Back to Program


A Comparison Study of Robotic-Assisted Laparoscopic vs. Open Ureteral Reimplantation for Treatment of Vesicoureteral Reflux in Children and Young Adults
Courtney K. Rowe, M.D., Brian J. Minnillo, M.D., Young K. Hong, M.D., David A. Diamond, M.D., Alan B. Retik, M.D., Hiep T. Nguyen, M.D.
Children's Hospital Boston, Boston, MA

Introduction: Vesicoureteral reflux (VUR) occurs in 1-2% of pediatric patients. High-grade VUR may require surgical treatment and open ureteral reimplantation remains the gold-standard technique. Nevertheless, less invasive approaches have been developed to reduce morbidity and robotic-assisted laparoscopic ureteral reimplantation (RALUR) has proved feasible. Yet, this procedure is technically demanding and performed by few surgeons. Our purpose is to describe the authors’ initial experience with RALUR and to compare outcomes with the open technique.
Methods: We performed a retrospective chart review including all patients with intra/extravesical RALUR from March 2007-2010 at a single institution. Patients (>4yrs with bladder capacity >200cc) were candidates for intravesical robotic technique. We matched them to an open cohort using specific criteria: surgery date, age, gender, reflux grade. All patients had a VCUG on postoperative day one to rule out bladder leakage. The Foley catheter was then removed and the patient discharged home. VCUG was repeated 3 and 12 months postoperatively. Clinical success was defined as the absence of infection/pyelonephritis and radiologic success as no VUR. Anova one-way test was used (p<0.05=statistical significance).
Results: There were 19 intravesical and 20 extravesical RALUR matched with a cohort of open intravesical reimplantations. There was no difference regarding operative time, estimated blood loss, intraoperative complications, or need to convert RALUR to an open procedure (Table1). Ureteral stent was more common in the extravesical group because several patients had a solitary kidney. There was no significant difference in hospital stay (1.7/1.8 days intra/extravesical, 2.6 days open), urethral catheter time, ready-to-discharge time, or complication rate (Table1). Follow-up time was 12.5-21 months with VCUG performed at 3 months (all patients) and 12 months (40% of patients). Success rates (95-100%) were similar at 3 months for patients and renal units. In addition, no difference was found at 12 months. Duration of bladder discomfort/spasm and use of narcotics and anticholinergics were less in the laparoscopic versus open group.
Conclusion: Open ureteral reimplantation remains the gold-standard technique for VUR related surgery and yet less invasive approaches have been recently developed to reduce morbidity. Though technically demanding and performed by only a small number of surgeons, the robotic-assisted laparoscopic ureteral reimplantation is safe and feasible providing similar outcomes to the open technique with less bladder discomfort/spasm.

Table1-Perioperative Data
IntravesicalExtravesical
Intraoperative
Units Reimplanted
One0(0%)13(65%)
Two19(100%)7(35%)
Total3827
Associated Procedures1 (5%)5 (25%)
Operative Time(min)232.6±37.4233±60
EBL(mL)13.4+12.615±23
Ureteral Stent Placement0(0%)6(30%)
IntravesicalExtravesical
Postoperative
Foley Period1.8±1.71.2±0.5
Patients with complications10(52%)6(30%)
Urinary Retention1(5%)2(10%)
Pain8(42%)4(20%)
Bladder Spasm2(10%)2(10%)
Bladder Leak3(16%)1(5%)
Ureteral Leak1(5%)2(10%)
Wound0(0%)2(10%)
Hospital Stay1.8±1.21.7±1.0
Ready-to-discharge1.1±0.41.1±0.3


Back to Program