Vesicoscopy In Children: A Potential Gold Standard Procedure With Good Outcome

Aim We report our experience on the use of vesicoscopy in children for treating Vesicoureteral Reflux (VUR), Refluxing Megaureter (RM) and Primary Symptomatic Bladder Diverticula (BD). Material and Methods 63 patients aged 3 to 12 years have been operated at our Institution from January 2007 to December 2015. There were 45 VUR , 3rd to 5th degree, 2 refluxing megaureter, 16 Primary Bladder Diverticula. All the procedures have been performed with three-trocar technique. Under cystoscopic control, a first midline 5-mm trocar was introduced for a 0° telescope at the dome of the bladder, and 2 left and right 3- or 5-mm trocars were inserted through the anterolateral wall. The refluxing ureter have been treated with Cohen’s technique while Megaureter were tailored before the reimplantation. Primary bladder diverticula were excised by endovesical technique inverting the sac in the bladder en bloc or progressively. The detrusor was sutured in one of two layers. Results Mean operative time ranged from 80 to 240 min. (mean 150 min.) in cases of Ureteral Cohen’s reimplantation and 120-220 min. in Refluxing Megaureters respectively; In BD operative time ranged from 50 to140 min, (mean time 90 min). No major perioperative complication (hemorrage, urinoma) occurred nor conversion to open surgery was necessary. Operative complications have been: • 1 fracture of the needle for suspension of the bladder removed with the aid of the image intensifier; • 9 displacementof the trocars which resulted in the leakage of gas in the perivesicalspace compromising the space and the intravesical endoscopic vision. In this case the trocars were replaced or relocatedin a more lateral position. • 3 subcutaneous emphysemas • Two VUR recurred and were treated the first with endoscopic injection while the other resolved with antibiotic prophilaxis. No recurrence occurred in the two girls with RM. One diverticiculum recurred at VCUG control in acase of bilateral huge congenital diverticula Conclusion Our experience seems to confirm that vesicoscopy can be performed safely and effectively in children.