MODIFIED LICH-GREGOIR URETERAL REIMPLANTATION - EXPERIENCE OF A CANADIAN CENTER

Purpose: Various techniques of ureteral reimplantation have been descr ibed for correction of vesicoureteral reflux. We report our experience regarding the safety and efficacy of a modified Lich-Gregoir extraves ical approach. Material and Methods: From January 1991 to January 1996 we evaluated prospectively 256 patients who underwent a modified Lich -Gregoir procedure for correction of vesicoureteral reflux. A total of 385 vesicoureteral units were reimplanted, including 41 duplex system s. The modification to the Lich-Gregoir technique we used consists of ending the paraureteral myotomy with an inverted Y, which permits easi er detrusor muscle reapproximation. Results: This procedure was succes sful initially in 214 of 237 patients, as confirmed by a normal voidin g cystourethrogram 4 to 6 months postoperatively. Of the 237 cases per sistent vesicoureteral reflux developed in 13 patients, which resolved spontaneously in 9 after 1 year, contralateral reflux developed in 8, which was treated conservatively, and ureteral obstruction developed in 2. Thus, the 1-year overall success rate was 96%. Urinary retention developed in 12 children with bilateral reimplantation (8.3%) with su ccessful recovery in all after conservative management with urethral c atheter drainage of 1 week or less. The duration of hospitalization af ter surgery ranged from 1 to 3 days. Conclusions: The modified Lich-Gr egoir technique 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 t he use of this technique when indicated to correct vesicoureteral refl ux in children.