Robotic extravesical anti-reflux operations in complex cases: technical considerations and preliminary results

Area of Science:

• Urology
• Minimally Invasive Surgery
• Pediatric Surgery

Background:

• High-grade vesicoureteral reflux (VUR) often presents with complicating factors like bladder dysfunction or renal scarring.
• Traditional surgical approaches may carry significant morbidity in these complex pediatric cases.

Purpose of the Study:

• To assess the technical feasibility and outcomes of robot-assisted extravesical anti-reflux surgery.
• To evaluate this technique in patients with high-grade VUR and associated complicating conditions.

Main Methods:

• Retrospective review of five patients undergoing robot-assisted extravesical Lich-Gregoir repair for high-grade VUR with complicating factors.
• Assessment of surgical aspects, reflux status, bladder function, and complications at follow-up.

Main Results:

• Successful reflux resolution in 9 out of 10 ureters.
• Complete resolution of para-ostial diverticulae.
• No lasting urinary retention; temporary catheterization needed in two patients. No obstruction, persistent infections, or negative impact on bladder function.

Conclusions:

• Robot-assisted extravesical anti-reflux surgery is a promising option for complex high-grade VUR.
• Offers a higher cure rate than injection therapy with potentially lower morbidity than open surgery.
• Further studies are needed to validate these initial findings.