Multi-institutional review of outcomes of robot-assisted laparoscopic extravesical ureteral reimplantation

Gwen M. Grimsby, Moira E. Dwyer, Micah A. Jacobs, Michael C. Ost, Francis X. Schneck, Glenn M. Cannon, Patricio C. Gargollo

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Purpose We performed a multi-institutional assessment of the outcomes and complications of robot-assisted laparoscopic extravesical ureteral reimplantation for vesicoureteral reflux in children. Materials and Methods We retrospectively reviewed the records of patients who underwent robot-assisted laparoscopic extravesical ureteral reimplantation as done by 1 of 5 surgeons at Children's Medical Center, Dallas, Texas, or Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, from 2010 to 2013. Procedure failure was defined as persistent vesicoureteral reflux on postoperative voiding cystourethrogram or radionuclide cystogram and/or the need for reoperation. Multivariate logistic regression was done to identify possible risk factors for failure using STATA®, version 11. Results A total of 61 patients (93 ureters) with a mean age of 6.7 years (range 0.6 to 18.0) underwent a procedure, of which 32 (52%) were bilateral. Ten patients (16%) underwent previous subureteral injection for vesicoureteral reflux. At a mean followup of 11.7 months the procedure was successful in 44 of 61 patients (72%). There were 14 cases of persistent vesicoureteral reflux (23%), 6 complications (10%) and 9 reoperations (11%). Multivariate logistic regression identified no factor that increased the risk of failure (p = 0.737). Conclusions Compared to the literature we found a notably lower success rate for robot-assisted laparoscopic extravesical ureteral reimplantation in the hands of 5 fellowship trained, robotically experienced pediatric urologists. More than 10% of patients required at least 1 reoperation for persistent vesicoureteral reflux or a surgical complication. Our experience suggests a higher complication rate and a lower success rate for robot-assisted laparoscopic ureteral reimplantation compared to the gold standard of open reimplantation.

Original languageEnglish (US)
Pages (from-to)1791-1795
Number of pages5
JournalJournal of Urology
Volume193
Issue number5
DOIs
StatePublished - May 1 2015

Fingerprint

Vesico-Ureteral Reflux
Replantation
Reoperation
Logistic Models
Ureter
Radioisotopes
Outcome Assessment (Health Care)
Pediatrics
Injections

Keywords

  • laparoscopy
  • replantation
  • robotic
  • ureter
  • vesico-ureteral reflux

ASJC Scopus subject areas

  • Urology

Cite this

Grimsby, G. M., Dwyer, M. E., Jacobs, M. A., Ost, M. C., Schneck, F. X., Cannon, G. M., & Gargollo, P. C. (2015). Multi-institutional review of outcomes of robot-assisted laparoscopic extravesical ureteral reimplantation. Journal of Urology, 193(5), 1791-1795. https://doi.org/10.1016/j.juro.2014.07.128

Multi-institutional review of outcomes of robot-assisted laparoscopic extravesical ureteral reimplantation. / Grimsby, Gwen M.; Dwyer, Moira E.; Jacobs, Micah A.; Ost, Michael C.; Schneck, Francis X.; Cannon, Glenn M.; Gargollo, Patricio C.

In: Journal of Urology, Vol. 193, No. 5, 01.05.2015, p. 1791-1795.

Research output: Contribution to journalArticle

Grimsby, Gwen M. ; Dwyer, Moira E. ; Jacobs, Micah A. ; Ost, Michael C. ; Schneck, Francis X. ; Cannon, Glenn M. ; Gargollo, Patricio C. / Multi-institutional review of outcomes of robot-assisted laparoscopic extravesical ureteral reimplantation. In: Journal of Urology. 2015 ; Vol. 193, No. 5. pp. 1791-1795.
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abstract = "Purpose We performed a multi-institutional assessment of the outcomes and complications of robot-assisted laparoscopic extravesical ureteral reimplantation for vesicoureteral reflux in children. Materials and Methods We retrospectively reviewed the records of patients who underwent robot-assisted laparoscopic extravesical ureteral reimplantation as done by 1 of 5 surgeons at Children's Medical Center, Dallas, Texas, or Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, from 2010 to 2013. Procedure failure was defined as persistent vesicoureteral reflux on postoperative voiding cystourethrogram or radionuclide cystogram and/or the need for reoperation. Multivariate logistic regression was done to identify possible risk factors for failure using STATA{\circledR}, version 11. Results A total of 61 patients (93 ureters) with a mean age of 6.7 years (range 0.6 to 18.0) underwent a procedure, of which 32 (52{\%}) were bilateral. Ten patients (16{\%}) underwent previous subureteral injection for vesicoureteral reflux. At a mean followup of 11.7 months the procedure was successful in 44 of 61 patients (72{\%}). There were 14 cases of persistent vesicoureteral reflux (23{\%}), 6 complications (10{\%}) and 9 reoperations (11{\%}). Multivariate logistic regression identified no factor that increased the risk of failure (p = 0.737). Conclusions Compared to the literature we found a notably lower success rate for robot-assisted laparoscopic extravesical ureteral reimplantation in the hands of 5 fellowship trained, robotically experienced pediatric urologists. More than 10{\%} of patients required at least 1 reoperation for persistent vesicoureteral reflux or a surgical complication. Our experience suggests a higher complication rate and a lower success rate for robot-assisted laparoscopic ureteral reimplantation compared to the gold standard of open reimplantation.",
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N2 - Purpose We performed a multi-institutional assessment of the outcomes and complications of robot-assisted laparoscopic extravesical ureteral reimplantation for vesicoureteral reflux in children. Materials and Methods We retrospectively reviewed the records of patients who underwent robot-assisted laparoscopic extravesical ureteral reimplantation as done by 1 of 5 surgeons at Children's Medical Center, Dallas, Texas, or Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, from 2010 to 2013. Procedure failure was defined as persistent vesicoureteral reflux on postoperative voiding cystourethrogram or radionuclide cystogram and/or the need for reoperation. Multivariate logistic regression was done to identify possible risk factors for failure using STATA®, version 11. Results A total of 61 patients (93 ureters) with a mean age of 6.7 years (range 0.6 to 18.0) underwent a procedure, of which 32 (52%) were bilateral. Ten patients (16%) underwent previous subureteral injection for vesicoureteral reflux. At a mean followup of 11.7 months the procedure was successful in 44 of 61 patients (72%). There were 14 cases of persistent vesicoureteral reflux (23%), 6 complications (10%) and 9 reoperations (11%). Multivariate logistic regression identified no factor that increased the risk of failure (p = 0.737). Conclusions Compared to the literature we found a notably lower success rate for robot-assisted laparoscopic extravesical ureteral reimplantation in the hands of 5 fellowship trained, robotically experienced pediatric urologists. More than 10% of patients required at least 1 reoperation for persistent vesicoureteral reflux or a surgical complication. Our experience suggests a higher complication rate and a lower success rate for robot-assisted laparoscopic ureteral reimplantation compared to the gold standard of open reimplantation.

AB - Purpose We performed a multi-institutional assessment of the outcomes and complications of robot-assisted laparoscopic extravesical ureteral reimplantation for vesicoureteral reflux in children. Materials and Methods We retrospectively reviewed the records of patients who underwent robot-assisted laparoscopic extravesical ureteral reimplantation as done by 1 of 5 surgeons at Children's Medical Center, Dallas, Texas, or Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, from 2010 to 2013. Procedure failure was defined as persistent vesicoureteral reflux on postoperative voiding cystourethrogram or radionuclide cystogram and/or the need for reoperation. Multivariate logistic regression was done to identify possible risk factors for failure using STATA®, version 11. Results A total of 61 patients (93 ureters) with a mean age of 6.7 years (range 0.6 to 18.0) underwent a procedure, of which 32 (52%) were bilateral. Ten patients (16%) underwent previous subureteral injection for vesicoureteral reflux. At a mean followup of 11.7 months the procedure was successful in 44 of 61 patients (72%). There were 14 cases of persistent vesicoureteral reflux (23%), 6 complications (10%) and 9 reoperations (11%). Multivariate logistic regression identified no factor that increased the risk of failure (p = 0.737). Conclusions Compared to the literature we found a notably lower success rate for robot-assisted laparoscopic extravesical ureteral reimplantation in the hands of 5 fellowship trained, robotically experienced pediatric urologists. More than 10% of patients required at least 1 reoperation for persistent vesicoureteral reflux or a surgical complication. Our experience suggests a higher complication rate and a lower success rate for robot-assisted laparoscopic ureteral reimplantation compared to the gold standard of open reimplantation.

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