Outcomes of complex robot-assisted extravesical ureteral reimplantation in the pediatric population

Arlen, Angela M.; Broderick, Kristin M.; Travers, Curtis; Smith, Edwin A.; Elmore, James M.; Kirsch, Andrew J.

doi:10.1016/j.jpurol.2015.11.007

Cited by 62 publications

(37 citation statements)

References 23 publications

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“…haematuria and bladder spasms) and shorter hospitalization [3][4][5]. The extravesical ureteric reimplantation technique has been performed using both a laparoscopic and a robot-assisted approach, with reported success rates ranging from 77 to 100% [6][7][8][9]. Bladder dysfunction, including urinary retention, has been reported as a potential complication of extravesical ureteric reimplantation, especially in bilateral cases, caused by injury of the pelvic nerve plexus during ureteric dissection [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot‐assisted approach: results of a multicentre international survey

et al. 2019

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Objectives To assess and compare postoperative bladder dysfunction rates and outcomes after laparoscopic and robot‐assisted extravesical ureteric reimplantation in children and to identify risk factors associated with bladder dysfunction. Patients and Methods A total of 151 children underwent minimally invasive extravesical ureteric reimplantation in five international centres of paediatric urology over a 5‐year period (January 2013–January 2018). The children were divided in two groups according to surgical approach: group 1 underwent laporoscopic reimplantation and included 116 children (92 girls and 24 boys with a median age of 4.5 years), while group 2 underwent robot‐assisted reimplantation and included 35 children (29 girls and six boys with a median age of 7.5 years). The two groups were compared with regard to: procedure length; success rate; postoperative complication rate; and postoperative bladder dysfunction rate (acute urinary retention [AUR] and voiding dysfunction). Univariate and multivariate logistic regression analyses were performed to assess predictors of postoperative bladder dysfunction. Factors assessed included age, gender, laterality, duration of procedure, pre‐existing bladder and bowel dysfunction (BBD) and pain control. Results The mean operating time was significantly longer in group 2 compared with group 1, for both unilateral (159.5 vs 109.5 min) and bilateral procedures (202 vs 132 min; P = 0.001). The success rate was significantly higher in group 2 than in group 1 (100% vs 95.6%; P = 0.001). The overall postoperative bladder dysfunction rate was 8.6% and no significant difference was found between group 1 (6.9%) and group 2 (14.3%; P = 0.17). All AUR cases were managed with short‐term bladder catheterization except for two cases (1.3%) in group 1 that required short‐term suprapubic catheterization. Univariate and multivariate analyses showed that bilateral pathology, pre‐existing BBD and duration of procedure were predictors of postoperative bladder dysfunction (P = 0.001). Conclusion Our results confirmed that short‐term bladder dysfunction is a possible complication of extravesical ureteric reimplantation, with no significant difference between the laparoscopic and robot‐assisted approaches. Bladder dysfunction occurred more often after bilateral repairs, but required suprapubic catheterization in only 1.3% of cases. Bilaterality, pre‐existing BBD and duration of surgery were confirmed on univariate and multivariate analyses as predictors of postoperative bladder dysfunction in this series.

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Section: Introductionmentioning

confidence: 99%

Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot‐assisted approach: results of a multicentre international survey

et al. 2019

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“…Clinical success rates, radiographic and complication risk were similar. 17 In a study Cohen's procedure was compared with extravesical detrusorrhaphy and it was concluded that success rate of both techniques were almost similar. 18 Apart from similar success rate, need for anticholinergics and pain medications to treat bladder spasms was lesser in patients undergoing bilateral EVR.…”

Section: Discussionmentioning

confidence: 99%

Vesicoureteral Reflux

Irshad

Arslan

Riaz

et al. 2018

TPMJ

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ABSTRACT… Objectives:The objective of our study is to compare the extravesical and intravesical ureteric reimplantation for the treatment of bilateral vesicoureteral reflux in children. Period: April 2013 and July 2016. Setting: Urology Department of Mayo Hospital, Lahore. Methodology: 66 children diagnosed with primary vesicoureteral reflux and undergoing ureteric reimplantation. The Cohen cross-trigonal reimplantation (intravesical) and modified Lich-Gregoir procedure (extravesical) were performed on two separate groups Group IR and group ER. The following parameters were compared: postoperative duration of stay in the hospital, hematuria and bladder spasm. Frequency of hematuria, bladder spasm and average duration of stay in the hospital were compared in both group. Mean and standard deviation was calculated for age, gender and duration of surgery in both groups.). Chi square test was applied to check the association of outcome variables with demographical variables and duration of surgery. Results: These 100% (n=66) patients were divided into 2 groups equally, 33 in each, i.e. group ER and group IR. The mean age and duration of surgery of the patients of group ER were 13.78±2.83 years, 102.45±4.13 minutes respectively. While the mean age and duration of surgery of the patients of group IR was 30.33±4.58 years and 119.7±10.70 minutes respectively ( Table-II).The main outcome variables of this study were the hospital stay, postoperative bladder spasm and hematuria. The mean hospital stay of the patients of group ER and group IR was 4.30±1.35 days and 5.84±1.0 respectively ( Table-II). It was observed that bladder spasm in group ER and group IR was 39.4% (n=13) and 54.5% (n=18) respectively (Figure-1). It was also observed that hematuria in group ER and group IR was 36.4% (n=12) and 48.5% (n=16) respectively (Figure-2). Conclusion: The observation of this study concludes that extravesical ureteric reimplantation has an edge over conventional procedure of intravesical ureteric approach. Intravesical procedure has disadvantages of more frequency of postoperative complications like, hospital stay, bladder spasms and hematuria. Key words:Vesicoureteral Reflux, Extravesical ureteric reimplantation, Intravesical ureteric reimplantation

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“…The reported complications associated with RALUR range from mild to severe [11121314151617181920212223242526272829]. The most common complication is urinary retention, which can be considered a relatively mild complication since it usually does not require an extended hospital stay or additional surgical procedures.…”

Section: Extravesical Approachmentioning

confidence: 99%

“…As a result, minimally invasive surgery options have become increasingly available for many complex reconstructive procedures in pediatric urology. Since first introduced in 2004 [11], robot-assisted laparoscopic ureteral reimplantation (RALUR) has been described as one of these new minimally invasive procedures that have been increasingly adopted and described in several clinical series [1213141516171819202122232425262728293031]. …”

Section: Introductionmentioning

confidence: 99%

Lessons learned over a decade of pediatric robotic ureteral reimplantation

Baek

Koh

2017

Investig Clin Urol

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The da Vinci robotic system has improved surgeon dexterity, ergonomics, and visualization to allow for a minimally invasive option for complex reconstructive procedures in children. Over the past decade, robot-assisted laparoscopic ureteral reimplantation (RALUR) has become a viable minimally invasive surgical option for pediatric vesicoureteral reflux (VUR). However, higher-than-expected complication rates and suboptimal reflux resolution rates at some centers have also been reported. The heterogeneity of surgical outcomes may arise from the inherent and underestimated complexity of the RALUR procedure that may justify its reclassification as a complex reconstructive procedure and especially for robotic surgeons early in their learning curve. Currently, no consensus exists on the role of RALUR for the surgical management of VUR. High success rates and low major complication rates are the expected norm for the current gold standard surgical option of open ureteral reimplantation. Similar to how robot-assisted laparoscopic surgery has gradually replaced open surgery as the most utilized option for prostatectomy in prostate cancer patients, RALUR may become a higher utilized surgical option in children with VUR if the adoption of standardized surgical techniques that have been associated with optimal outcomes can be adopted during the second decade of RALUR. A future standard of RALUR for children with VUR whose parents seek a minimally invasive surgical option can arise if widespread achievement of high success rates and low major complication rates can be obtained, similar to the replacement of open surgery with robot-assisted laparoscopic radical prostectomy as the new strandard for men with prostate cancer.

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Outcomes of complex robot-assisted extravesical ureteral reimplantation in the pediatric population

Cited by 62 publications

References 23 publications

Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot‐assisted approach: results of a multicentre international survey

Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot‐assisted approach: results of a multicentre international survey

Vesicoureteral Reflux

Lessons learned over a decade of pediatric robotic ureteral reimplantation

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