Introduction

Robot-assisted laparoscopic ureteral reimplantation (RALUR) has been criticized due to concerns about technique and success rates. Within a 4-site Robotic Research Collaborative (RRC) we aimed to: (1) determine if sufficient technical variability exists to conduct a prospective study, and (2) evaluate the association between RALUR technical factors and patient outcomes._x000D_

Methods

A retrospective study of children undergoing RALUR for 1° vesicoureteral reflux (VUR) from 1/2013-5/2015 was conducted. Exclusions: neurogenic bladder, megaureter, or follow-up <30 days. Clinical failure definition: persistent VUR Grade ≥II, febrile urinary tract infection (fUTI) within 1 year of RALUR, or complication requiring reoperation. Fisher&[prime]s exact test was used for bivariate comparisons.

Results

98 patients (143 ureters, 85% single system, 79% female, median age 5 years) underwent RALUR by 9 surgeons. Indications included VUR non-resolution (43%), renal scarring (37%), and breakthrough UTI (27%). Highest VUR grade was I/II in 15%, III in 45%, IV/V in 38%, and ungraded in 2%. Bowel/bladder dysfunction was noted in 45%. Variability in multiple technical details was identified (Table 1). 17 patients (17%) had clinical failure: 9 (9%) VUR Grade ≥II, 9 (9%) fUTI, 2 (2%) fUTI + persistent VUR, and 2 (2%) required reoperation. None of the technical factors in Table 1 were associated with clinical failure (e.g., Table 2).

Conclusions

Patients undergoing RALUR at 4 RRC sites had an 83% clinical success rate, comparable to historical open surgery rates. It was feasible to collect some technical details retrospectively; technique variability was documented. This initial series found no association between technical factors and clinical outcomes. Future plans include prospectively evaluating associations between technical factors and RALUR outcomes, and developing standardized technique recommendations.

Funding

None