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Comment on “Robotic-assisted laparoscopic ureteral re-implant (RALUR): Can post-operative urinary retention be predicted?”

      We read with great interest the article by Kawal et al. [
      • Kawal T.
      • Srinivasan A.K.
      • Chang J.
      • Long C.
      • Chu D.
      • Shukla A.R.
      Robotic-assisted laparoscopic ureteral re-implant (RALUR): can post-operative urinary retention be predicted?.
      ] evaluating the risk factors for postoperative urinary retention after robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR) in pediatric patients in a recent issue of the journal. As mentioned by the authors, retention is a potential complication reported after open extravesical reimplantation and RALUR at a rate of 3–22% and 2–10%, respectively. The incidence can reach up to 4–37%, especially in bilateral cases [
      • Song S.H.
      • Kim I.A.
      • Han J.H.
      • Kim K.S.
      • Kim E.J.
      • Sheth K.
      • et al.
      Preoperative bladder bowel dysfunction is the most important predictive factor for postoperative urinary retention after robot-assisted laparoscopic ureteral reimplantation via an extravesical approach: a multi-center study.
      ]. Surgical technique is one of the main reasons for retention, and it has been attributed to the neuropraxia of autonomic nerve fibers around the ureteral hiatus or direct nerve damage [
      • Song S.H.
      • Kim I.A.
      • Han J.H.
      • Kim K.S.
      • Kim E.J.
      • Sheth K.
      • et al.
      Preoperative bladder bowel dysfunction is the most important predictive factor for postoperative urinary retention after robot-assisted laparoscopic ureteral reimplantation via an extravesical approach: a multi-center study.
      ]. Although the other most common known risk factor for retention was reported as bilaterality [
      • Srinivasan A.K.
      • Maass D.
      • Shrivastava D.
      • Long C.J.
      • Shukla A.R.
      Is robot-assisted laparoscopic bilateral extravesical ureteral reimplantation associated with greater morbidity than unilateral surgery? A comparative analysis.
      ], only male gender and length of surgical time were found to be predictive by Kawal et al. [
      • Kawal T.
      • Srinivasan A.K.
      • Chang J.
      • Long C.
      • Chu D.
      • Shukla A.R.
      Robotic-assisted laparoscopic ureteral re-implant (RALUR): can post-operative urinary retention be predicted?.
      ]. Contrary, high grade reflux, younger age (<3 years) and a history of bladder bowel dysfunction (BBD) have also been reported as other risk factors for retention according to other studies [
      • Song S.H.
      • Kim I.A.
      • Han J.H.
      • Kim K.S.
      • Kim E.J.
      • Sheth K.
      • et al.
      Preoperative bladder bowel dysfunction is the most important predictive factor for postoperative urinary retention after robot-assisted laparoscopic ureteral reimplantation via an extravesical approach: a multi-center study.
      ,
      • Esposito C.
      • Varlet F.
      • Riquelme M.A.
      • Fourcade L.
      • Valla J.S.
      • Ballouhey Q.
      Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot-assisted approach: results of a multicentre international survey.
      ].
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      References

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        • Srinivasan A.K.
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        Robotic-assisted laparoscopic ureteral re-implant (RALUR): can post-operative urinary retention be predicted?.
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        Preoperative bladder bowel dysfunction is the most important predictive factor for postoperative urinary retention after robot-assisted laparoscopic ureteral reimplantation via an extravesical approach: a multi-center study.
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        Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot-assisted approach: results of a multicentre international survey.
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      Linked Article

      • Robotic-assisted laparoscopic ureteral re-implant (RALUR): Can post-operative urinary retention be predicted?
        Journal of Pediatric UrologyVol. 14Issue 4
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          Urinary retention following robotic-assisted laparoscopic extravesical ureteral reimplantation (RALUR) is proposed to be due to traction or injury of the pelvic parasympathetic nerve plexus during distal ureteral dissection. Nerve-sparing techniques have been employed to avoid injury to the pelvic plexus, either directly or indirectly. This single-center study assessed postoperative urinary retention rates after extravesical RALUR and investigated whether demographic or operative factors could predict this occurrence.
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