Comparison of Robot-assisted Laparoscopic Extravesical Ureteral Reimplantation for Primary Vesicoureteral Reflux in Infants Under One Year of Age and Older Children.

PURPOSE: To assess the surgical outcomes of Robot-Assisted Laparoscopic Extravesical Ureteral Reimplantation (RALUR-EV) in infants under one year of age with primary vesicoureteral reflux (VUR) as compared to older children.

MATERIALS AND

METHODS

A retrospective analysis was conducted on 48 children with VUR who underwent unilateral or bilateral RALUR-EV between June 2018 and December 2022. Patients were divided into two groups: Group A (25 infants under one year) and Group B (23 children over one year). Preoperative evaluations included voiding cystourethrogram (VCUG), diuretic renography, ultrasonography, magnetic resonance urography, and urodynamic studies. Standard follow-up was conducted postoperatively, and both the resolution of reflux and any complications were meticulously documented.

RESULTS

All procedures were completed using the Da Vinci Surgical System without conversion to open surgery or major intraoperative complications. Group A had significantly smaller bladder capacities compared to Group B (70 [60, 90] ml vs. 150 [90, 200] ml, P <0.001) and a higher proportion of refractory febrile UTIs preoperatively (88.00 % vs. 60.87 %, P = 0.030). No significant differences in Operation time, estimated blood loss, or postoperative complications were observed between the groups. The success rates of reflux resolution were 96.00 % in Group A and 95.65 % in Group B. The length of hospital stay was significantly shorter in Group A (5 [4, 6] days vs. 7 [6, 10] days, P = 0.001).

CONCLUSION

RALUR-EV for the treatment of VUR in infants under one year of age is safe and effective. Compared to older children, the procedure does not increase intraoperative risks, and postoperative outcomes are comparable.