs. Cohen ureteral re-implantation surgery for bilateral vesicoureteral reflux: A propensity score analysis.

BACKGROUND

The Lich-Gregoir procedure for bilateral vesicoureteral reflux (VUR) is limited by the risk of urinary retention. Here, we investigated the efficacy of the Lich-Gregoir procedure compared to that of the Cohen procedure for bilateral VUR in children.

METHODS

We retrospectively evaluated children who underwent open ureteral re-implantation for bilateral VUR between 2010 and 2022. The patients' clinical characteristics and perioperative outcomes were compared after 1:1 propensity score matching (PSM).

RESULTS

A total of 137 patients were enrolled in this study, with 122 undergoing the Cohen procedure and 15 undergoing the Lich-Gregoir procedure. After PSM, there were 14 patients in each group. The operative time was shorter in the Lich-Gregoir group (121.0 vs. 157.0 min; p = 0.018), while the urethral Foley stay was longer in the Cohen group (6.0 vs. 4.0 days; p < 0.001). Only the Cohen group required ureteral catheter insertion (4.5 days) and had a higher rate of bladder spasms (85.7% vs. 0%; p < 0.001). The Cohen group experienced two postoperative complications, while the Lich-Gregoir group had one patient with temporary urinary retention. The hospitalization period was longer in the Cohen group (8.0 vs. 7.0 days; p < 0.001). There were no significant differences in postoperative hydronephrosis, postoperative urinary tract infection, and persistent VUR between the two groups.

CONCLUSIONS

The Lich-Gregoir procedure for bilateral VUR was safely and effectively performed in patients who met several criteria (e.g., toilet-trained patients, mild-to-moderate reflux, and normal bladder volume and function).