Extravesical ureteral reimplantation [Lich-Gregoir] and our experience at King Hussein medical center

ABSTRACT

Various techniques of ureteral reimplantation have been described for the correction of vesicoureteral reflux. We report our experience regarding the efficacu of Lich-Gregoir method in the treatment of vesicoureteral reflux. During the period September 1999 - May 2002, 14 patients [6 males and 8 females] were treated by the Lich-Gregoir method for the treatment of vesicoureteral reflux. The procedure consisted of suprahiatal detrusor myotomy and exposure of the bladder mucosa followed by placing the ureter over bladder mucosa and detrusor muscle was closed over it using 4/0 polyglycolic acid suture. This procedure was initially successful in all patients. However, one of our patients who had bilateral grade IV reflux continued to have mild degree of reflux in the left side, which was treated conservatively for one year with improvement. Thus the success rate was 93% after surgery and the one-year success rate was 100%. Urinary retention developed in one child and successful recovery after conservative management with urethral catheter drainage for 5 days. Hopitalization after surgery ranged from 1-3 days. The Lich-Gregoir method of extravesical ureteral reimplantation is successful, simple to perform, reproducible and associated with low morbidity. It also requires minimal hospital stay. These results should encourage the use of this technique when indicated to correct vesicoureteral reflux in children