Factors associated with reflux resolution in extravesical laparoscopic and robotic surgery

This study aims to assess the surgical outcomes of laparoscopic or robotic surgery for primary vesicoureteral reflux and elucidate the factors contributing to vesicoureteral reflux resolution.

We retrospectively reviewed the medical records of consecutive patients who underwent extravesical laparoscopic ureteral reimplantation or robot-assisted laparoscopic ureteral reimplantation at our institution between March 2012 and July 2020. First, we reviewed surgical outcomes in the paediatric (n = 100) and adult (n = 15) patient groups. Second, we compared the surgical findings and outcomes of both procedures in the paediatric patient group and investigated the factors contributing to surgical success in the paediatric patient group.

The combined success rates for both procedures were 89.1% in the paediatric group and 70.0% in the adult group. The overall success rate among paediatric patients was not significantly different between those who underwent laparoscopic ureteral reimplantation (91.1%) and those who underwent robot-assisted laparoscopic ureteral reimplantation (85.5%). Post-operative urinary retention was observed in 5.0% and 6.7% of paediatric and adult patients, respectively. Univariate and multivariate analyses revealed that the ureteral diameter measured during surgery was significantly associated with vesicoureteral reflux resolution regardless of the use of a robotic platform (p = 0.046).

Both laparoscopic and robot-assisted laparoscopic ureteral reimplantation are favourable and safe procedures for paediatric patients with primary vesicoureteral reflux. To improve the success rate, a sufficient length of the submucosal tunnel must be ensured based on intraoperative measurements of ureteral diameter.