Predictors of Failure in 90 Complex Ureters Using Robot-Assisted Laparoscopic Surgery

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Robot-assisted laparoscopic ureteral (RALUR) reimplantation has been adopted as an alternative surgical approach to treat children with persistent high-grade vesicoureteral reflux (VUR). The debate continues in regards to the safety, feasibility and standardized technique. We performed a retrospective analysis of perioperative outcomes in patients undergoing RALUR; using our recent technique modifications to identify predictors of surgical failure.


We reviewed a prospectively maintained database of children undergoing RALUR at a single-institution from 2010-2017. Only patients with high-grade VUR at age 5, urinary tract infections, or renal scarring were selected for surgical correction. This series included patients who received the previously reported LUAA technique, which stands for length of detrusor tunnel (L), U stitch (U), ureteral alignment suture (A), and the inclusion of ureteral adventitia (A). Patients with ureterovesical junction obstruction were excluded. Radiographic failure was defined as persistent VUR on postop VCUG. Complications were grade using Clavien-Dindo scale. Logistic regression analysis was used to determine predictors of failure. Significance was set at p