Duplex Ureter Research Articles

How to deal with an unsuspected and asymptomatic blind-ending duplex ureter?

How to deal with an unsuspected and asymptomatic blind-ending duplex ureter?

236.12: Selective Ureteric Stenting Is Non-inferior to Routine Stenting for Major Urological Complications Following Renal Transplant in Low-Risk Patients

Introduction: Major urological complications (MUC) are a significant source of morbidity following a renal transplant occurring in up to 4% of cases. At our institution it has been standard practice to routinely place a J-J ureteric stent across the ureteroneocystostomy at the time of transplant. Meta-analysis has shown reduced incidence of MUC in randomised-controlled trials of stenting with a number needed to treat of 14 to prevent 1 MUC. Despite the potential benefits of routine stenting, evidence suggests there may be no statistical difference between routine vs. selective stenting for low-risk patients in terms of complications such as urinary leak and ureteric obstruction suggesting equipoise for this sub-group. Also, stenting itself is associated with several complications and increased costs such as urinary tract infection (UTI), BK virus and the need to retrieve the stent through flexible cystoscopy. We hypothesised that in select low-risk patients not stenting would be non-inferior to routine stenting in the remainder of our patients. Study design: After local ethics approval, our prospective observational cohort study was run between June 2017 and June 2021. In this period 380 consecutive renal transplants were performed at our centre. 30 patients were excluded who had dual kidney (including paediatric en bloc) transplant, early graft loss not related to a MUC, duplex ureter in the donor or an intra-peritoneal implantation. Following this, 350 transplants were included for analysis, 240 were stented and 110 were not. Primary outcomes were MUC and UTI and secondary outcome was the incidence of BK viraemia. All transplants used the same technique for ureteroneocystostomy, the Lich-Gregoir anti-refluxing anastomosis. The same 3 surgeons performed or directly supervised each transplant. The decision of whether to stent was at the discretion of each surgeon based on suggested criteria. Stenting was suggested for multiple donor renal arteries, technically difficult surgery, high risk (e.g. obese) patients or surgeon concerns regarding the ureteric anastomosis. A 5Fr Cook UniversaTM ureteric stent was used when stenting was performed. Patients were followed from transplant for a minimum of 6-months. Results: MUC occurred in 6.25% of stented vs. 7.2% of the not stented groups. These included early (<10 days) and late urinary leak, haematuria requiring washout, hydronephrosis requiring nephrostomy and stent encrustation. Observed rates of urinary tract infection (28.7% vs. 26.3%) and BK viraemia (8.7% vs. 8.1%) were similar between groups. Conclusions: In our cohort of 350 renal transplants, selectively stenting low-risk patients did not result in a higher rate of MUC. Rates of UTI or BK viraemia were not significantly different. Finally, not needing to remove a stent in our selective group was associated with savings of an estimated $165,000 AUD over 3 years with no statistically significant difference in complications.

Complete Duplex of the Left Ureter with Lower Moiety Hydronephrosis Secondary to Ureteral Stone in Adult

Ureteral duplication is a common embryologic abnormality of the kidney with an incidence rate of 0.8% in adults. However, complete duplex ureters opening independently into the urinary bladder are rarely present. We report a 35-year-old female who presented with left flank pain in the last three years. Abdominal CT scan showed left complete duplicated system with lower moiety hydroureteronephrosis and obstructed midureteral stone. The patient underwent left retroperitoneal exploration with complete excision of the hydronephrotic sac. The postoperative course was uneventful without complications. In conclusion, a complete duplex kidney with lower moiety hydronephrosis caused by mid ureteric stone is rare. The renal duplication system should be diagnosed and followed with image guidance periodically as the late diagnosis may have poor outcomes with loss of the kidney or part of it.

A0635 - Duplex ureters in potential living kidney donors

A0635 - Duplex ureters in potential living kidney donors

"Duplex Ureter": ¿Are we Aware of this Uncommon Finding?

A 27-year-old, gravida 0 para 0, female presented herself for an evaluation of recurrent urinary tract infections and severe dysmenorrhea. The ultrasound revealed a bilateral small but complex adnexal mass, suggesting endometriosis (Figure 1). Ca 125 was 88 U. Laparoscopic surgery was performed, showing evidence of infiltrative endometriosis and entrapment of the right ureter on the right pelvic sidewall (Figure 2); During the initial anatomical inspection a duplicated ureter was diagnosed (Figure 3).

Ultrasonography of complete duplex ureter with paraurethral ectopic opening of the upper kidney ureter

Ultrasonography of complete duplex ureter with paraurethral ectopic opening of the upper kidney ureter

Diagnosis and management of ectopic ureter in a low resource setting – A case series

Aims: To review the experience of women and girls treated for ectopic ureter in Surkhet through the fistula camps and Fistula Treatment Centre and analyse the diagnostic method, management and outcome.&#x0D; Methods: This was a retrospective study of the patients with ectopic ureter who received treatment in Surkhet since 2009. Data were analysed from patient records and interviews.&#x0D; Results: Seven patients were diagnosed with ectopic ureter over a period of 12 years. Five patients were prepubertal with age range of 7 - 15 years. History of continuous incontinence with normal voiding was suggestive of ureteric fistula in six out of seven cases. The seventh case had massive ureterocele in the distal end of the duplex right ureter. Ultrasound suggested a diagnosis of duplex collecting system in five cases. IVU or CT IVU suggested duplex ureter in only three cases. Diagnosis was confirmed by examination under anaesthesia after i.v. frusemide in six cases. All cases were managed by implantation of the ectopic ureter into the bladder. In the case with ureterocele heminephrectomy was performed. All seven patients are well at follow-up between 6 months and five years after presentation. &#x0D; Conclusion: Ectopic ureter is a treatable cause of urinary incontinence and the diagnosis may be overlooked. A lifelong history of continuous urinary leakage with normal voiding, in absence of trauma or surgical procedure should raise the suspicion. Examination under anaesthetic and ultrasound proved most effective in confirming the diagnosis

P13 Finding an answer for an adolescent with back pain

Case report - IntroductionThis is the case of an adolescent referred to rheumatology following 5 years of back pain. After years of trying a number of treatments without much success, the cause was found to be a previously undiagnosed urological pathology. The case highlights awareness of non-rheumatological causes and incidental findings which can redirect a patient towards more appropriate treatment and reduce the potential for long-term adverse health issues and anxiety.Case report - Case descriptionB was referred age 16 to rheumatology with a 5-year history of lower back pain. She had previously seen paediatricians with symptoms initially attributed to constipation due to intermittent straining and hard stool. However, constipation remedies had not relieved the pain which progressed gradually to a more persistent dull ache with impact on daily activities. Various analgesics (including paracetamol and non-steroidal anti-inflammatories), exercises and acupuncture had not helped. There was no history of recurrent urinary tract infections or symptom correlation with fluid intake, menstruation or bowel habit. No inflammatory features or connective tissue disease symptoms were noted and family history was unremarkable Clinical examination was normal apart from mild tenderness in the lumbar region.Rheumatoid factor was borderline positive (15 iu/mL) with the rest of blood tests normal including renal function, inflammatory markers (CRP, ESR), anti CCP and ANA. She had minimal microscopic haematuria without proteinuria. MRI spine in 2015 was normal. In view of her young age and symptoms affecting daily activities, STIR sequence spinal MRI was requested. This excluded any new or old inflammatory changes but incidentally identified a dilated left pelvi-calyceal system.Renal ultrasound confirmed a grossly hydronephrotic left kidney with hydroureter and minimal renal tissue suggesting longstanding obstruction. No calculi were seen. The patient was referred to urologists. Further investigations (including MRI abdomen) confirmed similar findings and a distal ureteric stricture. A MAG 3 renogram showed a normal right kidney but only 12% functioning of the left kidney. Urologists have advised surgery (removal of left kidney and ureter) which may relieve symptoms or a conservative non-surgical approach (continue analgesia, physiotherapy and monitoring). The patient and her family are relieved to have a possible cause identified and are considering the surgical option due to ongoing flank discomfort. Case report - DiscussionThis was an interesting finding of hydroureter and hydronephrosis causing longstanding back pain presenting to rheumatologists. Until completion of the spondyloarthropathy protocol MRI (STIR images), aetiology had been unclear. Hydronephrosis and hydroureter has no specific age or racial predilection. Signs and symptoms may depend on whether obstruction is acute/chronic. Chronic cases may be asymptomatic or present as a dull discomfort (like this case). Some cases may only present in adulthood with pain precipitated by fluid intake. Blood tests may show impaired kidney function. Post-mortem studies suggest 50% of people have at least one renal abnormality (e.g., renal cysts, duplex ureters) with autopsy series incidence of hydronephrosis reported as 3.1%. Causes include anatomical abnormalities such as vesico-ureteric reflux, urethral strictures (usually present in childhood), calculi, benign prostatic hyperplasia, or intrapelvic neoplasms, pregnancy and infections (e.g., TB). Sudden onset unilateral renomegaly was reported in one case of primary Sjogren’s with lymphocytic interstitial nephritis and positive Sjogren’s autoantibodies. Our patient has no clinical or serological evidence of connective tissue disease.Minor pelvi-calyceal distension can occur as a normal finding in well-hydrated patients and pregnancy. However, significant hydronephrosis requires assessment to determine cause as it may affect long term renal function. Imaging via computed tomography, ultrasound and urograms can help guide further management.In this case the preceding cause and duration of pathology is unknown. Sterile, giant hydronephrosis treatment options include observation and ureteric stent or nephrostomy in patients unfit for surgery. Nephrectomy is advised for pain and recurrent infection in a non-functioning kidney. Complications may include bowel perforation, vascular injury and urine leakage. Both open and minimally invasive procedures have good reported outcomes. The COVID-19 pandemic and exams have affected timing of any elective procedures and the patient understands surgery may or may not offer complete symptom resolution.Case report - Key learning pointsNon-inflammatory causes of back pain should always be considered in cases of persistent back pain, particularly in young people to ascertain if there is a treatable causeHydronephrosis cases can be asymptomatic or present with vague, intermittent, non-specific abdominal symptoms with normal physical examination with or without haematuria. This can cause diagnostic uncertainty and delay referral to urology and appropriate renal investigations Assessment of renal function (including MAG 3 renogram) is important to guide further managementSurgical interventions (pyeloplasty/nephrectomy) may ease symptoms long term but there is no guarantee of a successful outcome and operative risks need to be considered tooLeft undiagnosed, potentially this patient could have had further disruption to daily activities and both physical and mental well being

V03-03 VESICOSCOPIC COMMON SHEATH COHEN’S REIMPLANT IN DUPLEX URETERS

INTRODUCTION AND OBJECTIVE:Vesicoscopic Cohen’s Reimplant (VCR) is a technically challenging procedure in pediatric age group. Handling duplex ureters during reimplant is even more challenging. Mob...

Surgical technique of uretero-ileal anastomosis in patients with bilateral duplex ureters undergoing radical cystectomy and ileal conduit urinary diversion: initial experience

Background We present a simple technique for construction of wide ureteral plate, consisting of four ureters, incorporated in ureteroileal anastomosis of ileal conduit urinary diversion. Methods We retrospectively reviewed the charts of six cases of ureteral duplication (five bilateral and one unilateral) and muscle-invasive bladder cancer, treated with radical cystectomy and ileal conduit diversion, at our institution from 2015 to 2020. Briefly, our technique includes construction of wide ureteral plate, consisting of four ureters from two separate ureteral units, after previous construction of right and left ureteral plates for each unit, according to the standard Wallace technique. Additionally, during construction of definite ureteral anastomotic plate, we used a modified Wallace I technique consisted of eversion of posteromedial ureteral walls of both ureteral units, with muco-mucosal running suture. Results Four males and two females underwent radical cystectomy with ileal conduit for muscle invasive bladder cancer. A total of 12 complications (CDC I–III) were registered in 4/6 (66.6%) patients, whereby ten of them (83.3%) occurred within 90 days post-surgery. High-grade (CDC III) complications were registered in 33.3% of patients. Within the first three months post-surgery, hydronephrosis and high-grade vesicoureteral reflux were associated with pyelonephritis and observed in two patients (33.3%), while uretero-intestinal anastomotic stricture or leakage were not detected during follow-up in any patients. Conclusion Modified Wallace uretero-ileal anastomosis after radical cystectomy and ileal conduit urinary diversion is functionally and cosmetically effective way to treat patients with bilateral duplex ureters harbouring muscle invasive bladder cancer.

Unilateral complete duplex ureter – report of a rare underdiagnosed anomaly

Unilateral complete duplex ureter – report of a rare underdiagnosed anomaly

A case report of duplex kidney and ureter abnormality accompanied with lower giant hydronephrosis

Duplex kidney and ureter abnormality are one of the most common malformation in urinary system, with most of patients present no apparent symptom, and only a few patients being complicated by ureter obstruction and serious hydronephrosis, which is difficult to differentiate with renal cyst. Therefore a case with duplex kidney and ureter abnormality was reported to provide information for clinical practice. Key words: Ureteral disease; Duplex kidney and ureter abnormality; Hydronephrosis

Transection of Duplex Ureter During Vaginal Hysterectomy

Duplex ureter, an embryological developmental anomaly, can lead to intra-operative injuries, even by surgeons with a stronghold on normal ureteric anatomy. We describe the first case of an ectopic ureter transected during vaginal hysterectomy performed for pelvic organ proplase, due to its abnormally low implantation into the bladder, worsened by cystocoele. The injury was recognised, and the duplex ureter was diagnosed with cystoscopy and retrograde pyelography. A post-operative computed tomography urogram allowed us to map the exact course. In this case, there was injury to the ectopic, non-functional ureter, thus averting any further intervention. However, lower urinary tract injuries are serious complications with high morbidity, especially during delayed diagnosis. Knowledge of the ureter variants, meticulous tracing of the course, and use of post-operative cystoscopy could reduce these complications, particularly in face of increasing minimally invasive approaches.

Horseshoe Kidney with Bilateral Duplex Ureters

Horseshoe Kidney with Bilateral Duplex Ureters

Robot-assisted laparoscopic common sheath ureteral reimplantation in duplex ureters: LUAA technique tips for optimal outcomes

To describe surgical tips for robot-assisted laparoscopic (RAL) common sheath ureteral reimplantation using the previously reported LUAA technique in patients with duplex renal collecting systems, and to assess the efficacy of this technique by reviewing operative outcomes in a single-institution case series. We retrospectively reviewed a consecutive series of patients with duplicated collecting systems and vesicoureteral reflux (VUR) who underwent RAL extravesical common sheath ureteral reimplantation at a single medical center from 2010 to 2017. We included all duplex ureters requiring antireflux surgery. A standardized technique (LUAA) was used in each case, with additional tips used as described herein: a) careful common sheath ureteral mobilization, b) wide detrusorotomy with adequate detrusor flap elevation from the mucosa, and c) appropriate tension during tunnel detrusorraphy. Patient demographics, perioperative data, and follow-up imaging were reviewed. Radiographic resolution was defined as absence of VUR on voiding cystourethrogram (VCUG) performed 4 months postoperatively. Only patients undergoing ureteral reimplantation for VUR were included. Those with ureterovesical junction obstruction were excluded. A total of 13 patients underwent RAL common sheath ureteral reimplantation, with three bilateral cases for a total of 16 duplicated ureters reimplanted. Mean age at surgery was 3.64±1.04 years. Mean operative time was 125.1±30.73min in unilateral cases and 200±51.18 in bilateral cases. Complete resolution of VUR was achieved in 14 of 16 ureters (87.50%). There were no high-grade complications (IIIV on the Clavien-Dindo scale). There were two grade II complications in our cohort, with a mean follow-up of 17.18±18.41 months. We report a radiographic success rate of 87.50% for RAL common sheath ureteral reimplantation in children with duplicated ureters, using the LUAA technique with several additional technical considerations. In our experience, careful mobilization of the ureter to preserve vascularity, a wide detrusorotomy to adequately elevate the detrusor flaps, and appropriate tension during detrusorraphy are essential components to optimize outcomes and prevent complications.

MP69-09 ARE DUPLEX REIMPLANTS WORTH LESS THAN SINGLE SYSTEM REIMPLANTS: AN ANALYSIS OF 30 DAY OUTCOMES

You have accessJournal of UrologyPediatrics: Urinary Tract Infection & Vesicoureteral Reflux1 Apr 2018MP69-09 ARE DUPLEX REIMPLANTS WORTH LESS THAN SINGLE SYSTEM REIMPLANTS: AN ANALYSIS OF 30 DAY OUTCOMES Kristina Suson, Janae Preece, and Yegappan Lakshmanan Kristina SusonKristina Suson More articles by this author , Janae PreeceJanae Preece More articles by this author , and Yegappan LakshmananYegappan Lakshmanan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2233AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The 2017 National Physician Fee Schedule allots 19.95 work relative value units (wRVUs) for single system ureteral reimplantation (SUR) but only 19.66 wRVUs for duplicated ureter reimplantation (DUR). We hypothesized that DUR would have perioperative outcomes reflective of more work on behalf of the surgeon and a higher complication rate than that of SUR. METHODS The American College of Surgeons National Surgical Quality Improvement Program data file was queried for ureteroneocystostomy, with anastomosis of single ureter (SU) or duplex ureters (DU) to bladder (50780, 50782) from 2012 - 2014. Patients who underwent concomitant reconstructive procedures, including ureteral tailoring (CPT code 50783), were excluded. Patients with 50780 as the primary code and 50782 as an additional procedure were analyzed with the DU group. The patients with DU were matched to those with SU by unilateral vs bilateral, gender, and age. Data points included: age, ASA class, type of surgeon, length of stay, operative time, and 30 day outcomes including complications, reoperations, and readmissions. RESULTS Of the 271 patients comprising each group, 79.3% were female and 20.7% were male. No significant differences were found in year of procedure (p=0.461), race (p=0.837), or operating specialty (p=0.478). The average age was 1425.0±41.9 days. Children undergoing DUR were more likely to have a lower ASA class (DUR: ASA 1 34.0%, ASA 2 62.0%, ≥ ASA 3 4.1%, SUR: ASA 1 29.2%, ASA 2 60.9%, ≥ ASA 3 9.2%; p=0.040). Nearly 30% of cases were bilateral. The operative time for children undergoing DUR was longer (151.5±4.0 vs 138.4±3.5 minutes, p=0.015). There was no difference in length of stay (1.9±0.1 days SUR vs 2.0±0.1 days DUR, p=0.528). Both procedures had a low complication rate (5.5% SUR vs 3.7% DUR, p=0.306). There was no difference in need for reoperation (0% SUR vs 0.7% DUR, p=0.499) or readmission (3.7% SUR vs 3.0% DUR, p=0.806). CONCLUSIONS Analysis of perioperative measures suggests that there is no justification for fewer wRVUs for duplex ureteroneocystostomy when compared to those performed on single systems. The operative time for DUR was longer, and despite a higher ASA class among children undergoing SUR, there was a similar length of stay, complication rate, and need for reoperation or readmission. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e928-e929 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kristina Suson More articles by this author Janae Preece More articles by this author Yegappan Lakshmanan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP69-05 PREDICTORS OF FAILURE IN 90 COMPLEX URETERS USING ROBOT-ASSISTED LAPAROSCOPIC SURGERY

You have accessJournal of UrologyPediatrics: Urinary Tract Infection & Vesicoureteral Reflux1 Apr 2018MP69-05 PREDICTORS OF FAILURE IN 90 COMPLEX URETERS USING ROBOT-ASSISTED LAPAROSCOPIC SURGERY Maria Veronica Rodriguez, Aaron Wallace, Nimrod Barashi, William Boysen, and Mohan S Gundeti Maria Veronica RodriguezMaria Veronica Rodriguez More articles by this author , Aaron WallaceAaron Wallace More articles by this author , Nimrod BarashiNimrod Barashi More articles by this author , William BoysenWilliam Boysen More articles by this author , and Mohan S GundetiMohan S Gundeti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2229AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robot-assisted laparoscopic ureteral (RALUR) reimplantation has been adopted as an alternative surgical approach to treat children with persistent high-grade vesicoureteral reflux (VUR). The debate continues in regards to the safety, feasibility and standardized technique. We performed a retrospective analysis of perioperative outcomes in patients undergoing RALUR; using our recent technique modifications to identify predictors of surgical failure. METHODS We reviewed a prospectively maintained database of children undergoing RALUR at a single-institution from 2010-2017. Only patients with high-grade VUR at age 5, urinary tract infections, or renal scarring were selected for surgical correction. This series included patients who received the previously reported LUAA technique, which stands for length of detrusor tunnel (L), U stitch (U), ureteral alignment suture (A), and the inclusion of ureteral adventitia (A). Patients with ureterovesical junction obstruction were excluded. Radiographic failure was defined as persistent VUR on postop VCUG. Complications were grade using Clavien-Dindo scale. Logistic regression analysis was used to determine predictors of failure. Significance was set at p<0.05. RESULTS A total of 63 patients (90 ureters) met inclusion criteria. Mean age was 68.41 months (4.32 yrs) and 75.38% were female. Our cohort included patients with complex anatomies, such as duplex ureters, bladder diverticulum, and post-deflux injection. Of the 90 ureters reimplanted 85.56% showed radiographic VUR resolution at 4-months. In our cohort of 63 patients, 10 (15.87%) presented with grade II complications and 1 (1.59%) with grade I. However, none presented grade III, IV or V complications. Out of the 13 ureters that failed surgery, 9 had preoperative high-grade VUR (IV-V) and concomitant complex anatomy features. On univariate analysis, length of the detrusor tunnel was associated with increased odds of radiographic failure after RALUR (p=0.01). (Table 1) CONCLUSIONS Using the LUAA technique, RAL surgery has shown to improve operative outcomes in children undergoing extravesical ureteral reimplantation for persistent high-grade and complex VUR. We observed that the length of the detrusor tunnel is a critical step to optimize outcomes and prevent complications while doing this operation. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e926-e927 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Maria Veronica Rodriguez More articles by this author Aaron Wallace More articles by this author Nimrod Barashi More articles by this author William Boysen More articles by this author Mohan S Gundeti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Unilateral duplex ureter

A routine cadaveric dissection of a 77 year old female with metastatic breast cancer demonstrated an ectopic unilateral left duplex ureter. The duplicated ureters originated separately at the renal pelvis, communicating 2 cm below the originating point. This anatomical variant is estimated to represent 1% of all renal tract anomalies, occurring in 0.5% of the total population. The clinical outcomes of duplex ureters are well documented in current literature.

Pitfalls of the duplex system: the mystery of the missing stone

A duplex ureter constitutes about 1% of the renal tract anomalies.A 39-year-old man presented with a 4-week history of left loin pain and microscopic haematuria. Investigation with a non-contrast CT...

Multi-Institutional Review of Outcomes and Complications of Robot-Assisted Laparoscopic Extravesical Ureteral Reimplantation for Treatment of Primary Vesicoureteral Reflux in Children

Robot-assisted laparoscopic extravesical ureteral reimplantation has been proposed as a minimally invasive alternative to open ureteral reimplantation for correcting primary vesicoureteral reflux in children. However, in the current literature there are conflicting data regarding the safety and efficacy of this approach. Amid ongoing debate we analyzed outcomes and complications from this procedure in a large multi-institutional cohort. We reviewed the records of children who underwent robot-assisted laparoscopic extravesical ureteral reimplantation at 9 academic centers from 2005 to 2014. Radiographic failure was defined as persistent vesicoureteral reflux on postoperative voiding cystourethrogram or radionuclide cystogram. Complications were graded using the Clavien-Dindo scale. A total of 260 patients (363 ureters) underwent robot-assisted laparoscopic extravesical ureteral reimplantation for primary vesicoureteral reflux during the study period. The cohort included 90 patients with either duplex ureter (42), failed endoscopic treatment (40) or concomitant diverticulectomy (8). Of the 280 ureters with postoperative voiding cystourethrogram or radionuclide cystogram available radiographic resolution was seen in 246 (87.9%). There were 25 complications overall (9.6%), with 7 grade 3 complications (2.7%) and no grade 4 or 5 complications. Four patients (3.9%) had transient urinary retention following bilateral reimplantation. Robot-assisted laparoscopic extravesical ureteral reimplantation has a low complication rate consistent with published series of open ureteral reimplantation. Radiographic success rates are approaching those of the open procedure but continue to fall short of the gold standard approach. These findings necessitate critical thinking regarding potential technique improvements and further prospective investigation into the efficacy of this procedure.