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Published on: January 7, 2019
Is Postoperative Voiding Cystourethrogram Routinely Indicated Following Robotic-assisted Laparoscopic Ureteral
Ahmed Abdelhalim1, Amr Elbakry2, Khaled Eldabek3
1The Department of Urology, West Virginia University, Morgantown, WV; The Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Insights
Routine voiding cystourethrogram (VCUG) is not necessary to confirm resolution of vesicoureteral reflux (VUR) after robotic-assisted laparoscopic ureteral reimplantation (RALUR) in children. Clinical success rates remain high without routine VCUG post-RALUR.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urologic Imaging
Background:
- Vesicoureteral reflux (VUR) is a common condition in children, often managed surgically.
- Robotic-assisted laparoscopic ureteral reimplantation (RALUR) is an increasingly utilized minimally invasive technique for VUR correction.
- The necessity of routine postoperative voiding cystourethrogram (VCUG) to confirm VUR resolution after RALUR is debated.
Purpose of the Study:
- To evaluate the need for routine voiding cystourethrogram (VCUG) in confirming vesicoureteral reflux (VUR) resolution post-robotic-assisted laparoscopic ureteral reimplantation (RALUR) in pediatric patients.
- To assess radiological and clinical success rates following RALUR for VUR.
Main Methods:
- A single-center review of a prospectively maintained database of pediatric patients (<18 years) who underwent RALUR for VUR.
- Analysis of baseline characteristics, surgical details, and postoperative follow-up including renal bladder ultrasound and VCUG.
- Primary endpoint: radiological success (absence of VUR on VCUG). Secondary endpoints: clinical success (absence of febrile UTI, urinary retention, reoperation).
Main Results:
- 42 children (48 ureters) underwent RALUR; 83.4% had grade III+ VUR, 20.8% had duplex kidneys.
- Radiological reflux resolution was confirmed in 87.5% of ureters with postoperative VCUG.
- Clinical success rate was high at 97.6%, with no reoperations for persistent VUR.
Conclusions:
- Routine postoperative voiding cystourethrogram (VCUG) is not indicated following robotic-assisted laparoscopic ureteral reimplantation (RALUR) for VUR in children, once surgical proficiency is achieved.
- High clinical success rates can be achieved with RALUR, suggesting that imaging surveillance can be tailored.
Objective:
To examine the need to routinely obtain voiding cystourethrogram (VCUG) to confirm vesicoureteral reflux (VUR) resolution following robotic-assisted laparoscopic ureteral reimplantation (RALUR) in children.
Methods:
A single-center, prospectively maintained database was reviewed for patients <18 years old who underwent RALUR for VUR. Patient charts were reviewed for baseline characteristics and surgical details. Patients were routinely followed up by renal bladder ultrasound at 6-8 weeks and VCUG at 3 months postoperatively. The primary endpoint was radiological success defined as the absence of VUR on postoperative VCUG. The secondary endpoints were clinical success, defined as the absence of postoperative febrile urinary tract infection, postoperative urinary retention, and reoperation for persistent VUR or RALUR complications.
Results:
Between 2018 and 2023, 42 children (48 refluxing ureters) underwent extravesical RALUR at the study institution at a mean age of 70.4 + 23.7 months. A majority of 81% were females, and 85.7% had associated bladder and bowel dysfunction. Six patients (14.3%) had bilateral RALUR. Of the ureters, 83.4%(40/48) had grade III or higher VUR, and 20.8%(10/48) had duplex kidneys. Postoperative VCUG was completed in 36(85.7%) patients. Radiological reflux resolution was confirmed in 87.5%(35/40) of ureters. The remaining five ureters had VUR downgrading to grade I or II; all remained asymptomatic, and none required reoperation. One patient required ureteral stenting for 6 weeks for an unidentified unilateral ureteral injury without long-term consequences. Postoperative urine retention requiring short-term catheterization occurred in three patients. The clinical success rate was 97.6%.
Conclusion:
After bypassing the learning curve, VCUG is not routinely indicated following RALUR for VUR.
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