Open versus minimally invasive ureteroneocystostomy: A population-level analysis

Area of Science:

• Urology
• Pediatric Surgery
• Health Services Research

Background:

• Open ureteroneocystostomy (UNC) is the standard surgical treatment for vesicoureteral reflux (VUR).
• Limited national data exist on outcomes for minimally-invasive (MIS) UNC in pediatric VUR patients.

Purpose of the Study:

• To compare postoperative outcomes, including complications, length of stay (LOS), and cost, between open and MIS UNC in children using national population-level data.

Main Methods:

• A retrospective analysis of the Nationwide Inpatient Sample (1998-2012) identified pediatric VUR patients undergoing open or MIS UNC.
• Data on demographics, complications (NSQIP), LOS, and cost were extracted and analyzed using weighted regression models.

Main Results:

• MIS UNC was associated with a shorter LOS (1.0 vs. 1.8 days) and higher costs ($9230 vs. $6,304) compared to open UNC.
• Adjusted analysis revealed MIS UNC had significantly higher rates of postoperative urinary complications (OR 3.1), shorter LOS (RR 0.8), and higher costs (RR 1.4).
• MIS UNC patients were older, more likely to be publicly insured, and treated more recently.

Conclusions:

• Open UNC remains far more common than MIS UNC (nearly 100:1 ratio).
• While MIS UNC offers shorter hospitalization, it is linked to increased urinary complication risks and higher costs.
• Limitations include the retrospective design and lack of long-term outcome data.