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Multi-Institutional Review of Outcomes and Complications of Robot-Assisted Laparoscopic Extravesical Ureteral Reimplantation for Treatment of Primary Vesicoureteral Reflux in Children
- Source :
- Journal of Urology. 197:1555-1561
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
Abstract
- 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.
- Subjects :
- Male
medicine.medical_specialty
Voiding cystourethrogram
Urology
medicine.medical_treatment
030232 urology & nephrology
Vesicoureteral reflux
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Ureter
Robotic Surgical Procedures
medicine
Humans
Child
Retrospective Studies
Vesico-Ureteral Reflux
medicine.diagnostic_test
business.industry
medicine.disease
Surgery
Treatment Outcome
surgical procedures, operative
medicine.anatomical_structure
Replantation
030220 oncology & carcinogenesis
Urologic Surgical Procedures
Female
Laparoscopy
business
Ureteral reimplantation
Subjects
Details
- ISSN :
- 15273792 and 00225347
- Volume :
- 197
- Database :
- OpenAIRE
- Journal :
- Journal of Urology
- Accession number :
- edsair.doi.dedup.....32d314e4326c54b04eff917df298b11d