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Assessing Voiding Function after Robotic-Assisted Laparoscopic Extravesical Ureteral Reimplantation
David Chalmers, M.D.1, Katherine Herbst, M.Sc.2, Christina Kim, M.D.2.
1University of Connecticut Medical Center/Connecticut Children's Medical Center, Hartford, CT, USA, 2Connecticut Children's Medical Center, Hartford, CT, USA.

BACKGROUND:
A significant concern when performing an extravesical ureteral reimplantation is creating postoperative urinary retention. Robotic-assisted laparoscopic (RAL) extravesical ureteral reimplantation is still in its infancy. The expected risk of postoperative complications is still being established.
Our goal was to assess our initial surgical experience and evaluate postoperative voiding function.
METHODS:
After obtaining IRB approval, we performed a retrospective case series on our first cohort of patients who underwent RAL extravesical ureteral reimplantation. Demographics, operative times, hospital course, and postoperative outcomes were reviewed. We measured both post-void residual (PVR) by bladder scan and dysfunctional elimination score (DES) questionnaire scores to assess their voiding status. Expected bladder capacity (EBC) was calculated with the equation (age in years +2) x 30 mL. Based on this volume, the PVR was summarized as a percentile of EBC.
RESULTS:
A total of 13 cases were identified; 8 unilateral and 5 bilateral repairs. All patients were female and all cases performed by one surgeon. Mean age at surgery was 6.25 years and mean weight was 27.2 kg. Four patients had prior failed Deflux surgery. Mean hospital stay was 1.3 days.
One patient was lost to follow up. For the remaining 12 patients, we saw resolution of reflux in 10 patients (83%) and 15 ureters (88%). There was downgrading of reflux in the remaining patients.
All patients were discharged volitionally voiding. There were no patients who required postoperative catheterization. The average PVR was 5.6%.
CONCLUSIONS:
Although our case series is small in size, it is promising. We have seen no problems with postoperative voiding after extravesical dissection. Some literature suggests lower rates of retention when dissecting out the pelvic plexus fibers. This initial patient series did not have any formal dissection of the pelvic plexus, yet we saw solid success rates and no voiding complications. We aim to perform prospective analysis of our surgical outcomes with both PVR and dysfunctional elimination syndrome (DES) questionnaire scores.


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