title: Robot-assisted extravesical ureteral reimplantation: outcomes and conclusions from 78 ureters.
abstract: OBJECTIVE
  Extravesical robot-assisted laparoscopic ureteral reimplantation (RALUR) is a popular alternative to open surgery. We report our experience with RALUR and evaluate clinical variables as predictors for failure.
  
  
  METHODS
  We retrospectively evaluated the records of patients who underwent RALUR by a single surgeon for treatment of primary vesicoureteral reflux. Clinical and demographic variables were determined. Clinical variables were compared with surgical outcomes using the Student two-tailed type 2 t test.
  
  
  RESULTS
  Fifty patients underwent a combined 78 extravesical RALURs. Median (range) age was 6.2 (1.9-18.0) years; median (range) preoperative reflux grade was 3 (0-5). Dysfunctional elimination syndrome (DES) was present in 32 (64%). Ten (20%) patients had prior deflux, and two (4%) had prior ureteroneocystostomy on the ipsilateral side. Postoperative cystogram was performed in 100% at a median (range) of 55 (27-133) days. Median (range) follow-up was 286 (27-2238) days. Febrile urinary tract infection occurred in five (10%), none of whom had reflux on initial follow-up postoperative cystogram. All five had a history of DES and were female. Six complications occurred in five (10%) patients, including ileus (2), ureteral obstruction (2), ureteral injury (1), and perinephric fluid collection (1). Transient urinary retention occurred in one. Five of 22 (22.7%) patients undergoing unilateral surgery had contralateral de novo reflux. Six of 78 ureters (7.7%) had persistent reflux postoperatively. Neither persistent nor de novo reflux was associated with any of the clinical variables assessed.
  
  
  CONCLUSIONS
  RALUR is an effective and safe option for patients with primary vesicoureteral reflux requiring surgery.
authors.affiliation: Division of Pediatric Urology, Seattle Children's Hospital, 4800 Sand Point Way, NE, Seattle, WA 98105, USA.
authors.forename: Ardavan
authors.initials: A
authors.lastname: Akhavan
authors.affiliation: Division of Pediatric Urology, Seattle Children's Hospital, 4800 Sand Point Way, NE, Seattle, WA 98105, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Avery
authors.affiliation: Division of Pediatric Urology, Seattle Children's Hospital, 4800 Sand Point Way, NE, Seattle, WA 98105, USA. Electronic address: Thomas.lendvay@seattlechildrens.org.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Lendvay
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D012092:Replantation; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis / Q000601:surgery*
keywords: Dysfunctional elimination syndrome; Robotic surgery; Ureteral reimplantation; Urinary retention; Vesicoureteral reflux