Laparoscopic bladder 'wrap' technique for repair of vesicoureteric reflux in a porcine model

Purpose: The aim of this study was to determine if vesicoureteric reflux (VUR) can be successfully corrected laparoscopically by a bladder 'wrap' technique in a pig model. Methods: In 15 female piglets (mean weight, 22.5 kg) bilateral VUR was created by an open technique (11 grade 3, 2 each of grades 2 and 4). Eight weeks later (range, 4 to 16 weeks) VUR was confirmed by fluoroscopic cystogram, and unilateral laparoscopic correction was performed. The contralateral ureter was used as a control. The bladder was emptied, and a 3F ureteric catheter was inserted on the repair side. Four 11- mm ports were inserted transperitoneally. The ureter was dissected to the ureterovesical junction (UVJ). Commencing at the UVJ, 2 (n = 9) or 3 (n = 6) black silk sutures were placed through the bladder muscle on either side of the ureter creating a bladder wrap around the distal 2 to 4 cm of ureter. At a mean of 16 weeks (range, 4 to 24 weeks) cystograms were repeated. The animals were killed the bladder and ureters underwent histopathology examination. Results: VUR was corrected in 12 animals (80%). There was persistence of VUR in 2 and ureteric obstruction in 1. The wrap was intact in all animals. Conclusions: Laparoscopic correction of VUR by the bladder wrap technique is successful in pigs. Long-term follow-up studies will determine if this will be a satisfactory alternative surgical treatment for correction of VUR in children.