Factors associated with reflux resolution in extravesical laparoscopic and robotic surgery

Area of Science:

• Urology
• Minimally Invasive Surgery
• Pediatric Surgery

Background:

• Primary vesicoureteral reflux (VUR) is a common condition in children, often leading to recurrent urinary tract infections.
• Surgical correction aims to prevent renal scarring and long-term complications.
• Laparoscopic and robotic-assisted ureteral reimplantation are established minimally invasive techniques for VUR treatment.

Purpose of the Study:

• To evaluate and compare the surgical outcomes of laparoscopic versus robot-assisted laparoscopic ureteral reimplantation for primary VUR.
• To identify factors influencing the resolution of VUR after minimally invasive surgery.

Main Methods:

• Retrospective review of medical records for patients undergoing extravesical laparoscopic or robot-assisted laparoscopic ureteral reimplantation (March 2012 - July 2020).
• Analysis of surgical outcomes in pediatric (n=100) and adult (n=15) cohorts.
• Comparison of procedures in pediatric patients and investigation of success factors.

Main Results:

• Overall success rates were 89.1% in pediatric and 70.0% in adult patients.
• Pediatric success rates were similar for laparoscopic (91.1%) and robot-assisted (85.5%) ureteral reimplantation.
• Intraoperative ureteral diameter was a significant predictor of VUR resolution (p=0.046).

Conclusions:

• Both laparoscopic and robot-assisted laparoscopic ureteral reimplantation are safe and effective for pediatric primary VUR.
• Ensuring adequate submucosal tunnel length, guided by intraoperative ureteral diameter, is crucial for optimizing surgical success.