Propensity Score–Matched Comparison of Laparoscopic Transvesical Ureteral Reimplantation and Intravesical Open Ureterocystoneostomy for Primary Vesicoureteral Reflux: A Multicenter Study in Japan
Year: 2026
Type: article
Study design: Observational Study
Abstract: Purpose: 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; P < .001) but was associated with earlier catheter removal (3 [2-5] vs 6 [3-7] days; P < .001) and shorter hospitalization (5 [3-7] vs 7 [5-9] days; P < .001). Intraoperative and postoperative complications were more frequent with laparoscopic TVUR (4.4% vs 0.5% and 12.4% vs 4.1%, respectively; P < .001). Urinary peritonitis occurred only after laparoscopic TVUR. Reoperation was more common in this group (2.8% vs 0.7%; hazard ratio: 3.74, 95% confidence interval: 1.05-13.24; P = .041). 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.
Source: JU Open Plus
Authors: 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 Kawauchi
Institutions: Shiga University of Medical Science, Fukuoka Children's Hospital and Medical Center for Infectious Diseases, Kyoto Prefectural University of Medicine, Osaka City General Hospital, Nagano Children's Hospital, Kagoshima University, University of the Ryukyus, Nara Medical University, Hyogo Medical University, Tokushima University, Dokkyo Medical University Saitama Medical Center, Saitama Medical University, Akita Red Cross Hospital, Kanazawa Medical University, Nagasaki University, Kobe Children's Hospital, Fujita Health University, Kanagawa Children's Medical Center, Oita University, Kindai University, National Hospital Organization, Kure Medical Center, Maebashi Red Cross Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7224239140