Open vs. robot-assisted laparoscopic ureteral reimplantation in a contemporary pediatric cohort: a retrospective single-institution analysis

TL;DR

The study compares open and robot-assisted ureteral reimplantation in children and finds similar outcomes in terms of efficacy and complications.

Contribution

This study provides a contemporary comparison of open and robotic ureteral reimplantation outcomes in a pediatric cohort.

Findings

Both open and robot-assisted ureteral reimplantation had similar rates of post-operative febrile UTI.

The complication rates and efficacy of the two surgical approaches were comparable.

Persistent VUR was managed similarly in both groups.

Abstract

Ureteral reimplantation (UR) in children is traditionally performed to correct vesicoureteral reflux (VUR). The traditional open approach can be performed using various techniques. More recently, the robotic approach has gained popularity but with concerns regarding cost, complications, and overall efficacy. This study aims to understand clinical outcomes in patients undergoing UR via both approaches. We hypothesize robot-assisted ureteral reimplantation (RALUR) has comparable outcomes to open ureteral reimplant (OUR) in a contemporary cohort. An IRB approved registry was queried for all patients with primary VUR who underwent UR procedures between 2015 and 2022. Demographics, pre/postoperative history, and operative details were retrospectively aggregated. There were 185 patients who met inclusion criteria: 44 OUR and 141 RALUR. Both cohorts had a similar rate of reported preoperative febrile UTI (91% OUR vs. 97% RALUR, p = 0.22). OUR cohort were younger, with a median age of 26.74 months versus 66.16 months in the RALUR group (p < 0.001) and had higher grades of VUR (p < 0.001). In terms of 30-day complications: Clavien-Dindo grade 3b events were reported in 2 RALUR patients, both requiring stent placement due to obstruction. During a median follow up of 21 months in the OUR and 16 months in the RALUR group (p = 0.68), both cohorts had similar rates of febrile UTI following surgery, with 7 (16%) patients in the OUR compared to 29 (21%) in the RALUR group (p = 0.66). Three patients had persistent VUR on postoperative VCUG that was managed with subureteral injection. In this single-institution cohort of contemporary patients undergoing UR, the RALUR approach had similar efficacy, complications and post-operative febrile UTI rate compared to the traditional open approach.