ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Urology
The effect of Pneumovesicoscopic Cohen surgery using a segmented submucosal tunnel and reduced intra-abdominal pressure for the treatment of vesicoureteral reflux in children
Provisionally accepted
- Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Objective: To explore the effect of using a segmented submucosal tunnel and reducing intra-abdominal pressure in the treatment of CO2 leaking from the bladder into the abdominal cavity in Vesicoureteral reflux (VUR) patients during pneumovesicoscopic Cohen surgery. Method: Retrospective analysis was conducted on children aged 0-1 years with VUR who underwent pneumovesicoscopic Cohen surgery at the Department of Urology, Fujian Children's Hospital from May 1, 2021 to October 1, 2024. Among them, 56 cases had CO2 from the bladder leaking into the abdominal cavity during the surgery. The patients were divided into two groups based on the surgical method: Group A, 28 cases, where a submucosal tunnel was directly established during surgery; Group B, 28 cases, where a submucosal tunnel was established in segments and decompression of the abdominal cavity was performed during surgery. The intraoperative and postoperative situation, complications, and clinical efficacy of the two groups were compared. Results: There were no complications from bladder leakage, anastomotic stenosis, or urinary retention in either group after surgery and no reoperations were necessary. In Group A two cases were converted to open surgery, while no conversions were necessary in Group B. There was no statistically significant difference in indicators such as placement of the ureteral catheter, pain score (6h after surgery), postoperative hospitalization time, conversion to open reimplantation, postoperative UTI, or postoperative VUR,postoperative hematuria time. The operation time (187.11±55.29 min vs. 157.79±44.96min, P<0.05), and pain score two hours after surgery (2.21±0.79 vs. 1.39±0.99, P<0.05) in Group B were lower than in Group A. Conclusion: Reducing intra-abdominal pressure and segmental submucosal tunnelling are simple, safe, and effective. Reducing intra-abdominal pressure and segmental submucosal tunnel creation is recommended when CO2 from the bladder is leaking into the abdominal cavity of VUR patients during pneumovesicoscopic Cohen surgery.
Keywords: Children's bladder surgery, vesicoureteral reflux, Pneumovesicoscopic Cohen surgery, infants, Retrospective Studies
Received: 20 Sep 2025; Accepted: 26 Nov 2025.
Copyright: © 2025 Chen, Cui, Zhou, Zhang and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jianqin Zhang
Liu Chen
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