Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): Outcomes and complications

William R. Boysen, Ardavan Akhavan, Joan Ko, Jonathan S. Ellison, Thomas S. Lendvay, Jonathan Huang, Michael Garcia-Roig, Andrew Kirsch, Chester J. Koh, Marion Schulte, Paul Noh, M. Francesca Monn, Benjamin Whittam, Trudy Kawal, Aseem Shukla, Arun Srinivasan, Mohan S. Gundeti

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) is a minimally invasive alternative to open surgery. We have previously reported retrospective outcomes from our study group, and herein provide an updated prospective analysis with a focus on success rate, surgical technique, and complications among surgeons who have overcome the initial learning curve. Objective: To assess the safety and efficacy of RALUR-EV in children, among experienced surgeons. Design and methods: We reviewed our prospective database of children undergoing RALUR-EV by pediatric urologists at eight academic centers from 2015 to 2017. Radiographic success was defined as absence of vesicoureteral reflux (VUR) on postoperative voiding cystourethrogram. Complications were graded using the Clavien scale. Univariate regression analysis was performed to assess for association among various patient and technical factors and radiographic failure. Results: In total, 143 patients were treated with RALUR-EV for primary VUR (87 unilateral, 56 bilateral; 199 ureters). The majority of ureters (73.4%) had grade III or higher VUR preoperatively. Radiographic resolution was present in 93.8% of ureters, as shown in the summary table. Ureteral complications occurred in five ureters (2.5%) with mean follow-up of 7.4 months (SD 4.0). Transient urinary retention occurred in four patients following bilateral procedure (7.1%) and in no patients after unilateral. On univariate analysis, there were no patient or technical factors associated with increased odds of radiographic failure. Discussion: We report a radiographic success rate of 93.8% overall, and 94.1% among children with grades III-V VUR. In contemporary series, alternate management options such as endoscopic injection and open UR have reported radiographic success rates of 90% and 93.5% respectively. We were unable to identify specific patient or technical factors that influenced outcomes, although immeasurable factors such as tissue handling and intraoperative decision-making could not be assessed. Ureteral complications requiring operative intervention were rare and occurred with the same incidence reported in a large open series. Limitations include lack of long-term follow-up and absence of radiographic follow-up on a subset of patients. Conclusions: Radiographic resolution of VUR following RALUR is on par with contemporary open series, and the incidence of ureteral complications is low. RALUR should be considered as one of several viable options for management of VUR in children.Summary TableOutcomes, overall and by preoperative vesicoureteral reflux (VUR) grade. Radiographic resolution by preoperative VUR grade n a (%) I15/16(93.8) II24/26(92.1) III49/52(92.4) IV38/41(92.7) V10/10(100.0) Overall136/145(93.8)aNumber of ureters without VUR present/number of ureters studied with voiding cystourethrogram or radionuclide cystogram.

Original languageEnglish (US)
JournalJournal of Pediatric Urology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Vesico-Ureteral Reflux
Replantation
Multicenter Studies
Prospective Studies
Ureter
Urinary Retention
Learning Curve
Incidence
Radioisotopes
Decision Making
Regression Analysis
Outcome Assessment (Health Care)
Databases
Pediatrics
Safety
Injections

Keywords

  • Minimally invasive surgical procedures
  • Replantation
  • Robotic surgical procedures
  • Ureter
  • Vesico-ureteral reflux

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

Cite this

Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) : Outcomes and complications. / Boysen, William R.; Akhavan, Ardavan; Ko, Joan; Ellison, Jonathan S.; Lendvay, Thomas S.; Huang, Jonathan; Garcia-Roig, Michael; Kirsch, Andrew; Koh, Chester J.; Schulte, Marion; Noh, Paul; Monn, M. Francesca; Whittam, Benjamin; Kawal, Trudy; Shukla, Aseem; Srinivasan, Arun; Gundeti, Mohan S.

In: Journal of Pediatric Urology, 01.01.2018.

Research output: Contribution to journalArticle

Boysen, WR, Akhavan, A, Ko, J, Ellison, JS, Lendvay, TS, Huang, J, Garcia-Roig, M, Kirsch, A, Koh, CJ, Schulte, M, Noh, P, Monn, MF, Whittam, B, Kawal, T, Shukla, A, Srinivasan, A & Gundeti, MS 2018, 'Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): Outcomes and complications', Journal of Pediatric Urology. https://doi.org/10.1016/j.jpurol.2018.01.020
Boysen, William R. ; Akhavan, Ardavan ; Ko, Joan ; Ellison, Jonathan S. ; Lendvay, Thomas S. ; Huang, Jonathan ; Garcia-Roig, Michael ; Kirsch, Andrew ; Koh, Chester J. ; Schulte, Marion ; Noh, Paul ; Monn, M. Francesca ; Whittam, Benjamin ; Kawal, Trudy ; Shukla, Aseem ; Srinivasan, Arun ; Gundeti, Mohan S. / Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) : Outcomes and complications. In: Journal of Pediatric Urology. 2018.
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abstract = "Background: Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) is a minimally invasive alternative to open surgery. We have previously reported retrospective outcomes from our study group, and herein provide an updated prospective analysis with a focus on success rate, surgical technique, and complications among surgeons who have overcome the initial learning curve. Objective: To assess the safety and efficacy of RALUR-EV in children, among experienced surgeons. Design and methods: We reviewed our prospective database of children undergoing RALUR-EV by pediatric urologists at eight academic centers from 2015 to 2017. Radiographic success was defined as absence of vesicoureteral reflux (VUR) on postoperative voiding cystourethrogram. Complications were graded using the Clavien scale. Univariate regression analysis was performed to assess for association among various patient and technical factors and radiographic failure. Results: In total, 143 patients were treated with RALUR-EV for primary VUR (87 unilateral, 56 bilateral; 199 ureters). The majority of ureters (73.4{\%}) had grade III or higher VUR preoperatively. Radiographic resolution was present in 93.8{\%} of ureters, as shown in the summary table. Ureteral complications occurred in five ureters (2.5{\%}) with mean follow-up of 7.4 months (SD 4.0). Transient urinary retention occurred in four patients following bilateral procedure (7.1{\%}) and in no patients after unilateral. On univariate analysis, there were no patient or technical factors associated with increased odds of radiographic failure. Discussion: We report a radiographic success rate of 93.8{\%} overall, and 94.1{\%} among children with grades III-V VUR. In contemporary series, alternate management options such as endoscopic injection and open UR have reported radiographic success rates of 90{\%} and 93.5{\%} respectively. We were unable to identify specific patient or technical factors that influenced outcomes, although immeasurable factors such as tissue handling and intraoperative decision-making could not be assessed. Ureteral complications requiring operative intervention were rare and occurred with the same incidence reported in a large open series. Limitations include lack of long-term follow-up and absence of radiographic follow-up on a subset of patients. Conclusions: Radiographic resolution of VUR following RALUR is on par with contemporary open series, and the incidence of ureteral complications is low. RALUR should be considered as one of several viable options for management of VUR in children.Summary TableOutcomes, overall and by preoperative vesicoureteral reflux (VUR) grade. Radiographic resolution by preoperative VUR grade n a ({\%}) I15/16(93.8) II24/26(92.1) III49/52(92.4) IV38/41(92.7) V10/10(100.0) Overall136/145(93.8)aNumber of ureters without VUR present/number of ureters studied with voiding cystourethrogram or radionuclide cystogram.",
keywords = "Minimally invasive surgical procedures, Replantation, Robotic surgical procedures, Ureter, Vesico-ureteral reflux",
author = "Boysen, {William R.} and Ardavan Akhavan and Joan Ko and Ellison, {Jonathan S.} and Lendvay, {Thomas S.} and Jonathan Huang and Michael Garcia-Roig and Andrew Kirsch and Koh, {Chester J.} and Marion Schulte and Paul Noh and Monn, {M. Francesca} and Benjamin Whittam and Trudy Kawal and Aseem Shukla and Arun Srinivasan and Gundeti, {Mohan S.}",
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TY - JOUR

T1 - Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV)

T2 - Outcomes and complications

AU - Boysen, William R.

AU - Akhavan, Ardavan

AU - Ko, Joan

AU - Ellison, Jonathan S.

AU - Lendvay, Thomas S.

AU - Huang, Jonathan

AU - Garcia-Roig, Michael

AU - Kirsch, Andrew

AU - Koh, Chester J.

AU - Schulte, Marion

AU - Noh, Paul

AU - Monn, M. Francesca

AU - Whittam, Benjamin

AU - Kawal, Trudy

AU - Shukla, Aseem

AU - Srinivasan, Arun

AU - Gundeti, Mohan S.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) is a minimally invasive alternative to open surgery. We have previously reported retrospective outcomes from our study group, and herein provide an updated prospective analysis with a focus on success rate, surgical technique, and complications among surgeons who have overcome the initial learning curve. Objective: To assess the safety and efficacy of RALUR-EV in children, among experienced surgeons. Design and methods: We reviewed our prospective database of children undergoing RALUR-EV by pediatric urologists at eight academic centers from 2015 to 2017. Radiographic success was defined as absence of vesicoureteral reflux (VUR) on postoperative voiding cystourethrogram. Complications were graded using the Clavien scale. Univariate regression analysis was performed to assess for association among various patient and technical factors and radiographic failure. Results: In total, 143 patients were treated with RALUR-EV for primary VUR (87 unilateral, 56 bilateral; 199 ureters). The majority of ureters (73.4%) had grade III or higher VUR preoperatively. Radiographic resolution was present in 93.8% of ureters, as shown in the summary table. Ureteral complications occurred in five ureters (2.5%) with mean follow-up of 7.4 months (SD 4.0). Transient urinary retention occurred in four patients following bilateral procedure (7.1%) and in no patients after unilateral. On univariate analysis, there were no patient or technical factors associated with increased odds of radiographic failure. Discussion: We report a radiographic success rate of 93.8% overall, and 94.1% among children with grades III-V VUR. In contemporary series, alternate management options such as endoscopic injection and open UR have reported radiographic success rates of 90% and 93.5% respectively. We were unable to identify specific patient or technical factors that influenced outcomes, although immeasurable factors such as tissue handling and intraoperative decision-making could not be assessed. Ureteral complications requiring operative intervention were rare and occurred with the same incidence reported in a large open series. Limitations include lack of long-term follow-up and absence of radiographic follow-up on a subset of patients. Conclusions: Radiographic resolution of VUR following RALUR is on par with contemporary open series, and the incidence of ureteral complications is low. RALUR should be considered as one of several viable options for management of VUR in children.Summary TableOutcomes, overall and by preoperative vesicoureteral reflux (VUR) grade. Radiographic resolution by preoperative VUR grade n a (%) I15/16(93.8) II24/26(92.1) III49/52(92.4) IV38/41(92.7) V10/10(100.0) Overall136/145(93.8)aNumber of ureters without VUR present/number of ureters studied with voiding cystourethrogram or radionuclide cystogram.

AB - Background: Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) is a minimally invasive alternative to open surgery. We have previously reported retrospective outcomes from our study group, and herein provide an updated prospective analysis with a focus on success rate, surgical technique, and complications among surgeons who have overcome the initial learning curve. Objective: To assess the safety and efficacy of RALUR-EV in children, among experienced surgeons. Design and methods: We reviewed our prospective database of children undergoing RALUR-EV by pediatric urologists at eight academic centers from 2015 to 2017. Radiographic success was defined as absence of vesicoureteral reflux (VUR) on postoperative voiding cystourethrogram. Complications were graded using the Clavien scale. Univariate regression analysis was performed to assess for association among various patient and technical factors and radiographic failure. Results: In total, 143 patients were treated with RALUR-EV for primary VUR (87 unilateral, 56 bilateral; 199 ureters). The majority of ureters (73.4%) had grade III or higher VUR preoperatively. Radiographic resolution was present in 93.8% of ureters, as shown in the summary table. Ureteral complications occurred in five ureters (2.5%) with mean follow-up of 7.4 months (SD 4.0). Transient urinary retention occurred in four patients following bilateral procedure (7.1%) and in no patients after unilateral. On univariate analysis, there were no patient or technical factors associated with increased odds of radiographic failure. Discussion: We report a radiographic success rate of 93.8% overall, and 94.1% among children with grades III-V VUR. In contemporary series, alternate management options such as endoscopic injection and open UR have reported radiographic success rates of 90% and 93.5% respectively. We were unable to identify specific patient or technical factors that influenced outcomes, although immeasurable factors such as tissue handling and intraoperative decision-making could not be assessed. Ureteral complications requiring operative intervention were rare and occurred with the same incidence reported in a large open series. Limitations include lack of long-term follow-up and absence of radiographic follow-up on a subset of patients. Conclusions: Radiographic resolution of VUR following RALUR is on par with contemporary open series, and the incidence of ureteral complications is low. RALUR should be considered as one of several viable options for management of VUR in children.Summary TableOutcomes, overall and by preoperative vesicoureteral reflux (VUR) grade. Radiographic resolution by preoperative VUR grade n a (%) I15/16(93.8) II24/26(92.1) III49/52(92.4) IV38/41(92.7) V10/10(100.0) Overall136/145(93.8)aNumber of ureters without VUR present/number of ureters studied with voiding cystourethrogram or radionuclide cystogram.

KW - Minimally invasive surgical procedures

KW - Replantation

KW - Robotic surgical procedures

KW - Ureter

KW - Vesico-ureteral reflux

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