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The first 25 slides, exactly as they appear. The full deck has 70 content slides.
Paediatric Surgery
Surgical Treatment of Vesicoureteric Reflux
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
11 sections · 70 slides
Overview
- What this deck will teach you
The Problem
What reflux is and why it needs fixing
- First, the plumbing in plain terms
- Why a leaky valve endangers the kidney
- Two ways the valve fails: primary vs secondary
- The treatment ladder: surgery is the last rung
- The exact indication for an operation
- Ureteric re-implantation by the numbers
The Core Principle
Why a tunnel makes the valve work
- The single idea behind every re-implantation
- How long must the tunnel be
- General principles of any anti-reflux operation
- Tapering, stenting and drainage decisions
Open Surgery: The Approach
Still the commonest operation
- Why open surgery remains the workhorse
- Two broad families: intravesical vs extravesical
- Opening and exposing the bladder (intravesical)
- Mobilising the ureter: the critical first step
- Choosing among the three intravesical techniques
The Intravesical Operations
Politano-Leadbetter, Glenn-Anderson, Cohen
- The Politano-Leadbetter re-implant
- Politano-Leadbetter: the long vertical tunnel
- The Glenn-Anderson advancement
- Glenn-Anderson: advancement toward the bladder neck
- The Cohen cross-trigonal re-implant
- Cohen cross-trigonal: the popular default
- Why can a Cohen re-implant make future ureteroscopy difficult, and how is that solved?
The Extravesical Operation
Lich-Gregoir, without opening the bladder
- The Lich-Gregoir extravesical technique
- Lich-Gregoir: reshaping the valve from outside
- The catch: nerves and voiding after Lich-Gregoir
- The extravesical trade-off
Difficult Anatomy
Tapering and the psoas hitch
- Tapering a widely dilated ureter
- Ureteric tapering: making a fat ureter fit
- The psoas hitch
- The psoas hitch: a straight, kink-free ureter
Minimally Invasive Surgery
Keyhole and robotic re-implantation
- How minimally invasive re-implantation evolved
- Laparoscopic vs robotic: what each offers
- The honest downsides of going minimally invasive
- Vesicoscopic re-implant: first steps
- Vesicoscopic re-implant: completing it
- Vesicoscopic (intravesical) re-implantation
- Why vesicoscopic surgery is so demanding
- Laparoscopic Lich-Gregoir re-implant
- RALUR-EV: the robotic extravesical operation
Does It Work?
Outcomes across the techniques
- Open surgery: the benchmark to beat
- Reported success by surgical approach
- Minimally invasive intravesical results
- Minimally invasive extravesical results
- Head-to-head: minimally invasive versus open
What Changes the Odds
Factors affecting outcome
- Prior endoscopic injection and grade of VUR
- Bilateral robotic repair, age, and bladder function
- A child with VUR and untreated dysfunctional voiding is booked for re-implantation. What should happen first?
When Things Go Wrong
Complications and their management
- Persistent reflux on the operated side
- New reflux on the opposite side
- Obstruction of the re-implanted ureter
- Urinary leak and bowel injury
- A simplified VUR surgical pathway
- The essentials to remember
- References (1/4)
- References (2/4)
- References (3/4)
- References (4/4)
- Pediatric Surgery and Pediatric Urology