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Arlen D Hanssen - One of the best experts on this subject based on the ideXlab platform.
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diagnosis and management of prosthetic joint infection clinical practice guidelines by the infectious diseases society of america
Clinical Infectious Diseases, 2013Co-Authors: Douglas R Osmon, Arlen D Hanssen, Anthony R Berendt, Elie F Berbari, Werner Zimmerli, James M Steckelberg, Walter R WilsonAbstract:Abstract These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged Reimplantation, 1-stage Reimplantation, and amputation.
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executive summary diagnosis and management of prosthetic joint infection clinical practice guidelines by the infectious diseases society of america
Clinical Infectious Diseases, 2013Co-Authors: Douglas R Osmon, Arlen D Hanssen, Anthony R Berendt, Elie F Berbari, Werner Zimmerli, James M Steckelberg, Walter R WilsonAbstract:Abstract These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged Reimplantation, 1-stage Reimplantation, and amputation.
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reinfection after two stage revision for periprosthetic infection of total knee arthroplasty
International Orthopaedics, 2012Co-Authors: Bernd Kubista, Douglas R Osmon, Arlen D Hanssen, Robert U Hartzler, Christina M Wood, David G LewallenAbstract:Purpose Limited data exist regarding the long-term results or risk factors for failure after two-stage Reimplantation for periprosthetic knee infection. The purpose of this retrospective review was to investigate infection-free implant survival and identify variables associated with reinfection after this procedure. Furthermore, a staging system was evaluated as a possible prognostic tool for patients undergoing two-stage Reimplantation of infected total knee arthroplasty (TKA).
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two stage Reimplantation for periprosthetic knee infection involving resistant organisms
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Yogesh Mittal, Arlen D Hanssen, Thomas K Fehring, Camelia Marculescu, Susan M Odum, Douglas R OsmonAbstract:Background: Two-stage Reimplantation is the most accepted mode of treatment for patients with a periprosthetic infection following total knee arthroplasty. Most studies, however, do not stratify their results on the basis of the type of infecting organism. The purpose of this study was to determine the outcomes for patients who had two-stage Reimplantation for the treatment of infection with a resistant organism, methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis, at the site of a total knee replacement. Methods: A multicenter study was performed to review the cases of all patients treated between 1987 and 2003 because of an infection with methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis organisms at the site of a total knee replacement. The prevalence of reinfection following two-stage Reimplantation was determined. Variables that may influence the outcome, such as the duration and type of intravenous antibiotics administered, previous surgery, and comorbidities of the host, were analyzed. Results: We identified thirty-seven patients who had an infection with a resistant organism. All patients had negative cultures at the time of Reimplantation. Four of the thirty-seven patients had a reinfection with the same organism, while five had a reinfection with a different organism. None of the variables noted above were found to be significantly associated with reinfection, on the basis of the numbers available. Conclusions: Reports in the literature have discouraged Reimplantation for the treatment of an infection with a resistant organism at the site of a total knee replacement. While 24% of the patients in this series had a reinfection, 14% had a reinfection with a different organism. We believe that two-stage Reimplantation remains a viable treatment option for patients who have an infection with a resistant organism at the site of a total knee replacement. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
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mid term to long term followup of two stage Reimplantation for infected total knee arthroplasty
Clinical Orthopaedics and Related Research, 2004Co-Authors: Abdul A Haleem, Daniel J Berry, Arlen D HanssenAbstract:Between January 1989 and December 1994, 94 patients (96 knees) had a two-stage Reimplantation for treatment of an infected total knee arthroplasty. All patients were treated with an interval antibiotic-loaded static cement spacer and had antibiotic-loaded bone cement for prosthesis fixation at the time of Reimplantation. The purpose of this study was to assess the long-term risk of reinfection and the mechanical durability of these Reimplantation arthroplasties. Patients were followed up for a median of 7.2 years (range, 2.5-13.2 years). At final followup, 15 knees (16%) had required reoperation. Nine knees (9%) had component removal for reinfection and six knees (6%) were revised for aseptic loosening. The median time to reoperation for reinfection was 1 year (range, 0.1-9.8 years). The risk of recurrent infection was not correlated with the type of organism, patient demographics, or method of prosthesis fixation at Reimplantation. The survivorship free of implant removal for any reason was 90% (confidence intervals, 83.9-96.4%) at 5 years and 77.3% (confidence intervals, 65.5-89.6%) at 10 years. The survivorship free of implant removal for reinfection was 93.5% (confidence intervals, 88.5-98.7%) at 5 years and 85% (confidence intervals, 73.8-96.3%) at 10 years. Survival free of revision for mechanical failure (aseptic loosening or radiographic loosening) was 96.2% (confidence intervals, 92-100%) at 5 years and 91% (confidence intervals, 80.8-98.3%) at 10 years. These results suggest that the high likelihood of early success after two-stage Reimplantation of an infected TKA is well maintained throughout long-term followup, with a modest rate of late recurrent infection or mechanical implant failure.
Javad Parvizi - One of the best experts on this subject based on the ideXlab platform.
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positive cultures during Reimplantation increase the risk of subsequent failure in two stage exchange arthroplasty
Orthopaedic Proceedings, 2018Co-Authors: Jorge Manrique, Miguel M Gomez, Antonia F Chen, Javad ParviziAbstract:It is strongly recommended that tissue and synovial fluid culture samples be obtained during Reimplantation performed as part of a two-stage exchange arthroplasty. The incidence of positive cultures during Reimplantation and the influence of positive cultures on subsequent outcome are unknown. This aim of this study was to determine the incidence of positive cultures during Reimplantation and to investigate the association between positive cultures at Reimplantation and the subsequent outcomeA retrospective review was conducted on 267 patients that met the Musculoskeletal Infection Society (MSIS) criteria for PJI that completed both stages of two-stage exchange arthroplasty (Table 1). Intraoperative culture results from tissue and/or synovial fluid were obtained. Cultures were positive in 33 cases (12.4%) undergoing Reimplantation surgery (Figure 1). Treatment failure was assessed based on the Delphi consensus definition. Logistic regression analysis was performed to assess the predictors of positive cult...
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utility of synovial white blood cell count and differential before Reimplantation surgery
Journal of Arthroplasty, 2017Co-Authors: Benjamin Zmistowski, Elie Ghanem, Corey T Clyde, James R Gotoff, Carl Deirmengian, Javad ParviziAbstract:Abstract Background Determining optimal timing of Reimplantation during 2-stage exchange for periprosthetic joint infection (PJI) remains elusive. Joint aspiration for synovial white blood cell (WBC) count and neutrophil percentage (PMN%) before Reimplantation is widely performed; yet, the implications are rarely understood. Therefore, this study investigates (1) the diagnostic yield of synovial WBC count and differential analysis and (2) the calculated thresholds for persistent infection. Methods Institutional PJI databases identified 129 patients undergoing 2-stage exchange arthroplasty who had joint aspiration before Reimplantation between February 2005 and May 2014. Persistent infection was defined as a positive aspirate culture, positive intraoperative cultures, or persistent symptoms of PJI—including subsequent PJI-related surgery. Receiver-operating characteristic curve was used to calculate thresholds maximizing sensitivity and specificity. Results Thirty-three cases (33 of 129; 25.6%) were classified with persistent PJI. Compared with infection-free patients, these patients had significantly elevated PMN% (62.2% vs 48.9%; P = .03) and WBC count (1804 vs 954 cells/μL; P = .04). The receiver-operating characteristic curve provided thresholds of 62% and 640 cells/μL for synovial PMN% and WBC count, respectively. These thresholds provided sensitivity of 63% and 54.5% and specificity of 62% and 60.0%, respectively. The risk of persistent PJI for patients with PMN% >90% was 46.7% (7 of 15). Conclusion Synovial fluid analysis before Reimplantation has unclear utility. Although statistically significant elevations in synovial WBC count and PMN% are observed for patients with persistent PJI, this did not translate into useful thresholds with clinical importance. However, with little other guidance regarding the timing of Reimplantation, severely elevated WBC count and differential analysis may be of use.
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leukocyte esterase strip test can predict subsequent failure following Reimplantation in patients with periprosthetic joint infection
Journal of Arthroplasty, 2017Co-Authors: Michael M Kheir, Colin T Ackerman, Timothy L Tan, Andrea Benazzo, Eric H Tischler, Javad ParviziAbstract:Abstract Background Leukocyte esterase (LE) strip test is an accurate marker for diagnosing periprosthetic joint infection (PJI). This study aims to determine if LE is a good predictor of persistent infection and/or subsequent failure in patients undergoing Reimplantation. Methods This single-institution study prospectively recruited and retrospectively analyzed 109 patients who underwent two-stage exchange treatment of PJI, from 2009-2016, and had an LE test performed at time of Reimplantation. LE results of "2+" were considered positive. Ninety-five patients had 90-day minimum follow-up to assess treatment failure, defined by Delphi criteria. Eighteen patients were excluded due to blood contamination of LE test, resulting in a final cohort of 77 patients (mean follow-up 1.76 years). Results Of the final cohort, 19 patients (24.7%) experienced subsequent failure. At Reimplantation, LE test was positive in 22.2% of culture-positive and 4.4% of culture-negative cases. The LE test was negative in all patients who had not failed at latest follow-up, yielding sensitivity, specificity, positive predictive value, negative predictive value, and AUC of 26.3%, 100%, 100%, 87.5%, and 0.632, respectively; in comparison, MSIS criteria respectively yielded 25.0%, 87.3%, 27.6%, 85.8%, and 0.562 ( P = .01 for specificity). Kaplan-Meier curves revealed higher failure rate in patients who had a positive LE test at time of Reimplantation ( P Conclusion There is a dire need for an accurate diagnostic test to determine optimal timing of Reimplantation in patients undergoing surgical treatment for PJI. The current study suggests that a positive LE test may be indicative of persistence of infection and results in a higher rate of subsequent failure.
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positive culture during Reimplantation increases the risk of subsequent failure in two stage exchange arthroplasty
Journal of Bone and Joint Surgery American Volume, 2016Co-Authors: Miguel M Gomez, Jorge Manrique, Javad Parvizi, Antonia F ChenAbstract:Background: It is strongly recommended that tissue and synovial fluid culture samples be obtained during Reimplantation performed as part of a 2-stage exchange arthroplasty. The rate of positive cultures during Reimplantation and the influence of positive cultures on subsequent outcomes, to our knowledge, are unknown. This study was designed to determine the rate of positive cultures during Reimplantation and to investigate the association between positive cultures at Reimplantation and subsequent outcomes. Methods: We retrospectively reviewed the data of 259 patients who met the Musculoskeletal Infection Society criteria for periprosthetic joint infection (PJI) and who underwent both stages of 2-stage exchange arthroplasty at our institution from 1999 to 2013. Among these patients were 267 PJIs (186 knees and 81 hips); 33 (12.4%) had ≥1 positive culture result at Reimplantation. Treatment failure was assessed according to the Delphi-based consensus definition. Logistic regression analysis was performed to assess the predictors of positive culture and risk factors for failure of 2-stage exchange arthroplasty. Results: Of the 33 cases with PJI, 15 (45.5%) had a subsequent failure of the 2-stage exchange arthroplasty compared with 49 (20.9%) of the cases that were culture-negative at Reimplantation. When controlling for other variables using multivariate analyses, the risk of treatment failure was higher (odds ratio = 2.53; 95% confidence interval [CI] = 1.13 to 5.64) and reinfection occurred earlier (hazard ratio = 2.00; 95% CI = 1.05 to 3.82) for the cases with a positive culture during Reimplantation. The treatment failure rate did not differ (p = 0.73) between cases with ≥2 positive cultures (36.4%) and 1 positive culture (50%). Conclusions: Positive intraoperative culture at the time of Reimplantation, regardless of the number of positive samples, was independently associated with >2 times the risk of subsequent treatment failure and earlier reinfection. Surgeons should be aware that a positive culture at the time of Reimplantation independently increases the risk of subsequent failure. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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positive cultures during Reimplantation increase the risk of subsequent failure in two stage exchange arthroplasty
Journal of Bone and Joint Surgery-british Volume, 2015Co-Authors: Jorge Manrique, Miguel M Gomez, Antonia F Chen, Javad ParviziAbstract:It is strongly recommended that tissue and synovial fluid culture samples be obtained during Reimplantation performed as part of a two-stage exchange arthroplasty. The incidence of positive cultures during Reimplantation and the influence of positive cultures on subsequent outcome are unknown. This aim of this study was to determine the incidence of positive cultures during Reimplantation and to investigate the association between positive cultures at Reimplantation and the subsequent outcome A retrospective review was conducted on 267 patients that met the Musculoskeletal Infection Society (MSIS) criteria for PJI that completed both stages of two-stage exchange arthroplasty (Table 1). Intraoperative culture results from tissue and/or synovial fluid were obtained. Cultures were positive in 33 cases (12.4%) undergoing Reimplantation surgery (Figure 1). Treatment failure was assessed based on the Delphi consensus definition. Logistic regression analysis was performed to assess the predictors of positive culture and risk factors for failure of two-stage exchange arthroplasty. Treatment failure was 45.5% for those with a positive intraoperative culture and 20.9% in those with negative cultures at the time of Reimplantation. When controlling for organism virulence, comorbidities, and other confounding factors, treatment failure was higher (odds ratio [OR]: 3.3; 95% confidence interval [CI]: 1.3–4.5) and occurred at an earlier time point (hazard ratio: 2.5; 95% CI: 1.3–4.5) in patients with a positive Reimplantation culture. The treatment failure rate was not different between cases with two or more positive cultures (36.4%) and one positive culture (42.8%). Positive intraoperative cultures during Reimplantation, regardless of the number of positive samples were independently associated with two times the risk of subsequent infection and earlier treatment failure. Surgeons should be aware that a positive culture at the time of Reimplantation independently increases the risk of subsequent failure and needs to be taken seriously. Given the significance of these findings, future studies are needed to evaluate the optimal management of positive cultures during Reimplantation surgery.
Eugene H Blackstone - One of the best experts on this subject based on the ideXlab platform.
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aortic root replacement with bicuspid valve Reimplantation are outcomes and valve durability comparable to those of tricuspid valve Reimplantation
The Journal of Thoracic and Cardiovascular Surgery, 2020Co-Authors: Suyog A Mokashi, Brad F Rosinski, Milind Y Desai, Brian P Griffin, Donald Hammer, Vidyasagar Kalahasti, Douglas R Johnston, Jeevanantham Rajeswaran, Eric E Roselli, Eugene H BlackstoneAbstract:Abstract Objectives To assess intermediate-term outcomes of aortic root replacement with valve-sparing Reimplantation of bicuspid aortic valves (BAV), compared to tricuspid aortic valves (TAV). Methods From January 2002 to July 2017, 92 adults underwent aortic root replacement with BAV Reimplantation and 515 with TAV Reimplantation at Cleveland Clinic. Balancing-score matching based on 28 preoperative variables yielded 71 well-matched BAV and TAV pairs (77% of possible pairs) for comparison of postoperative mortality and morbidity, longitudinal echo data, aortic valve reoperation, and survival. Results In the BAV group, 1 hospital death occurred (1.1%); mortality among all Reimplantations was 0.2%. Among matched patients, procedural morbidity was low and similar between BAV and TAV groups (1 stroke in TAV group; renal failure requiring dialysis, 1 patient each; red cell transfusion, 25% each). Five-year results: Severe aortic regurgitation was present in 7.4% of the BAV group and 2.9% of the TAV group (P=.7); 39% of BAV and 65% of TAV patients had none. Higher mean gradients (10 vs. 7.4 mmHg, P=.001) and left ventricular mass index (111 vs. 101 g/m2, P=.5) were present in BAV patients. Freedom from aortic valve reoperation was 94% in the BAV group and 98% in the TAV group (P=.10), and survival was 100% and 95%, respectively (P=.07). Conclusions Both BAV and TAV Reimplantations can be performed with equal safety and good mid-term outcomes; however, the constellation of higher gradients, less ventricular reverse remodeling, and more aortic valve reoperations with BAV Reimplantations raises concerns requiring continued long-term surveillance.
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aortic root replacement with bicuspid valve Reimplantation are outcomes and valve durability comparable to those of tricuspid valve Reimplantation
The Journal of Thoracic and Cardiovascular Surgery, 2020Co-Authors: Suyog A Mokashi, Brad F Rosinski, Milind Y Desai, Brian P Griffin, Donald Hammer, Vidyasagar Kalahasti, Douglas R Johnston, Jeevanantham Rajeswaran, Eric E Roselli, Eugene H BlackstoneAbstract:Abstract Objectives To assess intermediate-term outcomes of aortic root replacement with valve-sparing Reimplantation of bicuspid aortic valves (BAV), compared with tricuspid aortic valves (TAV). Methods From January 2002 to July 2017, 92 adults underwent aortic root replacement with BAV Reimplantation and 515 with TAV Reimplantation at the Cleveland Clinic. Balancing-score matching based on 28 preoperative variables yielded 71 well-matched BAV and TAV pairs (77% of possible pairs) for comparison of postoperative mortality and morbidity, longitudinal echocardiogram data, aortic valve reoperation, and survival. Results In the BAV group, 1 hospital death occurred (1.1%); mortality among all Reimplantations was 0.2%. Among matched patients, procedural morbidity was low and similar between BAV and TAV groups (1 stroke in TAV group; renal failure requiring dialysis, 1 patient each; red cell transfusion, 25% each). Five-year results: Severe aortic regurgitation was present in 7.4% of the BAV group and 2.9% of the TAV group (P = .7); 39% of BAV and 65% of TAV patients had none. Higher mean gradients (10 vs 7.4 mm Hg; P = .001) and left ventricular mass index (111 vs 101 g/m2; P = .5) were present in BAV patients. Freedom from aortic valve reoperation was 94% in the BAV group and 98% in the TAV group (P = .10), and survival was 100% and 95%, respectively (P = .07). Conclusions Both BAV and TAV Reimplantations can be performed with equal safety and good midterm outcomes; however, the constellation of higher gradients, less ventricular reverse remodeling, and more aortic valve reoperations with BAV Reimplantations raises concerns requiring continued long-term surveillance.
Douglas R Osmon - One of the best experts on this subject based on the ideXlab platform.
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executive summary diagnosis and management of prosthetic joint infection clinical practice guidelines by the infectious diseases society of america
Clinical Infectious Diseases, 2013Co-Authors: Douglas R Osmon, Arlen D Hanssen, Anthony R Berendt, Elie F Berbari, Werner Zimmerli, James M Steckelberg, Walter R WilsonAbstract:Abstract These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged Reimplantation, 1-stage Reimplantation, and amputation.
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diagnosis and management of prosthetic joint infection clinical practice guidelines by the infectious diseases society of america
Clinical Infectious Diseases, 2013Co-Authors: Douglas R Osmon, Arlen D Hanssen, Anthony R Berendt, Elie F Berbari, Werner Zimmerli, James M Steckelberg, Walter R WilsonAbstract:Abstract These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged Reimplantation, 1-stage Reimplantation, and amputation.
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reinfection after two stage revision for periprosthetic infection of total knee arthroplasty
International Orthopaedics, 2012Co-Authors: Bernd Kubista, Douglas R Osmon, Arlen D Hanssen, Robert U Hartzler, Christina M Wood, David G LewallenAbstract:Purpose Limited data exist regarding the long-term results or risk factors for failure after two-stage Reimplantation for periprosthetic knee infection. The purpose of this retrospective review was to investigate infection-free implant survival and identify variables associated with reinfection after this procedure. Furthermore, a staging system was evaluated as a possible prognostic tool for patients undergoing two-stage Reimplantation of infected total knee arthroplasty (TKA).
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two stage Reimplantation for periprosthetic knee infection involving resistant organisms
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Yogesh Mittal, Arlen D Hanssen, Thomas K Fehring, Camelia Marculescu, Susan M Odum, Douglas R OsmonAbstract:Background: Two-stage Reimplantation is the most accepted mode of treatment for patients with a periprosthetic infection following total knee arthroplasty. Most studies, however, do not stratify their results on the basis of the type of infecting organism. The purpose of this study was to determine the outcomes for patients who had two-stage Reimplantation for the treatment of infection with a resistant organism, methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis, at the site of a total knee replacement. Methods: A multicenter study was performed to review the cases of all patients treated between 1987 and 2003 because of an infection with methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis organisms at the site of a total knee replacement. The prevalence of reinfection following two-stage Reimplantation was determined. Variables that may influence the outcome, such as the duration and type of intravenous antibiotics administered, previous surgery, and comorbidities of the host, were analyzed. Results: We identified thirty-seven patients who had an infection with a resistant organism. All patients had negative cultures at the time of Reimplantation. Four of the thirty-seven patients had a reinfection with the same organism, while five had a reinfection with a different organism. None of the variables noted above were found to be significantly associated with reinfection, on the basis of the numbers available. Conclusions: Reports in the literature have discouraged Reimplantation for the treatment of an infection with a resistant organism at the site of a total knee replacement. While 24% of the patients in this series had a reinfection, 14% had a reinfection with a different organism. We believe that two-stage Reimplantation remains a viable treatment option for patients who have an infection with a resistant organism at the site of a total knee replacement. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
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delayed Reimplantation arthroplasty for candidal prosthetic joint infection a report of 4 cases and review of the literature
Clinical Infectious Diseases, 2002Co-Authors: David M Phelan, Douglas R Osmon, Michael R Keating, Arlen D HanssenAbstract:Fungal prosthetic joint infection (PJI) is rare, with Candida species being the most frequently reported pathogen in the medical literature. The risk of relapse following delayed Reimplantation arthroplasty for candidal PJI is unknown. We describe 4 new cases and summarize 6 previously reported cases of candidal PJI treated with delayed Reimplantation arthroplasty. Ninety percent of the patients received antifungal therapy. Eight patients received amphotericin B either alone or in combination with other antifungals. One patient received fluconazole alone. The median duration of time from resection arthroplasty to Reimplantation for total hip and total knee arthroplasties was 8.6 and 2.3 months, respectively. Eight patients did not have relapse of candidal PJI following delayed Reimplantation arthroplasty after a median duration of follow-up of 50.7 months (range, 2--73 months). Candidal PJI can be successfully treated with delayed Reimplantation arthroplasty after receipt appropriate antifungal therapy.
Ashay Patel - One of the best experts on this subject based on the ideXlab platform.
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vesicoscopic cross trigonal ureteral Reimplantation a minimally invasive option for repair of vesicoureteral reflux
The Journal of Urology, 2007Co-Authors: Stephen J Canon, Venkata R Jayanthi, Ashay PatelAbstract:Purpose: Cross-trigonal ureteral Reimplantation is a commonly performed procedure for the correction of vesicoureteral reflux. Most previously described laparoscopic techniques have used an extravesical approach. A “vesicoscopic” technique is analogous to standard open cross-trigonal repair in principle, except that 3 ports with insufflation of the bladder are used to perform the ureteral Reimplantation.Materials and Methods: A retrospective review was performed of patients treated for primary vesicoureteral reflux with either vesicoscopic or open ureteral Reimplantation. For patients with vesicoscopic Reimplantation a 5 mm port is placed in the dome of the bladder and 2, 3 mm ports are placed laterally. The ureters are mobilized transvesically, cross-trigonal submucosal tunnels are made and the ureters are sutured in place with intracorporeal suturing. The bladder ports are closed and a urethral catheter is left indwelling for 36 hours. Among the open Reimplantation group 38 patients underwent cross-trig...
