Summary
Introduction
With the advent of robot-assisted laparoscopic ureteral reimplantation (RALUR) for
primary vesicoureteral reflux (VUR), understanding and minimizing its complications
continues to be critical. Incidence of de novo hydronephrosis after RALUR could be
indicative of an outcome that needs further study or could be a benign transient finding.
Objective
In the present study, we hypothesized that the incidence of de novo hydronephrosis
after RALUR is low and resolves spontaneously.
Methods
An IRB-approved prospective single-institutional registry was utilized to identify
all patients undergoing RALUR via an extravesical approach from 2012 to 2020. Patients
with primary VUR and minimal (Grade I SFU) or no hydronephrosis prior to surgery were
included. Patients who had other associated pathology or underwent concomitant procedures
were excluded. Preoperative characteristics including VUR and hydronephrosis grades
as well as post-operative clinical details and hydronephrosis grades were aggregated
and analyzed.
Results
86/172 (50%) patients (133 ureters), with median reflux grade of 3 (IQR: G2, G3) met
the inclusion criteria. Patients underwent RALUR at a median age of 5.7 years (IQR:
3.4, 8.7) with median 36.2 months (IQR: 19.6, 63.6) follow-up. Renal ultrasound at
4–6 weeks post-op showed de novo hydronephrosis in 18 (13.5%) ureters; the complete
resolution was seen in 13 ureters (72%) at a median of 4.5 months from surgery. Among
the 5 with non-resolved hydronephrosis (SFU G2:4, G3:1), 2 patients (3 ureters) underwent
subsequent interventions.
Discussion
The present study evaluating the natural history of de novo hydronephrosis after RALUR-EV
performed for primary VUR, is to our knowledge the largest cohort of patients undergoing
RALUR that this has been studied in. In our cohort, the incidence of de novo hydronephrosis
after RALUR was 13.5%, similar to rates reported in two OUR cohorts, and significantly
lower than reported incidence rates of 22–26% in several OUR cohorts, and 30% in a
RALUR cohort. In the present cohort, hydronephrosis resolved spontaneously in more
than 72% of cases. The median time from surgery until resolution of hydronephrosis
was 4.5 (1.6, 10.5) months, which is shorter in comparison to the average time to
resolution of 7.6 months, reported by Kim et al. in an earlier study.
Conclusions
Summary Table
| Number of Patients | 86 |
| Number of ureters | 133 |
| Age at surgery (years), median (IQR) | 5.7 (3.4, 8.7) |
| Follow-up duration (months), median (IQR) | 36.2 (19.6, 63.6) |
| Worsened/de novo hydronephrosis after RALUR | 18 (13.5%) |
| Grade 2 | 14 (10.5%) |
| Grade 3 | 2 (1.5%) |
| Grade 4 | 2 (1.5%) |
| Resolution of de novo hydronephrosis | 13 (72.2%) |
| Time to hydronephrosis resolution (months), median (IQR) | 4.5 (1.6, 10.5) |
| Procedures performed after RALUR | 3 (16.7%) |
Keywords
Abbreviations:
OUR (Open ureteral reimplant), RALUR (Robotic-assisted laparoscopic ureteral reimplant), RALUR-EV (RALUR via an extravesical approach), VUR (Vesicoureteral reflux), UTI (Urinary tract infection), UVJ (Ureterovesical junction)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Summary of the AUA guideline on management of primary vesicoureteral reflux in Children.J Urol. 2010; 184: 1134-1144
- Use of pediatric open, laparoscopic and robot-assisted laparoscopic ureteral reimplantation in the United States: 2000 to 2012.J Urol. 2016; 196: 207-212
- Robot-assisted laparoscopic ureteral reimplantation: a single surgeon comparison to open surgery.J Pediatr Urol. 2014; 10: 875-879
- Robotic assisted laparoscopic ureteral reimplantation in children: case matched comparative study with open surgical approach.J Urol. 2011; 185: 1870-1875
- Pediatric robotic extravesical ureteral reimplantation: comparison with open surgery.J Urol. 2011; 185: 1876-1881
- Outcomes of complex robot-assisted extravesical ureteral reimplantation in the pediatric population.J Pediatr Urol. 2016; 12 (e1-. e6): 169
- Surgical management of vesicoureteral reflux in children.Pediatr Nephrol. 2012; 27: 551-561
- Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): outcomes and complications.J Pediatr Urol. 2018; 14 (e1-.e6): 262
- Robot-assisted extravesical ureteral reimplantation (revur) for unilateral vesico-ureteral reflux in children: results of a multicentric international survey.World J Urol. 2018; 36: 481-488
- Robot-assisted laparoscopic versus open ureteral reimplantation for pediatric vesicoureteral reflux: a systematic review and meta-analysis.World J Urol. 2018; 36: 819-828
- Does hydronephrosis after extravesical ureteral reimplantation deteriorate renal function?.J Urol. 2012; 187: 670-675
- Hydronephrosis following ureteral reimplantation: when is it concerning?.J Pediatr Urol. 2012; 8: 481-487
- Does de novo hydronephrosis after pediatric robot-assisted laparoscopic ureteral re-implantation behave similarly to open re-implantation?.J Pediatr Urol. 2019; 15 (e1-.e6): 604
- The robot-assisted extravesical anti-reflux surgery: how we overcame the learning curve.Front Pediatr. 2019; 7: 93
- Correlation of vesicoureteral reflux with degree of hydronephrosis and the impact of antireflux surgery.J Urol. 2003; 170 (discussion 2): 1560-1562
- Are postoperative studies justified after extravesical ureteral reimplantation?.J Urol. 2000; 164: 1064-1066
Article Info
Publication History
Published online: April 12, 2022
Accepted:
April 3,
2022
Received in revised form:
March 3,
2022
Received:
December 14,
2021
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
