title: Prospective long-term analysis of nerve-sparing extravesical robotic-assisted laparoscopic ureteral reimplantation.
abstract: OBJECTIVE
  To prospectively review our experience with extravesical robotic-assisted laparoscopic ureteral reimplantation to determine whether postoperative voiding dysfunction can be avoided with pelvic plexus visualization and to assess the efficacy of this approach for the treatment of vesicoureteral reflux (VUR).
  
  
  METHODS
  We prospectively followed 150 patients who underwent bilateral extravesical robotic-assisted laparoscopic ureteral reimplantation by a single surgeon at an academic institution. Each patient was followed for a 2-year period. All 150 patients had primary VUR of grade 3 or greater bilaterally, with 127 having parenchymal defects found on renal scans. All patients were toilet trained before surgical intervention. The operation was performed with an extravesical transperitoneal approach with robotic assistance using the daVinci Surgical System. All patients underwent voiding cystourethrography at 3 months postoperatively to document the resolution of VUR. Voiding dysfunction was assessed in each patient by uroflow, postvoid residual urine volume, and a validated questionnaire.
  
  
  RESULTS
  The operative success rate was 99.3% for VUR resolution on voiding cystourethrography. One patient with bilateral grade 5 VUR that was downgraded to unilateral grade 2 VUR was considered to have treatment failure. This patient ultimately underwent subsequent subureteral injection therapy after an episode of pyelonephritis. No patient experienced de novo voiding dysfunction.
  
  
  CONCLUSIONS
  Bilateral nerve-sparing robotic-assisted extravesical reimplantation has the same success rate as the traditional open approaches, with minimal morbidity and no voiding complications in our series.
authors.affiliation: Department of Surgery, Division of Urology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kasturi
authors.forename: Shailen S
authors.initials: SS
authors.lastname: Sehgal
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Christman
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Lambert
authors.forename: Pasquale
authors.initials: P
authors.lastname: Casale
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D010388:Pelvis / Q000294:innervation; D011446:Prospective Studies; D012092:Replantation / Q000379:methods*; D012371:Robotics; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014555:Urination Disorders / Q000209:etiology / Q000517:prevention & control; D013520:Urologic Surgical Procedures / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000601:surgery*