Login to Access Video or Poster Abstract: MP61-02
Sources of Funding: University of Chicago Section of Urology

Introduction

Minimally invasive surgical (MIS) approaches to ureteral reimplantation (UR) for vesicoureteral reflux (VUR) are being used with increasing frequency, despite variability in published rates of complications and reoperation. We assessed rates of secondary procedures following ureteral reimplantation in a prospectively maintained national database.

Methods

We queried MarketScan, a national employer based insurance database, to identify patients less than 18 years of age who underwent an open or MIS UR between 2008 and 2014. Rates of secondary procedures related to ureteral obstruction (placement of stent or nephrostomy tube, or dilation of ureteral stricture) within 120 days of UR and rates of repeat UR at any time point were assessed. Statistical analysis was performed using t-test, chi-square test, Wilcoxon rank-sum test, and multivariate regression.

Results

Between 2008 and 2014, 2,752 patients underwent UR with an open approach in 2,601 (94.5%) and MIS in 151 (5.5%). There was a trend toward increased utilization of MIS, with MIS comprising 2.5% of cases in 2008 and 9.3% in 2014 (p=0.026). Relative to the open group, mean age in years was higher in the MIS group (5.6 vs 4.3, p<0.01) and mean length of stay in days was shorter (1.44 vs 2.15, p<0.01). Mean inpatient hospital charges did not differ between the groups ($21,660 vs $20,621, p=0.59). The rate of secondary ureteral procedures within 120 days did not differ between the MIS and open groups (0.7% vs 0.3%%, p=0.76), but rate of subsequent open UR at any time was higher in the MIS group (3.97% vs 0.69%, p<0.01). On univariate analysis, patient age, gender, LOS, and surgical approach did not predict subsequent secondary procedures within 120 days (Table 1).

Conclusions

From 2008 to 2014 there has been a trend toward increased utilization of MIS UR. Relative to the open approach, MIS approach is associated with a shorter length of hospital stay with no difference in inpatient hospital charges. The rate of secondary ureteral procedure within 120 days of UR did not differ by approach, but patients treated with MIS UR had a higher rate of subsequent open UR.

Funding

University of Chicago Section of Urology