Modified Leadbetter-Politano Ureteroneocystostomy: A Safer Procedure

Open surgical reimplantation of ureters is a highly successful procedure, with reported correction rates of 95 to 99 percent regardless of the severity of vesicoureteral reflux (VUR). Leadbetter-Politano ureteroneocysto- stomy is one of the most preffered technique for open ureteroneocystostomy. The authors report the modified Poli- tano-Leadbetter technique with extravesical mobilization and transection of the ureter at the level of ureterovesical junction and intravesical reimplantation.

Fifty-seven children with unilateral VUR, underwent modified Leadbetter-Politano ureteral reimplantation with extravesical mobilization and transection of the ureter at the level of ureterovesical junction and intravesical reimplantation. Indications for open reimplantation were, persistence of VUR after en- doscopic correction, breakthrough urinary infections, complications due to antibiotics, progressive renal scarring, and parental preference. Operations were done by two full-time pediatric surgeons. Operation time and hospital stay of the patients, reflux persistency, voiding dysfunction and complications were recorded.

No ipsilateral VUR was detected postoperatively. While mean operation time was 78.42 min (±7.36 min; range, 70-86 min) Mean duration of the hospital stay is 82.31 h (±9.48 h; range, 71-94 h) for classic Leadbet- ter-Politano procedure, mean operation time was 56.54 min (±8.24 min; range, 52-67 min) and mean duration of the hospital stay is 62.31 h (±8.35 h; range, 50-63 h) for modified technique. Postoperative gross hematuria was not seen in any patients. No voiding dysfunction and no late complications was encountered.

Modified Leadbetter-Politano technique is a good option to treat VUR with success rate up to 100% without any major complicatons such as viscus perforation and ureteral obstruction. It is a rather simple technique that require less operative time.