A Novel Surgical Technique for Obstructed Megaureter: Robot-Assisted Laparoscopic Dismembered Extravesical Cross-Trigonal Ureteral Reimplantation - Short-Term Assessment

Purpose: To describe our experience with robot-assisted laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation (RADECUR) - a novel minimally invasive surgical technique for treatment of obstructed megaureter. Materials and Methods: A retrospective review of our prospectively collected data, of all pediatric patients who underwent unilateral RADECUR for the treatment of primary or secondary obstructed megaureter at two medical centers during a 3-year period. Patient demographics, perioperative data, surgical technique, complications, and results are described. Results: Thirty-five pediatric patients underwent RADECUR between January 2016 and May 2019. Median age and weight at surgery were 28 months (interquartile range [IQR]: 20-58) and 20 kg (IQR: 13-27), respectively. There were no conversions to an open procedure. Median console time was 100 minutes (IQR: 90-125). Ten patients underwent intracorporeal excisional tapering of the obstructed ureter. Mean pre- and postoperative ureteral diameters were 14.5 mm (IQR: 12-18) and 7 mm (IQR: 0-10), respectively (p < 0.0001). All but one patient demonstrated a reduction in hydronephrosis and ureteral diameter on follow-up ultrasonography. Grade 1-2 Clavien-Dindo complications occurred in five patients (14%) and another patient developed a grade 3 complication. Three patients developed postoperative febrile urinary tract infection, one of them was found to have high-grade reflux and subsequently underwent open ureteral reimplantation. Conclusions: Unilateral robotic extravesical cross-trigonal ureteral reimplantation for treatment of obstructed megaureter in the pediatric population is safe and effective. Further larger scale comparative studies with other surgical techniques are needed to determine the role of RADECUR in the armamentarium of treatment for distal ureteral obstruction.