Comparison of Open and Pneumovesical Cohen Approach for Treatment of Primary Vesicoureteral Junction Obstruction in Children.

Background

In this article, we report our experience on laparoscopic pneumovesical Cohen approach for vesicoureteral junction (VUJ) stricture in children and compared it with traditional open Cohen approach. Patients and

Methods

Ninety-eight children (114 ureters) with VUJ stricture were involved in this study who were treated from January 2008 to December 2017. Forty-eight patients (56 ureters) treated with open Cohen approach from January 2008 to December 2011 were marked as Group 1 and 50 patients (58 ureters) treated with laparoscopic pneumovesical Cohen approach from January 2012 to December 2017 were marked as Group 2. The preoperative data, operative details, and follow-up outcomes were studied and compared between two groups to discuss the advantages of the laparoscopic pneumovesical approach. Statistical comparison was made with unpaired t-tests, χ2 tests, and Fisher exact probabilities, with P value <.05 was considered significant.

Results

To bring less related effect during comparison, patients with similar preoperative data were selected. The time of operation of Group 2 was longer than that of Group 1, and the operation of Group 2 was completed with the laparoscopic pneumovesical approach in all but 1 patient (1 ureter), which was converted to open surgery. However, the postoperative gross hematuria duration, antibiotics consumption, retention time of urinary catheter, and hospital stay after surgery were shorter in Group 2 with less intraoperative blood loss, less postoperative complications, and less drainage catheter. All patients were followed up by ultrasonography, excretory retrograde urography, and magnetic resonance urogram for 3-24 months (mean 15.6 months) and the recovery and improvement were better in Group 2.

Conclusions

Compared with open surgery, the laparoscopic pneumovesical approach has many benefits and was effective for the treatment of obstructive megaureter in children.