Patient-reported symptoms suggestive of vesicoureteral reflux after robotic ureteral reimplantation in adults.

Little is known regarding the incidence of symptomatic, de novo vesicoureteral reflux (VUR) after ureteral reimplantation in adults. We sought to characterize this phenomenon in a contemporary cohort. We conducted a retrospective review of a multi-institutional database of robotic ureteral reconstruction (CORRUS, or Collaborative of Reconstructive Robotic Ureteral Surgery). Inclusion criteria were adult patients undergoing robotic ureteral reimplantation with at least 6 months of follow-up. Patients who had no evidence of recurrent ureteral stenosis were asked to complete a questionnaire characterizing their symptoms. The primary outcome was symptoms suggestive of VUR (SS-VUR), defined as flank pain of at least moderate severity that occurred at least weekly and worsened with voiding or a full bladder. We identified 257 patients who underwent robotic reimplantation, of which 97 (37.7%) were free from recurrent ureteral stenosis and responded to the questionnaire. At a median follow-up duration of 35.0 months (IQR 22.0-59.0), 26 patients (27.4%) reported flank pain of any severity on the same side as reimplantation. Nine patients (9.5%) met criteria for SS-VUR. Four patients underwent additional surgical intervention (two endoscopic, two robotic) after radiographic and functional workup confirmed VUR. On multivariable logistic regression, younger age was an independent predictor of SS-VUR (p = 0.041). In our contemporary series of robotic ureteral reimplantation in adults, over one-quarter of patients reported flank pain postoperatively in the absence of ureteral obstruction. A small proportion of patients had more bothersome symptoms particularly suggestive of VUR.