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

Autor: Sforza S; Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy. Electronic address: simone.sforza1988@gmail.com., Marco BB; Department of Urology, Charité University Clinic, Division of Paediatric Urology, Berlin, Germany., Haid B; Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria., Baydilli N; Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey., Donmez MI; Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Spinoit AF; Department Urology ERN Centre, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium., Paraboschi I; Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy., Masieri L; Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy., Steinkellner L; Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria., Comez YI; Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey., Lammers RJM; Department of Urology, University Medical Center Groningen, 9713 GZ Groningen, the Netherlands., 't Hoen LA; Department of Paediatric Urology, Sophia Children's Hospital, Erasmus University Medical Center, 3015 GD Rotterdam, the Netherlands., O'Kelly F; Division of Paediatric Urology, Beacon Hospital, DK18 AK68 Dublin, Ireland., Bindi E; Pediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy., Kibar Y; Department of Urology, University, Koru Hospital, Ankara, Turkey., Silay MS; Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey.
Jazyk: angličtina
Zdroj: Journal of pediatric urology [J Pediatr Urol] 2024 Apr; Vol. 20 (2), pp. 283-291. Date of Electronic Publication: 2023 Nov 14.
DOI: 10.1016/j.jpurol.2023.11.006
Abstrakt: Introduction: 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.
Objective: 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.
Study Design: 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.
Results: 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 11 kg (IQR 9.9-16.6 kg) while the RALUR group had 19 kg (IQR 13-25 kg) (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.
Discussion: 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.
Conclusion: 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.
Competing Interests: Conflict of interest Nil.
(Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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