ESPU Congress 2018 - Abstract Book

122

CONGRESS OF THE ESPU

09:31–09:34

S14-9 (PP)

SINGLE INSTITUTION EXPERIENCE AND TECHNIQUE

FOR ROBOTIC-ASSISTED LAPAROSCOPIC DISMEMBERED

URETERAL REIMPLANTATION

Arun SRINIVASAN, Jay SHAH, Diana BOWEN, Jason VAN BATAVIA, Yves BODAR,

Christopher LONG and Aseem SHUKLA

Children's Hospital of Philadelphia, Urology, Philadelphia, USA

PURPOSE

Robotic assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) can be utilized for

primary obstructive mega-ureter (POM) or ureters associated with diverticula. We hypothesize that

RALUR-EV approach is feasible and effective for dismembered reimplant with or without tapering

and tailoring of ureter.

MATERIAL AND METHODS

All patients undergoing robotic surgery at our institution are prospectively entered into an IRB ap-

proved registry. We retrospectively reviewed patients who underwent dismembered RALUR-EV

from April 2009 to August 2017, and had at least one post-operative ultrasound. Inclusion criteria

included POM, ureter associated with a bladder diverticula, distal ureteral stricture, or high grade

VUR. Patient demographics and outcome variables analyzed included age, gender, ureteral stent

placement, length of hospital stay (LOS), urinary tract infection (UTI), and complications by Clavien

grade.

RESULTS

25 patients (17 male, 8 female) had dismembered RALUR-EV with a median age of 4 years (IQR

1.4,8.5) and median follow up of 11.6 months (IQR 5,33). Diagnoses included POM in 13 patients

(52 %), UVJ obstruction in 6 (24 %), diverticulum in 4 (16 %) and high grade VUR in 2 (8 %). Median

operative time for RALUR-EV without tapering was 230 minutes (IQR 191,270; n=22) compared

with RALUR-EV with tapering which was 250 minutes (IQR 195,461; n=3). Median LOS was 2 days.

Ureteral stenting was used in 22 patients (88 %) for a median of 6 weeks (IQR 4,8.5). 3 patients

(12 %) developed febrile UTIs when they had stents in place and 4 (16 %)developed febrile UTIs

after stent was removed. There were no other complications. Postoperatively RBUS has shown

significant improvement in all patients with one patient having new vesicoureteral reflux diagnosed

after urinary tract infection.

CONCLUSIONS

Robot assisted laparoscopic approach for dismembered reimplantation with or without ureteral

tailoring yields excellent results and is comparable to other approaches.

09:34–09:46

Discussion