- 作者：Mohan S. Gundeti ; mgundeti@surgery.bsd.uchicago.edu" class="auth_mail" title="E-mail the corresponding author ; William R. Boysen ; Anup Shah
- 关键词：Vesicoureteral reflux ; Robotic surgery ; Reimplantation ; Extravesical
- 刊名：European Urology
- 出版年：2016
- 出版时间：November 2016
- 年：2016
- 卷：70
- 期：5
- 页码：818-823
- 全文大小：797 K
Objective
To describe technique modifications that may lead to improved radiographic vesicoureteral reflux (VUR) resolution.
Design, setting, and participants
Between December 2008 and February 2015, a single surgeon performed RALUR-EV at an academic medical center. Only children with persistent grade 3–5 VUR at age 5 yr on voiding cystourethrogram (VCUG), those who had breakthrough urinary tract infections, or those with renal scarring were selected to undergo surgical correction of VUR with RALUR-EV. Children undergoing RALUR-EV for obstructive megaureter or ureterovesical junction obstruction were excluded. Fifty-eight patients (83 ureters) fit the inclusion criteria.
Surgical procedure
We highlighted adjustments to our technique, called LUAA to represent length of detrusor tunnel (L), use of a U stitch (U), placement of permanent ureteral alignment suture (A), and inclusion of ureteral adventitia (A) in detrusorraphy.
Outcome measurements and statistical analysis
The primary end point was resolution of VUR on postoperative VCUG.
Results and limitations
Because technique modifications were made at two distinct time points, we generated three patient groups for comparison. We observed complete resolution of VUR in 82% of ureters, including 8 of 12 ureters (67%), 8 of 11 ureters (73%), and 52 of 60 ureters (87%) for technique modification cohorts 1, 2, and 3, respectively. There were no ureteral complications at median follow-up of 30 mo. Retrospective design and possible confounding from the learning curve limit this study.
Conclusions
Using the standardized LUAA technique, we demonstrated an improvement in outcomes. Given the wide range of published resolution rates following RALUR-EV, there is a need for standardization of technique to facilitate best possible outcomes. We propose the LUAA technique as a new standard for RALUR-EV to achieve this goal.
Patient summary
We examined the safety and efficacy of a minimally invasive surgery in children. We identified several critical adjustments to surgical technique that improve rates of successful outcome.