Ureteral Reimplantation Research Articles

Results of primary obstructive megaureter treatment using high-pressure balloon dilatation of ureterovesical junction in children

Aim. To evaluate the age dependence of efficacy and safety in high-pressure balloon dilatation (HPBD) for primary obstructive megaureter (POM) in children under 2 years.
 Materials and methods. From 2020 to 2022, we performed a single-center, unblinded study, with a total of 200 children, treated with HPBD for POM: 117 boys and 83 girls. Study included patients from 1 month to 2 years. The follow-up period was 1 year.
 Results. In this series the overall treatment effectiveness was 92.5%. In 15 cases treatment was not effective and these children proceeded with ureteral reimplantation. We didn’t achieve positive treatment results in children older than 15 months and our statistical model was not significant for failed cases. Treatment failure we presumed to be due to hard to dilate severe stenosis and extreme length of the stenotic area.
 Conclusion. In our study we found HPBD of uretero-vesical junction to be safe and effective method for treatment of primary obstructive megaureter in young children. The overall success rate was 92.5%. We recommend considering HPBD as the first line treatment for POM in young children. In failure cases we suggest to perform ureteral reimplantation.

Small Animal Ovariohysterectomy and Avoidance of Associated Complications in Pet Practices Across Pakistan: A Current Perspective

Ovariohysterectomy (OVH) is a routine surgical procedure in small animal practices for sterilization and management of several uterine diseases, namely pyometra, cystic endometrial hyperplasia, uterine tumors, rupture, and torsion. Ovariohysterectomy (OVH) offers numerous clinical advantages, but post-operative complications could pose financial challenges for veterinarians due to the inherent risk of malpractice suits and clients owing to the extended recovery period for their pets. The authors reviewed about two dozen peer-reviewed English language articles from PubMed, Scopus, Web of Science, and Google Scholar databases to identify risks and avoidance strategies following OVH. These may include the ones arising from celiotomy (infection, incisional hernias, wound dehiscence, inadvertent injury to organs and adhesions) or affections, such as intraoperative hemorrhage, stump pyometra, ovarian remnant syndrome, ureteral ligation, urinary incontinence, granulomas, fistulous tracts, post-surgery weight gain, and eunuchoid syndrome. This review emphasizes prevention and management methods for each of these complications. Effective surgical techniques play a vital role in preventing hemorrhage, while meticulous resection, ligation, and omentalization of uterine stump reduce the risk of stump pyometra. Complete removal of ovarian tissue and systematic exploration prevent ovarian remnant syndrome. The use of advanced imaging methods, such as ultrasound, fluoroscopy, or CT scans, can greatly aid in identifying and preserving ureters during surgical procedures, thus minimizing the risk of ureteral complications. Strategies to address urinary incontinence, granulomas, and post-surgery weight gain might encompass the use of hormonal therapy involving estradiol analogs or the application of precise surgical techniques involving ureteral reimplantation. Innovative strategies such as auto-transplantation of ovaries are suggested for managing eunuchoid syndrome, while inadvertent prostatectomy and bowel obstruction may simply be avoided by better tissue handling and dissection. In summary, optimizing surgical protocols, incorporating CT scans, using appropriate drug therapies, and continuous education within the veterinary community are crucial for reducing complications associated with OVH.

National Postoperative Opioid Prescribing Rates Following Pediatric Urology Procedures Before and After the 2018 American Academy of Pediatrics Challenge to Reduce Opioid Prescribing: A Claims Database Analysis

ObjectiveTo evaluate trends in opioid prescribing rates following pediatric urologic surgery. MethodsWe queried the TriNetX Research database for patients under age 18 who underwent one of seven common pediatric urology procedures. We identified the proportion of patients that received an oral opioid prescription within 5 days of surgery. The primary analysis evaluated the trend inpostoperative opioid prescriptions using 3-month intervals from January 2010 to December 2022. We performed an interrupted time series analysis assessing trends in opioid prescribing patterns both before and after the AAP challenge. ResultsOf the 81,644 pediatric urology procedures, 29,595 (36.2%) received a postoperative opioid prescription, including 29.8% of circumcisions, 25.8% of hydrocelectomies, 39.6% of hypospadias repairs, 42.7% of pyeloplasties, 42.8% of ureteral reimplants. For all procedures we observed rising rates of opioid prescribing, increasing by 0.9% per 3-month interval prior to the challenge statement release from 2010-2018. We observed an overall significant decrease in opioid prescribing by 2.2% per 3-month interval following the challenge statement release. Additionally, since 2018, there was a significant decrease in opioid prescribing in all of the race, ethnicity, and age cohorts. ConclusionsOpioid prescribing following pediatric urology procedures has sharply decreased following the 2018 AAP challenge statement which underscores the value of cross-specialty quality improvement initiatives. Nonetheless, opioid prescribing remains high with potential racial or age disparities that warrant further investigation.

Commentary to a multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV–V) vesicoureteral reflux

Commentary to a multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV–V) vesicoureteral reflux

Single-port-plus-one robot-assisted laparoscopic modified Lich-Gregoir direct nipple ureteral extravesical reimplantation in children with a primary obstructive megaureter.

To introduce a new technique of single-port-plus-one robotic laparoscopic-modified Lich-Gregoir direct nipple ureteral extravesical reimplantation and ascertain its validity in the treatment of pediatric primary obstructive megaureter. Between January 2021 and November 2021, we retrospectively analyzed the clinical data of 12 children with primary obstructive megaureter who were admitted to the Department of Pediatric Surgery of Fujian Provincial Hospital. All 12 children were treated with single-port-plus-one robotic laparoscopic Lich-Gregoir direct nipple ureteral extravesical reimplantation. Five of them were female and seven were male, including nine cases were simple obstructive type, while the remaining three cases were obstructive with reflux type. The mean age of the children was 17.33 ± 6.99 (10-36) months and the mean follow-up time was 14.16 ± 1.75 (12-17) months. Changes in preoperative and first-year postoperative parameters were compared. The mean operative time for all 12 children was 123.58 ± 10.85 (110-145) min, with a mean internal operative time of 101.42 ± 0.85 (90-120) min, a mean operative bleeding time of 2.42 ± 0.67 (2-4) ml, and a mean hematuria duration of 16.08 ± 1.44 (14-19) h. The mean indwelling catheterization time was 2.25 ± 0.45 (2-3) days and the mean hospitalization time was 3.83 ± 0.39 (3-4) days. At the postoperative first year, the ureteral diameter, calyceal diameter, and anterior-posterior renal pelvic diameter were found to be significantly smaller than at the preoperative period (18.83 ± 3.21 mm vs. 6.83 ± 1.27 mm, 13.99 ± 3.58 mm vs. 3.5 ± 2.90 mm, and 34.92 ± 4.25 mm vs. 10.08 ± 1.88 mm, P < 0.001). There was a significant increase in renal cortical thickness and the percentage of differential renal function (3.63 ± 1.66 mm vs. 5.67 ± 1.88 mm, 33.75 ± 2.77 mm vs. 37.50 ± 1.31 mm, P < 0.001). The resolution rate of obstruction was 100% and no child developed DeNovo vesicoureteral reflux. The technique of modified Lich-Gregoir direct nipple ureteral extravesical reimplantation can help maintain the physiological direction of the ureter and at the same time enhance the effectiveness of antirefluxing in robotic surgery. The design of a single-port-plus-one wound can produce a cosmetic appearance by concentrating and hiding the wound around the umbilicus. This modified reimplantation procedure has the potential to become a promising technique in the robot-assisted treatment of primary obstructive megaureter.

A multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV–V) vesicoureteral reflux

Traditionally, open ureteral reimplantation (OUR) has been the standard treatment for primary vesicoureteral reflux (VUR) requiring reimplantation. Robotic-assisted laparoscopic ureteral reimplantation (RALUR) is gaining popularity and high success rates have been reported. In this multi-institutional study, we aimed to compare the perioperative and postoperative outcomes of OUR and RALUR for high-grade (IV+V) VUR in children. A retrospective evaluation was performed collecting data from 135 children (0-18 years) who underwent high grade VUR surgical correction at nine European institutions between 01/01/2009 and 01/12/2020, involving either open or robotic approaches. Institutional review board approval was obtained. Patients with lower grades of VUR (≤III), previous history of open or endoscopic ureteral surgery, neurogenic bladder, or refluxing megaureter in need of ureteral tapering were excluded. Pre-, peri- and post-operative data were statistically compared. Overall, 135 children who underwent either OUR (n=68), or RALUR (n=67) were included, and their clinic and demographic features were collected. The mean age of the open group was 11 months (interquartile range [IQR] 9.9-16.6 months), in the RALUR group it was 59 months (IQR 29-78mo) (p<0.01); the open cohort had a weight of 11kg (IQR 9.9-16.6kg) while the RALUR group had 19kg (IQR 13-25kg) (p<0.01). No significant differences were found for intraoperative (1.5% vs 7.5%, p=0.09) or for postoperative complication rates (7.4% vs 9%, p=0.15). Favorable outcomes were reported in the RALUR group: shorter time to stooling (1 vs 2 days), fewer indwelling urethral catheter days (1 vs 5 days), perioperative drain insertion time (1 vs 5 days) and a shorter length of hospital stay (2 vs 5 days) (p<0.01). The success rate was 94.0% and 98.5% in the open and RALUR groups, respectively. The long-term clinical success rates from both groups was comparable:42 vs 23 months for open and RALUR, respectively. This study reported a large multicentric experience focusing on high grade VUR. Furthermore, this study compares favorably to OUR in a safety analysis. There was also a trend towards higher success rates with RALUR utilizing an extravesical approach which has not been previously reported. RALUR is an efficacious and safe platform to use during ureteral reimplantation for high grade VUR. The overall peri-operative and post-operative complication rates are at least equivalent to OUR, but it is associated with a faster functional recovery and time to discharge. Medium to long term success rates are also equivalent to OUR.

Ureteral obstruction following transurethral resection of bladder cancer within the Hutch's diverticulum.

Here, we report a rare case of bladder cancer within the left congenital periureteral diverticulum, termed the Hutch's diverticulum. Following transurethral resection of the bladder tumor, repeated pyelonephritis was caused by stricture of the diverticulum orifice and ureter. We attempted transurethral dilation and ureteral stenting, but the obstruction did not improve. The patient's renal dysfunction showed gradual progression due to recurrent left pyelonephritis as well as the ureteral obstruction. Therefore, we finally performed a partial cystectomy, involving stricture and ureteral reimplantation. No tumor recurrence was observed over 39months, and renal dysfunction did not progress following partial cystectomy.

Our experience with management of congenital urological pathologies in adulthood: What pediatric urologists should know and adult urologists adopt in pediatric practice experience.

To summarize our experience in the management of congenital anomalies in the kidney and urinary tract (CAKUT) in adults. We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021. The study included 102 patients with a median age of 25 (interquartile range, 23-36.5). Of these, 85 (83.3%) patients reported normal prenatal ultrasound, and the remaining 17 (16.7%) patients were diagnosed with antenatal hydronephrosis. These patients were followed-up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care. All studied adult patients presented with the following pathologies: 67 ureteropelvic junction obstructions, 14 ectopic ureters, 9 ureteroceles, and 6 primary obstructive megaureters, and the remaining 6 patients were diagnosed with vesicoureteral reflux. Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles. Notably, 67% of patients underwent pyeloplasty, 9% underwent endoscopic puncture of ureterocele, 3% underwent ureteral reimplantation, 6% underwent endoscopic correction of reflux, 7% underwent partial nephrectomy of non-functioning moiety, and the remaining 9% underwent robotic-assisted laparoscopic ureteroureterostomy. The median follow-up period after surgery was 33 months (interquartile range, 12-54). Post-operative complications occurred in 5 patients (Clavien-Dindo 1-2). Patients with CAKUT present clinical symptoms later in life. Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility, and children should be appropriately counseled when they enter adolescence. Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.

Comparison of Treatment Methods of Primary Obstructive Megaureter

BACKGROUND: Primary megaureter (PM) is a common congenital uropathy. In this study, we compared the results of treatment options for primary megaureter with obstruction in UVJ.&#x0D; METHODS: The files of all patients who underwent open surgery and had a double J (JJ) ureteral stent for treating primary obstructive megaureter in our institution between 2010 and 2023 were evaluated retrospectively. The demographic information of the patients, the results of imaging tests before and after the surgery, early and late complications after the treatment, and the length of stay in the hospital were recorded. The results of both treatment methods were compared statistically.&#x0D; RESULTS: A total of 23 patients and 26 kidney units over 13 years were retrospectively analyzed. Eighteen patients were male (78%); 5 were girls (22%). Ureteral tapering and ureteroneocystostomy (UNC) were performed with open surgery in 8 patients, while JJ stent was placed in 12 patients primarily by cystoscopy. In the urinary system ultrasonography (USS) performed at an average of 3 months after the treatment, hydronephrosis grades were observed to regress in 25 units. All patients recovered after surgery and there was no significant difference between the two treatment methods (p&gt; 0.05).&#x0D; CONCLUSION: In the treatment of primary obstructive megaureter (POM), endoscopic JJ stenting is as effective as ureteral reimplantation with open surgery. It may be considered more valuable due to the shorter hospital stay

Robotic-assisted appendiceal onlay flap ureteroplasty combined with ureteral reimplantation for multifocal ureteral strictures: Case report and technical description.

To describe the surgical technique of robotic-assisted appendiceal onlay flap ureteroplasty combined with ureteral reimplantation to repair unilateral multifocal ureteral strictures in one stage and report 9-month follow-up outcomes. A longitudinal ventral incision of proximal ureter strictures No. 1 and 2 was performed, and the appendix was detubularised along its antimesenteric border. Then, the appendiceal onlay flap was anastomosed with the spatulated ureter in an onlay fashion. To manage the distal ureteral stricture No. 3, ureteral reimplantation was performed in a tension-free manner. Voiding cystourethrography and antegrade urography showed urine regurgitation into the ureter without dilation and no obstruction of the reconstructed ureteral segment 7weeks after surgery. No postoperative complications occurred during the 9-month follow-up. Robotic-assisted appendiceal onlay flap ureteroplasty combined with ureteral reimplantation appears to be a safe and effective surgical method for repairing the unilateral multifocal ureteral strictures.

Current management of symptomatic vesicoureteral reflux in pediatric kidney transplantation-A European survey among surgical transplant professionals.

Vesicoureteral reflux (VUR) is common in children and adolescents undergoing kidney transplantation (KTx) and may adversely affect allograft kidney function. To explore the current management of symptomatic native and allograft VUR in pediatric KTx recipients, an online survey was distributed to European surgical transplant professionals. Surgeons from 40 pediatric KTx centers in 18 countries participated in this survey. Symptomatic native kidney VUR was treated before or during KTx by 68% of the centers (all/selected patients: 33%/67%; before/during KTx: 89%/11%), with a preference for endoscopic treatment (59%). At KTx, 90% favored an anti-reflux ureteral reimplantation procedure (extravesical/transvesical approach: 92%/8%; preferred extravesical technique: Lich-Gregoir [85%]). Management strategies for symptomatic allograft VUR included surgical repair (90%), continuous antibiotic prophylaxis (51%), bladder training (49%), or noninterventional surveillance (21%). Redo ureteral implantation and endoscopic intervention for allograft VUR were equally reported (51%/49%). This survey shows uniformity in some surgical aspects of the pediatric KTx procedure. However, with regard to VUR, there is a significant variation in practice patterns that need to be addressed by future well-designed and prospective studies. In this way, more robust data could be translated into consensus guidelines for a more standardized and evidence-based management of this common condition in pediatric KTx.

Обструкція сечоводу після ендоскопічної корекції міхурово-сечовідного рефлюксу в дітей

Purpose - to investigate the ureteral obstruction (UO) frequency after endoscopic injection of the vesicoureteral reflux (VUR) in children. Materials and methods. 1068 children aged 8 months -15 years were respectively reviewed after endoscopic treatment of the VUR grades 2-4. The following factors were analyzed in terms of ureteral obstruction: age, sex, reflux grade. Also the clinical manifestations were reviewed as the ureteral obstruction management types (conservative - 28 (52.8%), stenting - (26.5%), reimplantation of the ureter - 11 (20.7%) as well. Statistical analysis of the frequency of OS (categorical data) was performed using nonparametric estimation methods (χ², Fisher's exact test). A difference of p&lt;0.05 was considered statistically significant. Results. The total incidence of ureteral obstruction was 3.44% (53/1539 ureters). There were early (41 children) and late (12 children) obstructed units. The following risk factors for developing ureteral obstruction proved to be significant: sex (males), low reflux grade. The early UO was treated mostly with watchful waiting, stenting (13 cases) and 2 cases were submitted to open surgery. In late UO ureteral reimplantation was utilized (9 cases) as well as ureteral stenting was helpful. Conclusions. UO is an infrequent but essential complication of the endoscopic VUR correction. The early UO cases are effectively treated by watchful waiting with/without empty bladder or ureteral stenting. Ureteral reimplantation seems to be the main procedure in late UO cases. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Does preoperative screening VCUG affect the outcomes and complications of pyeloplasty in patients with ureteropelvic junction obstruction?

The role of voiding cystourethrogram (VCUG) in evaluating vesicoureteral reflux (VUR) in patients with known ureteropelvic junction obstruction (UPJO) remains unclear. While VCUG is frequently performed, the incidence of concomitant VUR and UPJO is low, and VUR is often low-grade with high rates of spontaneous regression. To analyze the clinical relevance of VCUG in patients with UPJO by determining its incidence and studying the difference in clinical outcomes between patients with known, unknown, and negative VUR. Retrospective review of patients with UPJO who underwent pyeloplasty from 2012 to 2020 with <18 years-old, unilateral UPJO, postoperative follow-up of ≥2 months and had at least 1 renal ultrasound (US) after pyeloplasty. Results were compared among 3 groups: patients who underwent VCUG before pyeloplasty and were found to have VUR (group 1), patients who underwent VCUG before pyeloplasty without VUR (group 2), and patients who did not have a VCUG before pyeloplasty (group 3). A total of 275 patients met the inclusion criteria, of which 21 patients were classified in group 1, 166 patients in group 2, and 88 patients in group 3 (Table). The age at preoperative VCUG was 14.7±32.9 months in group 1 and 15.17±35.8 months in group 2 (p=0.960). Overall, the incidence of concomitant UPJO and VUR was 11.2%. In group 1 the initial VUR grade was 5 in 2 patients, 4 in 3, 3 in 5, 2 in 7, and 1 in 4 patients. Of these, only 1 patient required ureteral reimplantation after pyeloplasty. Post-pyeloplasty, no significant differences were observed in complications (p=0.7436), length of follow up (p=0.3212), SFU grade 4 hydronephrosis (p=0.2247), postoperative UTIs (p=0.1047) and pyeloplasty success rate (p=0.4206) among the 3 groups. Despite the use of antibiotic prophylaxis being significantly different amongst the three groups (p<0.001), it was not associated with a lower incidence of postoperative UTIs (group 1 p=0.068, group 2 p=0.486, group 3 p=1). In patients with reflux, an increase in age was associated with a decrease in the rates of complications (p=0.019). We found no significant difference in the outcomes in patients who had a preoperative VCUG as compared to those who did not. The preoperative diagnosis of VUR by VCUG changed the management in less than 1% of the study population and thus its role in patients with UPJO should be reevaluated.

Endoscopic treatment of primary obstructive megaureter with high pressure balloon dilation in infants

Ureteral reimplantation of the dilated ureter in infants is challenging; however, some patients with primary obstructive megaureter (POM) in this age group require intervention due to clinical or radiological progression. We sought to determine if high pressure balloon dilation (HPBD) can serve as a definitive treatment for POM in children under one year of age, or as a temporizing measure until later reimplantation. All patients from a single institution who underwent HPBD between October 2009 and May 2022 were retrospectively reviewed. Patients were excluded if older than 12 months or diagnosed with neurogenic bladder, posterior urethral valves, or obstructed refluxing megaureter. Patients with prior surgical intervention at the ureterovesical junction were excluded. Indications for surgery included progressive hydroureteronephrosis or urinary tract infection (UTI). Balloon dilation was performed via cystoscopy with fluoroscopic guidance, followed by placement of two temporary ureteral stents. Primary outcomes were improvement or resolution of megaureter and rates of subsequent reimplantation. Secondary outcomes included total number of anesthetics and postoperative UTIs. Fifteen infants with median age of 7.6 months (IQR3.8-9.7) underwent HPBD. Twelve (80%) patients were detected prenatally and 3 (20%) aftera UTI. Indication for surgery was progressivehydroureteronephrosis in 10 patients (67%) and UTI in five (33%). All had SFU grade 3 or 4 hydronephrosis on preoperative ultrasound and median distal ureteral diameter was 13mm. Median follow up was 2.9 years. Twelve (80%) succeeded with endoscopic treatment: 7 patients had an undetectable distal ureter on ultrasound at last follow-up, 5 were improved with median distal ureteral diameter of 7mm. Three patients (20%) required ureteral reimplantation due to progressive dilation, all with grade 4 hydronephrosis and distal ureteral diameters were 11, 15, and 21mm. Six patients (40%) required two anesthetics to complete endoscopic treatment. Among those, 4 patients required initial stent placement for passive dilation followed by a second anesthetic for HPBD weeks later. Two patients underwent repeat HPBD following postoperative proximal migration of the ureteral stents. All 15 patients had an additional anesthetic for removal of stents. Five patients (33%) were treated for a symptomatic UTI (4 febrile, 1 afebrile) with the stents indwelling but there were no UTIs in the group following stent removal. Balloon dilation is a practical option for treatment of POM in infants, and in most cases (80%) avoids subsequent open surgery (over median 2.9 years of follow-up).

Role of 3-dimensional Imaging in the Management of Ureteric Fistula

A patient in her late 20s presented with a month-long history of continuous dribbling of urine associated with right flank following suction-evacuation for an incomplete abortion. Contrast-Enhanced Computed Tomography (CECT) abdomen and Computerised Tomography (CT) urogram demonstrated a 1cm focal defect in the right lateral wall of the uterus communicating with a collection in the right hemipelvis and right paracolic region. Fluid was demonstrated in the uterus and cervix. The right ureter narrowed abruptly at the level of the S1 vertebra, with prominence of the proximal ureter. An opacified tract was seen between the right ureter and the uterus [Figures 1, 2 and 3] diagnosed as a fistula. The patient had a total laparoscopic hysterectomy with ureteric reimplantation into a Boari flap surgery and psoas hitch of the urinary bladder, with the clinical application of pre-operative 3D CT imaging allowing for surgical improved planning to optimise the outcome [Supplemental Figure 1].

Endoscopic balloon dilation of primary obstructive megaureter: is fluoroscopic guidance necessary?

To compare the long-term effectiveness, complications, and outcomes of primary obstructive megaureter (POM) treated by endoscopic balloon dilation under fluoroscopic guidance versus not using radioscopy during the procedure. A comparative study between POM cases treated at our institution by endoscopic balloon dilation (EBD) under fluoroscopic guidance (FG) (n = 43) vs no fluoroscopic guidance (NFG) (n = 48) between the years 2004 and 2018 was conducted. The procedure in FG consisted of performing a retrograde pyelography before dilation.Then, a guidewire is introduced to the renal pelvis, and the dilation of the vesicoureteral junction is performed using high-pressure balloon catheters under fluoroscopic vision. Finally, a double-J stent is placed between the renal pelvis and bladder. The procedure in NFG was performed exclusively under cystoscopic vision without radiological exposure. Complications, outcomes, and success rates were analyzed using Spearman's correlation test. Mean follow-up was 12.5 ± 2.2years in FG and 6.4 ± 1.3years in NFG. MAG-3 showed significant differences in renal drainage before and after endoscopic treatment in both groups (p < 0.001 T-test). Statistical analysis did not reveal differences between groups in initial technical failure (r: - 0.035,p = 0.74), early postoperative complications (r: - 0.029,p = 0.79), secondary VUR (r: 0.033, p = 0.76), re-stenosis (r: 0.022, p = 0.84), long-term ureteral reimplantation (r: 0.065, p = 0.55), and final outcome (r: - 0.054, p = 0.61). The endoscopic approach of POM had a long-term success rate of 86.5% in FG VS 89.6% in NFG. Endoscopic balloon dilation of POM can be done with no radiation exposure with similar results, effectiveness, and outcomes.

Transfer of acquired practical skills from dry lab into live surgery using the avatera robotic system: An experimental study

ObjectiveTo evaluate the transfer of the practical skills of robot-assisted surgery acquired in the dry-lab into a real live experimental setting for performing upper and lower urinary tract surgeries. Material and methodsAn in vivo experimental study design was utilized. Six urology trainees and fellows; two 2nd year trainees with no previous exposure to laparoscopic surgery (Group 1), two 4th year residents with medium exposure to laparoscopic surgery (Group 2) and two fellows trained to perform laparoscopic surgeries (Group 3) performed ureteral reimplantation into the bladder, pyeloplasty, and radical nephrectomy on three female pigs under general anesthesia. Prior to performing the requested procedures, each participant completed 10−14 h dry-lab robotic training acquiring skills in basic surgical tasks, such as suturing, cutting and needle passage. The recorded variables were the successful completion of the procedures, the console time, and the time to perform different steps and major complications. ResultsAll procedures were completed successfully by all groups except the pyeloplasty by group 1 which was complicated by bleeding from the renal vein, and the procedure was abandoned. Group 3 achieved shorter console time for all successfully completed procedures and for separate surgical steps compared to all groups, followed by Group 2. The slowest group for all procedures and steps analyzed was Group 3. ConclusionsAlthough further clinical evidence is needed, the robotic-assisted urological procedures and the most challenging steps could be performed safely and effectively after proper training in the dry lab under mentor supervision according to our study.

VE12 - Robot assisted post radiation VVF repair with ureteric reimplantation

VE12 - Robot assisted post radiation VVF repair with ureteric reimplantation

VE33 - Robot-assisted upper pole hemi-nephroureterectomy, distal common sheath ureterectomy and bladder cuff with reimplantation of lower moiety ureter in a duplex system with upper tract moiety urothelial carcinoma

VE33 - Robot-assisted upper pole hemi-nephroureterectomy, distal common sheath ureterectomy and bladder cuff with reimplantation of lower moiety ureter in a duplex system with upper tract moiety urothelial carcinoma

VE22 - Robot-assisted left ureteral reimplantation for treating transplant ureteral stricture: A modified V-Y technique with bladder flap

VE22 - Robot-assisted left ureteral reimplantation for treating transplant ureteral stricture: A modified V-Y technique with bladder flap