Ureteral reimplantation in paediatric urology for obstructive megaureter: A comparison of robotic and open technique from a single referral center

Aim of the study: Robotic assisted laparoscopic extravescical ureteral reimplantation (RALUR) for primary megaureter obstruction has gain popularity in the last years as an alternative approach to open surgery. Modern literature suggests that use of RALUR is increasing according to its safety and effectiveness in a better anatomical vision and its correlation with a reduction in hospitalization’ length. However, there are a lack of data for what concern comparison of the two approaches. Aim of the study is to review a single centre and single surgeon experience with RALUR and to compare outcomes with the open technique. Materials and methods: The records of all patients who underwent ureteral reimplantation at our Institute, between January 2016 and October 2018, were retrospectively collected and analysed. Inclusion criteria comprehend diagnosis of primary obstructive megaureter. Comparison was made between Group A (robotic procedure) and Group B (open approach). Preoperative, peri and postoperative data were recorded by medical doctors. Procedure success was defined as reduction of pelvis Antero Posterior Diameter (APD) at the post- operative ultrasound scan or resolution of VUR on post-operative cystourethrogram. Data were recorded in an organised chronological method in a Microsoft Excel database. The SPSS software was used for data entry and analysis. Data were tested for statistical analysis using univariate analysis. Results: Overall, a total of 15 patients were identified and summarize in table 1. Seven (3 Males and 4 Females) belonged to Group A and eight (7 Males and 1 Female) to Group B. Bilateral disease was present in only 1 case (group B, 12.5%). Mean age at surgery was 93 months (IQR 21–206) in group A and 19 months (IQR 13–50) in group B (p 0.072). Mean weight was 24 kg (IQR 12,2–48) in group A and 14 kg (10,8–16,5) in group B (p 0,315). Median operative time was 150 minutes (IQR 110 −180) in robotic group vs 145 minutes (IQR 125–150) in open surgery ( p 0,536). Median length of stay was 5 days in group A (IQR 5–6) and 7 days in group B (IQR 7–8) (p 0,001). Follow up was 20 months in group A (IQR 14–25) and 25 months in group B (IQR 14–30). Complications rate was 14,3% in group A and 12,5% in group B. Success rate was 85,7% in robotic group and 100% in patients treated with open surgery with a p value of 0,268. Only one required an endoscopic reintervention (bulking) for persisting vesical reflux with symptom. Discussion: According to our preliminary experience, RALUR is a safe procedure and a good option for treating paediatric patients affected by primitive obstructive megaureter with comparable outcomes to the open procedure in success rate and operative time and a reduction in length of stay.