Robot-assisted extravesical ureteral reimplantation: outcomes and conclusions from 78 ureters

Abstract

Objective: Extravesical robot-assisted laparoscopic ureteral reimplantation (RALUR) is a popular alternative to open surgery. We report our experience with RALUR and evaluate clinical variables as predictors for failure.

Methods: We retrospectively evaluated the records of patients who underwent RALUR by a single surgeon for treatment of primary vesicoureteral reflux. Clinical and demographic variables were determined. Clinical variables were compared with surgical outcomes using the Student two-tailed type 2 t test.

Results: Fifty patients underwent a combined 78 extravesical RALURs. Median (range) age was 6.2 (1.9-18.0) years; median (range) preoperative reflux grade was 3 (0-5). Dysfunctional elimination syndrome (DES) was present in 32 (64%). Ten (20%) patients had prior deflux, and two (4%) had prior ureteroneocystostomy on the ipsilateral side. Postoperative cystogram was performed in 100% at a median (range) of 55 (27-133) days. Median (range) follow-up was 286 (27-2238) days. Febrile urinary tract infection occurred in five (10%), none of whom had reflux on initial follow-up postoperative cystogram. All five had a history of DES and were female. Six complications occurred in five (10%) patients, including ileus (2), ureteral obstruction (2), ureteral injury (1), and perinephric fluid collection (1). Transient urinary retention occurred in one. Five of 22 (22.7%) patients undergoing unilateral surgery had contralateral de novo reflux. Six of 78 ureters (7.7%) had persistent reflux postoperatively. Neither persistent nor de novo reflux was associated with any of the clinical variables assessed.

Conclusions: RALUR is an effective and safe option for patients with primary vesicoureteral reflux requiring surgery.

Keywords: Dysfunctional elimination syndrome; Robotic surgery; Ureteral reimplantation; Urinary retention; Vesicoureteral reflux.