Is robot-assisted laparoscopic bilateral extravesical ureteral reimplantation associated with greater morbidity than unilateral surgery? A comparative analysis

Introduction Voiding dysfunction after bilateral extravesical ureteral reimplantation for vesicoureteral reflux has long remained a concern. Robotic approach with improved visualization that enables focused and minimal dissection may help with this concern. Objectives To compare postoperative outcomes after bilateral robot-assisted laparoscopic ureteral reimplantation to unilateral robot-assisted laparoscopic ureteral reimplantation. Study design This was a retrospective study using data abstracted from an institutional review board-approved registry prospectively maintained at our institution since 2012. Patient demographics, preoperative characteristics, and postoperative outcomes were analyzed. Patients with postoperative febrile urinary tract infection (UTI) underwent voiding cystourethrogram (VCUG). Surgical success is defined as absence of febrile UTI or febrile UTI with negative VCUG. Results 92 patients with a median follow-up of 14 (25th and 75th IQR 5, 28) months. Median operative time (150 vs. 178 min, p = 0.01) and median hospital stay (33 vs. 37 h, p = 0.01) were longer in the bilateral cohort. Weight-adjusted morphine equivalents requirement was also higher in the bilateral group (0.45 vs. 0.59, p = 0.019). Discussion Early postoperative voiding dysfunction is influenced by anesthesia, postoperative pain, analgesics, age, surgical dissection, and preoperative voiding issues. Effective preoperative management of voiding dysfunction, minimizing surgical dissection and cautery, and minimizing opiate use will aid improving outcomes after surgery and enable bilateral surgeries on uretero-vesical junction. A robotic approach to facilitate such strategies could help outcomes after bilateral ureteral reimplantation. Limitations of this study include its retrospective design, the absence of routine postoperative VCUG after ureteral reimplantation, and unknown confounding variables. Conclusion Robot-assisted laparoscopic bilateral extravesical ureteral reimplantation is not associated with an increased risk of postoperative morbidity compared with unilateral surgery. Table. Summary of important pre-operative variables and post-operative outcomes. Unilateral (N = 57) Bilateral (N = 35) p-value Age, years, median (25th and 75th IQR)4 (2, 6) 3.75 (2, 5) 0.86 VUG grade median (25th and 75th IQR)3 (2, 4) 3 (2, 3) 0.55 Toilet-trained children, N (%)34 (59.6%) 21 (60%) 0.9 Preoperative voiding dysfunction, N (%)13 (22.8%) 8 (22.9%) 0.99 Postoperative voiding dysfunction, new, N (%)7 (12.3%) 5 (14.3%) 0.32 Voiding dysfunction resolved after surgery, N (%)3 (5.2%) 4 (11.4%) 0.09 Postoperative febrile UTI and +ve VCUG, N (%) “Clinical and radiological failure = Surgical failure”5/57 (8.7%) 3/35 (8.6%) 0.98 Full-size table Table options View in workspace Download as CSV