Extravesical Ureteral Reimplantation Research Articles

Results of a previously unreported extravesical ureteroneocystostomy technique without ureteral stenting in 500 consecutive kidney transplant recipients.

Urologic complications can still occur following kidney transplantation, sometimes requiring multiple radiological and/or surgical procedures to fully correct the problem. Previously proposed extravesical ureteral reimplantation techniques still carry non-negligible risks of the patient developing urologic complications. About 10 years ago, a new set of modifications to the Lich-Gregoir technique was developed at our center, with the goal of further minimizing the occurrence of urologic complications, and without the need for initial ureteral stent placement. It was believed that an improvement in the surgical technique to minimize the risk of developing urologic complications was possible without the need for stent placement at the time of transplant. In this report, we describe the advantages of this technique (i.e., mobilized bladder, longer spatulation of the ureter, inclusion of bladder mucosa with detrusor muscle layer in the ureteral anastomosis, and use of a right angle clamp in the ureteral orifice to ensure that it does not become stenosed). We also retrospectively report our experience in using this technique among 500 consecutive (prospectively followed) kidney transplant recipients transplanted at our center since 2014. During the first 12mo post-transplant, only 1.4%(7/500) of patients developed a urologic complication; additionally, only 1.0%(5/500) required surgical repair of their original ureteroneocystostomy. Five patients(1.0%) developed a urinary leak, with 3/5 having distal ureteral necrosis, and 1/5 subsequently developing a ureteral stricture. Two other patients developed ureteral stenosis, one due to stricture and one due to ureteral stones. These overall results are excellent when compared with other reports in the literature, especially those in which routine stenting was performed. In summary, we believe that the advantages in using this modified extravesical ureteroneocystostomy technique clearly help in lowering the early post-transplant risk of developing urologic complications. Importantly, these results were achieved without the need for ureteral stent placement at the time of transplant.

Reimplante ureteral extravesical con técnica de Lich Gregoir

Se presenta el caso de una paciente femenina de 55 años de edad, que durante una histerectomía videolaparoscópica, se notó la presencia de orina libre en cavidad abdominal, se llamó a la unidad de urología para evaluación transoperatoria, quienes identificaron sección completa del uréter derecho en la unión ureterovesical. En el mismo tiempo quirúrgico se realizó reimplante ureteral extravesical con técnica de Lich Gregoir por la unidad de urología.

Results of laparoscopic extravesical antireflux operation in vesicoureteral reflux in children

The objective was to improve the results of surgical treatment of vesicoureteral reflux in children, using laparoscopic access. The prospective study was performed in 111 children (137 ureters) with the primary III–IV grade vesicoureteral reflux. The mean age was 34.7 months. The modified laparoscopic antireflux technique was performed on 73 children (91 ureters). We compared the perioperative complications and the medium-term outcome with a group of 38 children (46 ureters) who underwent classical laparoscopic extravesical reimplantation.3 In the modified group, the mean surgery time was 109.8 ± 31.5 minutes for unilateral cases and 176.5 ± 47.6 minutes for bilateral cases; in the classical group, it was 118.6 ± 34.3 and 209.5 ± 51.2 minutes respectively (p > 0.05). Postoperative vesicoureteral reflux had 2 (2.7 %) patients in the main group and 8 (21.1 %) children in the control group (p = 0.002). There was no ureteral obstruction in the both groups. The success rate for ureters was 97.8 % with modified technique versus 82.6 % after classical laparoscopic reimplantation (p = 0.003). Laparoscopic extravesical ureteral reimplantation is a safe and effective surgical procedure. The modified technique may improve the surgical treatment results.

Effectiveness of Ureteric Reimplantation on Non-Refluxing Obstructive Congenital Megaureter

Background: One in ten thousand children born with megaureter. A significant portion of this groups are of obstructed variety and the rest are refluxing ureter. It can cause obstructions and back pressure renal damage. Early diagnosis and treatment can stop deterioration of renal function and prevent complications like renal failure. Definitive treatment is uretero-neocystostomy with or without tailoring the ureter. Objective: Objective of this study was to observe the effectiveness of ureteric reimplantation on non-refluxing obstructive congenital megaureter. To achieve this objective we had observed serum creatinine level pre and postoperatively and assessed structural changes in kidney by ultrasonogram, IVU, MCU and RGP pre and postoperatively. We also observed the split renal function and split GFR of the affected kidney both pre and post operatively. Methods: This was a cross-sectional observational study. This study comprise of 35 cases of congenital non-refluxing obstructed megaureter, who were admitted in BIRDEM General Hospital and multiple other hospitals in Dhaka city from July 2013 to December 2014. Diagnosis was made by intravenous urography (IVU) reveling a dilated lower third or entire ureter with narrow tapering lower end. Obstruction was also confirmed by diuretic Tc99m DTPA scan. A voiding cystourethrogram was obtained to exclude VUR. Those with poor renal function were evaluated by ultrasonography, DTPA scan and retrograde ureteropyelography. Results: Of 35 patients, 20 were male and 15 were female. Age range 2 to 19 years. All patients underwent ureteric reimplantation, with tailoring in 15 cases. Post-operative mean serum creatinine was 0.99±0.34 which showed improvement. Split function in DTPA renogram and split GFR of patient with POM in the affected right side also showed improvement (29.49±4.02 and 29.64±4.86) as well as affected in left side (27.77±4.18 and 28.02±5.31). Conclusion: Ureteral tailoring with an extravesical ureteral reimplantation can be performed safely and effectively for primary obstructive megaureter. It is found that, ureteroneocystostomy ensured free renal drainage and preserved renal function as well as prevented complications and further deterioration. Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p 20-24

Robot-assisted laparoscopic extravesical versus conventional laparoscopic extravesical ureteric reimplantation for pediatric primary vesicoureteric reflux: a systematic review and meta-analysis.

To perform a systematic review and meta-analysis comparing the outcomes of robotic-assisted laparoscopic extravesical ureteric reimplantation (RALUR) with conventional laparoscopic extravesical ureteric reimplantation (LEVUR) for primary vesicoureteric reflux in children. We searched the databases to identify all papers of RALUR and LEVUR between 2001 and 2020. Systematic review was performed to identify patient data, age, reflux grades, laterality, duration of surgery, time to discharge, success rate and complications. Heterogeneity was reported with I2 statistics and publication bias was assessed by Doi curve and Luis Furuya-Kanamori index. Pooled data from both groups were compared with Student's t test and Fisher's exact test, wherever appropriate. From a total of 43 articles screened, 28 articles were included (18 RALUR and 10 LEVUR). The I2 statistics for RALUR and LEVUR showed heterogeneity of 86% and 25%, respectively. Both groups had comparable minor publication bias. RALUR had higher proportion of grade 5 VUR (p < 0.001) and bilateral reimplantations (p < 0.001). The success rate of RALUR was significantly lower than that of LEVUR (97.6% vs. 93.4%, p = 0.0018). RALUR took a significantly longer duration for surgery compared to LEVUR, both for unilateral and bilateral cases (p < 0.001). The complication rate was not significantly different: 6.6% for RALUR and 5.35% for LEVUR (p = 0.32). The most common complication in both groups was post-operative urinary retention in bilateral cases. Articles on LEVUR reported more consistent success. RALUR series had higher proportion of grade 5 cases and bilateral reimplantations. RALUR reported longer operative time and lower success compared to LEVUR, with a complication rate comparable to LEVUR.

Intravesical and extravesical ureteral reimplantation in children with bilateral refluxing megaureter: comparison of results

Introduction. Extravesical ureteral reimplantation is an accepted technique for the surgical treatment of high-grade vesicoureteral reflux. However, many surgeons continue to use an intravesical technique, including for the megaureter. We present our experience and outcomes with these techniques for primary bilateral refluxing megaureter.Purpose of the study. To improve the results of surgical treatment of refluxing megaureter in children.Materials and methods. A retrospective study was performed of 95 patients who underwent ureteral reimplantation between 2006 and 2019. The age of patients at the time of surgery was from 4 months to 13 years (median — 27.6 months), boys were 71 (74.7%), girls were 24 (25.3%). All patients are divided into 2 groups depending on the method of treatment. Group 1 consisted of 65 patients who underwent Cohen single-stage bilateral transvesical ureteral reimplantation. Group 2 included 30 children who underwent two-stage Barry extravesical ureteral reimplantation. The interval between operations was from 1 to 63 months (median — 5.2 months). Patient demographics, surgical technique and outcomes were recorded. A successful postoperative outcome was defined as improved hydronephrosis and no vesicoureteral reflux.Results. Median follow-up period was 3.2 years. The overall success rate was 80% for patients and 88% for ureters. Postoperative grade III – IV reflux had 15 patients (15,8%) and 16 ureters (8,4%). Persistent ureterohydronephrosis had 4 children (4,2%) and 6 ureters (3,2%). The effectiveness of treatment for patients in the Cohen group was 77%, in the Barry group — 87% (p = 0.408), for ureters — 86% and 93%, respectively (p = 0.223). The difference was not significant despite the higher effectiveness extravesical technique.Conclusion. Extravesical and transvesical ureteral reimplantation are effective methods of treatment for bilateral refluxing megaureter in children.

Robot-assisted laparoscopic diverticulectomy with ureteral reimplantation

The objective is to describe our experience with robot-assisted laparoscopic diverticulectomy with extravesical ureteral reimplantation in a pediatric patient. A 7-year-old male presented with a symptomatic urinary tract infection secondary to Staphylococcus epidermidis. The patient was found to have a large congenital paraureteral bladder diverticulum on work-up. His options were discussed and he proceeded with robotic diverticulectomy. Intraoperatively, the diverticulum was found to obscure the left ureteral orifice, which necessitated synchronous dismembered extravesical ureteral reimplantation. Robot-assisted laparoscopic diverticulectomy with extravesical ureteral reimplantation was performed. The procedure time was 283min, and estimated blood loss was 3mL. The patient was discharged home on post-operative day 1. He was last seen in clinic six months after surgery and was doing well without any recurrent urinary tract infections. This video demonstrates a robotic approach for the treatment of complex congenital bladder diverticula. Robotic surgery offers the benefits of good visualization in the pelvis, minimal blood loss, and quick convalescence. Key portions of the diverticulectomy and ureteral reimplantation are clearly illustrated in this video, which can help other surgeons adopt this technique.

Is Urinary Retention Following Extravesical Ureteral Reimplantation Still a Concern?

Transient urinary retention is a known complication of bilateral extravesical ureteral reimplantations. Recent studies have shown that the robotic-assisted bilateral extravesical reimplantation may have lower transient urinary retention rates than previously reported for the open approach. The purpose of this review is to compare urinary retention incidence in patients undergoing open versus robotic-assisted extravesical reimplantations. In some of the larger series, open bilateral extravesical ureteral reimplantation was noted to have a temporary urinary retention rate of 4–15%. In our recent experience with the open approach, we have noted a 2% incidence of transient urinary retention. In recent series of robotic-assisted bilateral extravesical reimplantations, transient retention was seen in 0–22%, with larger series favoring lower urinary retention rates. The incidence of transient urinary retention following open or robotic-assisted approaches in recent series is 0–2%, which is almost negligible. Dysfunctional elimination syndrome symptoms and constipation need to be aggressively treated preoperatively. Families of patients who undergo bilateral extravesical ureteral reimplantations, regardless of whether it is performed via the open or robotic-assisted approach, should not only be counseled of the small risk of transient urinary retention but should also be told that this can also be seen with any other surgical approach for the repair of primary vesicoureteral reflux.

Laparoscopic extravesical ureteral reimplantation of primary obstructive megaureter in children

Laparoscopic extravesical ureteral reimplantation of primary obstructive megaureter in children

WITHDRAWN: Open versus Robot-assisted Laparoscopic Ureteral Reimplantation: Hospital Charges Analysis and Outcomes at a Single Institution

Robot-assisted laparoscopic extravesical ureteral reimplantation has previously been described as a viable minimally invasive option to open surgery. However, concerns for robotic surgery have been raised owing to assumed higher costs and heterogeneous clinical outcomes. We hypothesized that similar hospital charges and clinical outcomes occur when comparing open and robotic cases in matched cohorts. Open and robotic reimplantation cases from 2013 to 2015 for primary vesicoureteral reflux were matched by age using 1:1 nearest neighbor matching. The matched cohorts were analyzed and compared for their direct itemized hospital charges per surgical case, complications, and clinical outcomes. There were 38 patients in each group after age-matching the 135 patients. Operating room charges were higher for the robotic group compared to the open group (p=0.002), whereas pharmacy and laboratory costs were lower for the robotic group. However, there were no significant differences in total overall charges between the open and robotic groups with cystoscopy or without cystoscopy (p=0.345, p=0.533), since the median hospital stay length was shorter for the robotic group (p<0.001). Clinical success rates were identical for the two groups (open 94.8% vs robotic 94.8%). There were also no significant differences in number of complications between the two cohorts. This is the first age-matched study comparing hospital charges and clinical outcomes of pediatric open and robotic reimplantation. While operating room charges were higher for the robotic cohort, lower hospitalization charges led to comparable overall hospital charges, as well as equivalent clinical outcomes for both cohorts. Level III (Retrospective comparative study) TYPE OF STUDY: Retrospective Study.

Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot-assisted approach: results of a multicentre international survey.

To assess and compare postoperative bladder dysfunction rates and outcomes after laparoscopic and robot-assisted extravesical ureteric reimplantation in children and to identify risk factors associated with bladder dysfunction. A total of 151 children underwent minimally invasive extravesical ureteric reimplantation in five international centres of paediatric urology over a 5-year period (January 2013-January 2018). The children were divided in two groups according to surgical approach: group 1 underwent laporoscopic reimplantation and included 116 children (92 girls and 24 boys with a median age of 4.5years), while group 2 underwent robot-assisted reimplantation and included 35 children (29 girls and six boys with a median age of 7.5years). The two groups were compared with regard to: procedure length; success rate; postoperative complication rate; and postoperative bladder dysfunction rate (acute urinary retention [AUR] and voiding dysfunction). Univariate and multivariate logistic regression analyses were performed to assess predictors of postoperative bladder dysfunction. Factors assessed included age, gender, laterality, duration of procedure, pre-existing bladder and bowel dysfunction (BBD) and pain control. The mean operating time was significantly longer in group 2 compared with group 1, for both unilateral (159.5 vs 109.5min) and bilateral procedures (202 vs 132min; P = 0.001). The success rate was significantly higher in group 2 than in group 1 (100% vs 95.6%; P = 0.001). The overall postoperative bladder dysfunction rate was 8.6% and no significant difference was found between group 1 (6.9%) and group 2 (14.3%; P = 0.17). All AUR cases were managed with short-term bladder catheterization except for two cases (1.3%) in group 1 that required short-term suprapubic catheterization. Univariate and multivariate analyses showed that bilateral pathology, pre-existing BBD and duration of procedure were predictors of postoperative bladder dysfunction (P = 0.001). Our results confirmed that short-term bladder dysfunction is a possible complication of extravesical ureteric reimplantation, with no significant difference between the laparoscopic and robot-assisted approaches. Bladder dysfunction occurred more often after bilateral repairs, but required suprapubic catheterization in only 1.3% of cases. Bilaterality, pre-existing BBD and duration of surgery were confirmed on univariate and multivariate analyses as predictors of postoperative bladder dysfunction in this series.

Laparoscopic extravesical ureteral reimplantation for correction of primary and secondary megaureters: Preliminary report of a new simplified technique

PurposeTo describe a simplified surgical technique for the treatment of primary and secondary obstructed megaureters in children by laparoscopic extravesical ureteral reimplantation (LEUR) and evaluate the short-term outcomes. MethodsProspective study of children with primary and secondary megaureters treated at our institution between 2016 and 2018 by LEUR. A transperitoneal approach was used in all cases. The distal ureter was transected at the level of the stenosis. Detrusor muscle fibers were divided to expose bladder mucosa. The distal ureter was introduced into the bladder to create a valve-like mechanism. The ureter was fixed to the bladder mucosa by four stitches. We analyzed indications for surgery, complications and outcomes. Definition of success was relieved of obstruction and absence of VUR. ResultsSix patients with a mean age of 28.83 months (SD: 21.4) underwent LEUR. Indications for surgery were: infection [2], obstruction [2], decrease in renal differential function [1] and increase in hydronephrosis [1]. There were no intraoperative complications. Resolution of hydronephrosis, obstruction and VUR was achieved in all cases. Mean follow-up was 13 months (SD: 6.67). ConclusionLEUR for the correction of primary and secondary megaureters by this new technique is safe. The most important advantage is that this technique is simpler and more easily reproducible than conventional LEUR. However, long-term follow-up is required. Type of studyProspective, observational. Level of evidenceLevel III.

Laparoscopic repair of female genitourinary fistulae: 10-year single-center experience

Laparoscopic repair of different female genitourinary fistulae has been recently reported, including both conventional and laparoendoscopic single-site surgery (LESS). We present our 10-year single-center experience of the laparoscopic repair of different types of female genitourinary fistulae. A retrospective analysis of our records over the last 10years was performed. Type of fistula, etiology, laparoscopic approach, operative data, postoperative outcome, and follow-up were recorded. Overall, 46 patients with laparoscopic repair of genitourinary fistulae were reported: 25 had vesicovaginal fistulae (VVF), 14 had vesicouterine fistulae (VUF), and 7 had ureterovaginal fistulae (UVF). Thirty-three patients had conventional laparoscopic repair, whereas 7 VVF and 6 VUF had LESS repair. In all patients with VVF and VUF, extravesical repair was carried out by excising the fistulous tract and closing both the bladder and the vagina or the uterus with interposing tissue in-between. In patients with UVF, extravesical ureteric re-implantation was performed. Mean operative time was 176 ± 25min. Mean blood loss was 105 ± 25 cc. No intraoperative or postoperative complications occurred. None was converted to open surgery. Mean postoperative hospital stay was 3.2 ± 1.2days. After a mean follow-up of 6.3 ± 3.1years, all patients had undergone successful repair, except for one patient with complex VVF. Laparoscopic repair of VVF, VUF, and UVF is a feasible procedure with a high success rate and low morbidity. LESS repair of VVF and VUF has a comparable success rate to conventional laparoscopy, but with a shorter hospital stay and fewer analgesic requirements.

Extravesical Ureteral Reimplantation Following Lich-Gregoir Technique for the Correction of Vesico-Ureteral Reflux Retrospective Comparative Study Open vs. Laparoscopy.

Introduction: The aim is to compare the outcome of open versus laparoscopic Lich-Gregoir technique in patients with vesicoureteral reflux. We report a retrospective multicenter comparative study between open and laparoscopic extra-vesical ureteral reimplantation (EVUR) following Lich-Gregoir (LG) technique for the correction of Vesico-Ureteral Reflux (VUR).Materials and Methods: Between January 2007 and December 2015, 96 patients with VUR (69 females and 27 males) and deterioration of the renal function, underwent EVUR following LG technique. Fifty patients (16 males and 34 females) were operated by open surgery (group A). The mean age was 4.22 years-old, (14–147 months). Laparoscopic approach (group B) was performed in 46 patients (11 males and 35 females). The mean age was 4.19 years-old (15–110 months). We compared the results in relation to degree of VUR, operative time, hospital stay, post-operative pain medications, recovery time, complications, successful rate, recurrence, and follow-up. Statistical analysis was done used Chi square test for categorical variables and the Student t-test for continuous variables. P < 0.05 was considered significant.Results: In both groups no correlation was identified between age or weight and operative time, length of stay or total analgesia used. The mean operative time for group A was 63.2 and 125.4 min for unilateral and bilateral VUR, respectively, and for the group B was 127.90 and 184.5 min, respectively. There was no conversion in the laparoscopic group. Perioperative mucosal perforation of the bladder occurred in 6 patients of group A and 4 patients of group B and was immediately repaired. One patient had to be reoperated for leakage in group B. The mean duration of Morphine, IV and PO analgesia was shorter in group B. The mean hospital stay was 5.46 days for group A and 1.54 days for Group B. The success rate was 98% in group A and 97, 8% in group B. The mean follow-up was 3.67 years for the open and 1.54 years for the laparoscopic group. Transitory voiding dysfunction occurred in bilateral EVUR in one case in each group.Conclusion: Laparoscopic or Open approach for the correction of VUR following Lich-Gregoir technique is effective in unilateral and bilateral VUR with similar results. Laparoscopic approach reduces significantly (p < 0.05 in each item) post-operative pain medication, hospital stay, and allows for a faster return to normal activity.

Outpatient robotic unilateral extravesical ureteral reimplantation in the pediatric population: short-term assessment of safety

PurposeRobotic extravesical ureteral reimplantation has been established as a viable option for surgical management of vesicoureteral reflux. Typically, this procedure is associated with a hospital stay for routine postoperative care. The aim of the study was to assess the short-term safety of robotic unilateral extravesical ureteral reimplantation as a scheduled outpatient procedure in a pediatric population. Material and methodsA retrospective cohort study was performed for patients who underwent robotic extravesical ureteral reimplantation between June 2012 and January 2018. No regional blocks were performed. Patients were discharged from the post anesthesia care unit without an extended stay, as a scheduled outpatient procedure. Postoperative outcomes included 30-day Emergency Room (ER) visits, readmissions, and Clavien-Dindo (CD) grade I-V complications. ResultsA total of 27 patients were identified (4 males, 23 females). Median age was 85 months (range 27-210). Median weight was 26 kilograms (range 13-97). Median robotic console time was 140 minutes (range 84-257). No patients required a hospital stay for pain management. Two (9%) patients required unplanned antibiotic therapy postoperatively (CD grade II) for management of bacterial cystitis and pneumonia. The patient with pneumonia was diagnosed during a subsequent ER visit. One patient was admitted on postoperative day 4 because of constipation. No CD grade III or higher complications were observed for any patient. ConclusionsRobotic unilateral extravesical ureteral reimplantation is safe as an outpatient procedure in the pediatric population. Further evaluation is warranted to assess its short- and long-term outcomes on a larger scale.

V7 - Laparoscopic extravesical ureteral reimplantation with the LUAA technique in an adult patient

V7 - Laparoscopic extravesical ureteral reimplantation with the LUAA technique in an adult patient

Unilateral open extravesical ureteral reimplanation with contralateral dextronomer/hyaluronic acid injection performed as an outpatient therapy

Historically, patients with unilateral high-grade vesicoureteral reflux (VUR) and contralateral low-grade or resolved VUR have been treated with bilateral intravesical ureteral reimplantation, which requires postoperative admission. If the high-grade VUR side is treated alone, then the contralateral side is at risk of developing recurrent or worsening VUR. Bilateral subureteric injection of dextronomer/hyaluronic acid (DHA) is another option that can be performed as an outpatient therapy, but a single injection is less effective for high-grade VUR. The safety and efficacy of an outpatient combination of open extravesical ureteral reimplantation (EVUR) and contralateral DHA injection were investigated. A retrospective review of children who had concomitant EVUR and subureteric injection of DHA between January 2005 and December 2015 was performed. Exclusion criteria were diagnosis other than VUR, repeat procedures, and patients with no follow-up. Patient characteristics, postsurgical complications, and follow-up imaging were evaluated. Febrile urinary tract infection (fUTI) was defined as ≥50,000Colony Forming Units (CFU) of an organism from clean-catch or catheterized urine and temperature ≥101.5F. Clinical success is defined as no fUTI for 1 year after the initial operation. Univariate analyses were used to identify risk factors for treatment failure. A total of 117 patients met inclusion criteria. Mean age at surgery was 6.0 years, and 85% were female. The mean pre-operative grade of VUR was 3.3 on the EVUR side and 0.6 on the contralateral side (42% resolved before treatment). Median follow-up was 12.2 months (interquartile range, 3.1-25.4). Sixteen patients (14%) had documented fUTI within 1 year, with a clinical success rate of 86%. Of these, five had a postoperative imaging showing resolution of VUR, increasing overall success to 91%. Postoperative fUTI was more common in patients with pre-operative bowel and bladder dysfunction (BBD) (P=0.003), but this was not associated with a higher reoperation rate (P=0.168). There were 11 total complications, with three grade 3 complications. This study is the first to report safety and outcomes of EVUR and contralateral DHA injection for patients with high-grade VUR with contralateral low-grade or resolved VUR. It was shown that it is an effective and safe treatment that can be performed as an outpatient therapy. Limitations to this study include the retrospective designand the clinical definition of success that is used in a cohort of patients from across the mountain west region without routine postoperative voiding cystourethrogram. Extravesical ureteral reimplantation and contralateral DHA injection can safely be performed as an outpatient therapy and are effective in the treatment of higher grade VUR with contralateral low-grade or resolved VUR. Treatment failure is more likely in patients with BBD.

Robotic-assisted laparoscopic ureteral re-implant (RALUR): Can post-operative urinary retention be predicted?

Urinary retention following robotic-assisted laparoscopic extravesical ureteral reimplantation (RALUR) is proposed to be due to traction or injury of the pelvic parasympathetic nerve plexus during distal ureteral dissection. Nerve-sparing techniques have been employed to avoid injury to the pelvic plexus, either directly or indirectly. This single-center study assessed postoperative urinary retention rates after extravesical RALUR and investigated whether demographic or operative factors could predict this occurrence. All RALUR cases entered into an Institutional Review Board-approved registry were retrospectively reviewed, and the rate of postoperative retention was determined. Postoperative urinary retention was defined as the need for catheterization at any time in the postoperative period during hospital admission or within 1 week after the operation. This included acute urinary retention episodes (AUR) as well as high post-void residuals (>50% of expected bladder capacity). Univariate analysis was performed to analyze for predictors of postoperative retention. Factors assessed included age, gender, clinical presentation, bowel bladder dysfunction (BBD), pre-operative urinary tract infection (UTI), procedure length, grade of vesicoureteral reflux (VUR), and operative laterality. A total of 128 patients underwent extravesical RALUR in 179 ureters during the study period 2012-2016. Male:female ratio was 1:2.6. Median age at surgery was 4 years. Bilateral RALUR was performed in 52 cases (40.6%), and unilateral in 76 (59.4%). Urinary retention requiring catheterization occurred in 11 cases (8.59%). Of these, seven were post-bilateral RALUR, while the remaining four were unilateral. In seven cases, postoperative retention occurred within 24h following RALUR. The remaining four instances occurred within 1 week, despite successful voiding in the immediate postoperative period. Univariate analysis revealed male gender (P=0.009) and operating room time (P=0.029) as predictors of retention. No association was found with age, weight, BBD, pre-operative UTI, grade of VUR, or laterality. Urinary retention after RALUR was an infrequent complication. When it did occur, urinary retention appeared to be secondary to covariates such as male gender and length of surgical time - possibly an indication of technical difficulty - rather than laterality of repair.

V32 - Laparoscopic extravesical ureteral reimplantation with the LUAA technique in an adult patient

V32 - Laparoscopic extravesical ureteral reimplantation with the LUAA technique in an adult patient

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 ...