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Robot-assisted laparoscopic extravesical ureteral reimplantation has been proposed as a minimally invasive alternative to open ureteral reimplantation for correcting primary vesicoureteral reflux in children. However, in the current literature there are conflicting data regarding the safety and efficacy of this approach. Amid ongoing debate we analyzed outcomes and complications from this procedure in a large multi-institutional cohort.We reviewed the records of children who underwent robot-assisted laparoscopic extravesical ureteral reimplantation at 9 academic centers from 2005 to 2014. Radiographic failure was defined as persistent vesicoureteral reflux on postoperative voiding cystourethrogram or radionuclide cystogram. Complications were graded using the Clavien-Dindo scale.A total of 260 patients (363 ureters) underwent robot-assisted laparoscopic extravesical ureteral reimplantation for primary vesicoureteral reflux during the study period. The cohort included 90 patients with either duplex ureter (42), failed endoscopic treatment (40) or concomitant diverticulectomy (8). Of the 280 ureters with postoperative voiding cystourethrogram or radionuclide cystogram available radiographic resolution was seen in 246 (87.9%). There were 25 complications overall (9.6%), with 7 grade 3 complications (2.7%) and no grade 4 or 5 complications. Four patients (3.9%) had transient urinary retention following bilateral reimplantation.Robot-assisted laparoscopic extravesical ureteral reimplantation has a low complication rate consistent with published series of open ureteral reimplantation. Radiographic success rates are approaching those of the open procedure but continue to fall short of the gold standard approach. These findings necessitate critical thinking regarding potential technique improvements and further prospective investigation into the efficacy of this procedure.

During follow up, VUR disappeared spontaneously in 7, while antireflux surgery was performed in 7. Mean systolic blood pressure (BP) and mean diastolic BP at final visit were 108 mmHg (127 to 89) and 66mmHg (89 to 41). According to Guideline by Japanese Society of Hypertension, while none exceeded standard level of systolic BP, two patients slightly exceeded standard level of diastolic BP. No significant proteinuria was detected in all patients. Estimated GFR was evaluated in all of 10 patients over 10 years old at final visit and in 7 of 17 patients under 10 during follow up. CKD stage was 1 in all these 17 patients. CONCLUSIONS: Significant clinical findings related to UDRPL detected at less than 1 year old was rarely observed during a mean of 10 years follow up in this study. Accordingly, UDRPL seems to be a benign condition. No specific attention would be necessary during follow up in patients with UDRPL on one side and no or limited scar on the other on the initial nuclear renal scan.