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Multi-Institutional Review of Outcomes of Robotic Assisted Extravesical Ureteral Re-Implantation
Gwen Grimsby*, Dallas, TX, Moira Dwyer, Pittsburgh, PA, Micah Jacobs, Dallas, TX, Glenn Cannon, Pittsburgh, PA, Patricio Gargollo, Dallas, TX

INTRODUCTION AND OBJECTIVES: The published literature reports a very high success rate of at least 90% in the largest studies of robotic assisted laparoscopic ureteral re-implantation for treatment of vesicoureteral reflux (VUR). Our experience, however, has contradicted these reports. The goal of this study was to report a multi-institutional review of success and complications after pediatric robotic extravesical ureteral re-implantation performed by skilled robotic surgeons for the surgical treatment of VUR.

METHODS: An IRB approved chart review was performed of all patients who underwent robotic extravesical ureteral reimplantation at Children's Medical Center in Dallas and Children's Hospital of Pittsburgh by 3 surgeons from 2010 to present. The indication for surgical correction of VUR was presence of cortical defects on DMSA scans performed at least 3 months from the time of last UTI (35), breakthrough UTIs (13), non-resolution of VUR (12), and parental non-compliance with antibiotics (1). Failure of the procedure was defined as persistence of VUR on post-operative VCUG and/or the need for reoperation.

RESULTS: 61 patients were treated with a mean age at surgery of 6.7 years old (0.58-18 yrs) at time of surgery. 80% were female, 10 (16%) had undergone a previous Deflux injection, and the procedure was bilateral in 32 patients (52%). At a mean 10 months follow up, the procedure was successful in 72% (44/61) of patients. Acute complications occurred in 6 patients (10%) and 9 re-operations were needed in a total of 7 patients (11%). See Table 1 for a description of failures, complications, and reoperations.

CONCLUSIONS: We found the success of robotic assisted extravesical ureteral re-implantation for the surgical treatment of VUR to be much less than reported in the literature. In addition, we found that over 10% of patients of required a re-operation for either persistent VUR or a surgical complication. While it is tempting to only report favorable outcomes, we are sharing our experiences with this procedure as we feel the advantages of this technique need to be weighed against realistic expectations for outcomes.

Source of Funding: None


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