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PROSPECTIVE MULTICENTER RESULTS
FROM THE ROBOTIC VERSUS OPEN URETERAL
REIMPLANTATION (ROVOUR) STUDY GROUP:
COMPLICATIONS AND OUTCOMES FROM ROBOT-
ASSISTED LAPAROSCOPIC EXTRAVESICAL URETERAL
REIMPLANTATION (RALUR-EV), 2015 TO 2016
William R BOYSEN
1
, Lauren BELLEVILLE
2
, Jonathan S ELLISON
3
,
Thomas S LENDVAY
3
, Joan KO
4
, Ardavan AKHAVAN
4
, Michael GARCIA-ROIG
5
,
Jonathan HUANG
5
, Andrew KIRSCH
6
, Chester KOH
7
, Marion SCHULTE
8
,
Paul NOH
8
, Trudy KAWAL
9
, Arun SRINIVASAN
9
, Aseem SHUKLA
9
, Christine KIM
10
,
Francesca MONN
11
, Benjamin WHITTAM
11
and Mohan S GUNDETI
1
1) University of Chicago Medicine, Section of Urology, Chicago, USA - 2) University of Chicago, Section
of Urology, Chicago, USA - 3) Seattle Children’s Hospital, Pediatric Urology, Seattle, USA - 4) John’s Hopkins
University, Department of Urology, Baltimore, USA - 5) Emory University, Department of Urology, Atlanta,
USA - 6) Children’s Healthcare of Atlanta, Pediatric Urology, Atlanta, USA - 7) Texas Children’s Hospital, Pediatric
Urology, Houston, USA - 8) Cincinnati Children’s Hospital, Pediatric Urology, Cincinnati, USA - 9) Children’s Hospital
of Philadelphia, Pediatric Urology, Philadelphia, USA - 10) Connecticut Children’s Hospital, Pediatric Urology, Hartford,
USA - 11) IU Health Riley Children’s Hospital, Department of Urology, Indianapolis, USA
PURPOSE
The use of RALUR-EV is increasing nationally, despite conflicting data on the safety and efficacy of
the procedure. We reviewed outcomes and complications from our multicenter cohort from 2015-
2016, hypothesizing that complications would be unchanged and outcomes improved with greater
surgeon experience.
MATERIAL AND METHODS
We reviewed our prospective database of children who underwent RALUR-EV performed by expe-
rienced pediatric urologists (mean RALUR-EV case volume 28 prior to study period) at 9 centers
from 2015 to 2016. Radiographic failure was defined as persistent VUR on postoperative imaging.
Complications were graded using the Clavien scale. Statistical analysis was performed with univari-
ate regression.
RESULTS
A total of 142 patients (205 ureters) underwent RALUR-EV for primary VUR, with mean preopera-
tive VUR grade of 3.0 (SD 1.0). Of the 149 ureters studied with postoperative VCUG or RNC, radio-
graphic resolution was seen in 138 (92.6%). Transient urinary retention occurred in 4 of 63 bilateral
cases (6.3%). There were 8 grade 3 complications (5.6%) and no grade 4 or 5 complications.
On univariate regression analysis, detrusor tunnel length greater than 2.5cm was associated with
decreased odds of radiographic failure (OR 0.08, p=0.01). No other technical factors (tunnel closure
technique, apical suture, distal U-stitch) or patient factors (age, gender, weight, prior endoscopic
injection) were associated with radiographic failure (p>0.05).
CONCLUSIONS
Radiographic success has improved to 92.6% with increased surgeon experience, and is on par
with the open approach for treatment of high grade VUR. RALUR-EV has a low complication rate
consistent with published series of open ureteral reimplantation. Tunnel length over 2.5cm is associ-
ated with decreased odds of radiographic failure, highlighting the importance of this technical factor.