1225 URETERAL STENTING IS UNNECESSARY DURING ROBOTIC-ASSISTED LAPAROSCOPIC EXTRAVESICAL URETERAL REIMPLANTATION FOR PRIMARY VESICOURETERAL REFLUX

INTRODUCTION AND OBJECTIVES: Robotic-assisted laparoscopic (RAL) surgery in children is an emerging, minimally invasive alternative to open surgery in children, such as for the surgical management of vesicoureteral reflux (VUR) via extravesical (EV) ureteral reimplantation. Previous reports have described the use of a ureteral stent during and after this robotic procedure. We previously presented our simplified (stent-less) technique. The purpose of this study is to review our experience of RAL EV ureteral reimplantation performed without the use of a ureteral stent. METHODS: 50 pediatric patients with primary VUR (40 unilateral and 10 bilateral for a total of 60 refluxing units) underwent RAL ureteral reimplantation surgery via an extravesical technique. An institutional review board-approved retrospective chart review was performed to collect patient demographic and perioperative data. RESULTS: The operative success rate, defined as complete resolution of the VUR on the voiding cystourethrogram (VCUG) at the 4-month mark after surgery, was 97% (58/60), which is equivalent to those of historical open surgery series. The median age at surgery was 5.0 years (1.0 – 12.0) and the VUR grade distribution was grades: I 1, II 15, III 27, IV 15, V 2. The median length of hospital stay was 1.3 days (0.9 19.3) and the estimated blood loss was minimal. The median follow-up was 22.8 months (1.0 – 31.0). One patient continued to be observed with postoperative non-dilating VUR and the other patient had improvement from grade IV to II-III, but required open re-operation for a paraureteral diverticulum. After overnight catheterization postoperatively, 3 patients (6%) required re-catheterization postoperatively, with resolution of the urinary retention within 2 weeks. Post-operative mild to moderate hydronephrosis (HN) was noted in 17 of the 60 kidney units (28%) at the one-month mark post-operatively, but all of the cases of HN resolved at a median time of 4 months (3 11) without the need for intervention. CONCLUSIONS: RAL EV ureteral reimplantation without ureteral stenting achieves comparable efficacy and safety of open ureteral reimplantation surgery without the use of ureteral stents. Post-operative hydronephrosis after RAL EV reimplantation surgery is usually temporary, self-limited, and does not require intervention.