Propensity Score–Matched Comparison of Laparoscopic Transvesical Ureteral Reimplantation and Intravesical Open Ureterocystoneostomy for Primary Vesicoureteral Reflux: A Multicenter Study in Japan
Kazuyoshi Johnin, Jun Matsubayashi, Yasuhiro Koikawa, Tatsuo Konomoto, Yasuyuki Naitoh, Keiichi Ishii, Midori Ichino, Shuichi Tatarano, Shotaro Nakanishi, Yosuke Morizawa, Katsuya Aoki, Akihiro Kanematsu, Masayuki Takahashi, Shigehiro Soh, Souhei Kanda, Hideaki Okajima, Toshiharu Kihara, Yoshifumi Sugita, Hitomi Sasaki, Morihiro Nishi, Tadamasa Shibuya, Toshihiko Itesako, Shogo Adomi, Masanobu Shigeta, Koichi Suzuki, Kenichi Kobayashi, Tetsuya Yoshida, Susumu Kageyama, Akihiro KawauchiPurpose:
The aim of this study was to assess the real-world perioperative safety and reoperation risk of laparoscopic transvesical ureteral reimplantation (TVUR), using intravesical open ureterocystoneostomy as a reference procedure, in patients with primary vesicoureteral reflux (VUR).
Materials and Methods:
We retrospectively reviewed patients with primary VUR who underwent laparoscopic TVUR or intravesical open ureterocystoneostomy in Japan (2012-2022). Laparoscopic TVUR was defined as a laparoscopic intravesical (vesicoscopic) transvesical approach; robot-assisted intravesical procedures were excluded. Propensity score matching was performed using age, sex, height, weight, bilaterality, duplex ureter, ureterocele, and maximum VUR grade. The primary outcome was reoperation. Secondary outcomes included operative time, catheter removal, hospital stay, and complications.
Results:
Among 1330 patients (laparoscopic TVUR: n = 514; intravesical open ureterocystoneostomy: n = 816), 868 were matched (434 per group). Laparoscopic TVUR required longer operative time (median [interquartile range]: 262 [220-321] vs 182 [151-229] min;
Conclusions:
In this multicenter propensity score–matched cohort of patients with primary VUR, laparoscopic TVUR was associated with earlier catheter removal and shorter hospitalization but higher complication and reoperation rates than intravesical open ureterocystoneostomy, underscoring the importance of careful patient selection and meticulous technique.