Bladder and bowel dysfunction syndrome (BBD) is reported to have no impact on success rate after open ureteral reimplantation (OUR).  However, Bladder dysfunction (BD) and urinary retention is reported to be one of the complications after OUR, especially when it is done bilaterally. The aim of this study is to report the preliminary outcome of initial experience with robotic ureteral reimplantation in pediatric patients with VUR and BBD.

We retrospectively reviewed all pediatric patients who underwent ERALUR. We identified 29 patients between July 2018 and December 2021. We excluded 3 patients who did not have at least 3 months follow. Out of the remaining 26 cases, a total of 23 patients/24 ureters were found to have preoperative BBD. All patients received an average of 6 weeks of preoperative standard Urotherapy.

Patients’ mean age is 6.1 years (SD 2). Most patients (50%) had grade 3 reflux. Only one patient underwent bilateral reimplantation. Mean operative time is 155 min (SD 27). Blood loss was minimum. The average tunnel length was 3.2 cm (SD 0.4). No reported intraoperative complications. Hospital stay was less than 24 hours in 22 (95.7%) patients and one patient was discharged after 48 hours. One postoperative complication was reported in a bilateral reimplantation, as patient had urinary extravasation that required stent placement.  Subsequent evaluation showed complete healing with no long-term consequences.  Postoperative ultrasound was normal in all patients except one who showed improvement of the preexisting hydronephrosis but not complete resolution. Postoperative VCUG was done in 21 patients (22 ureters) and showed resolution of reflux 20 patients/21 ureters (95%) and one patient showed improvement from grade 4 down to 1.  Also, 3 patients (14.3%) developed de novo contralateral grade 1 reflux. All patients showed stable or improved BBD without any case of urinary retention.

We are reporting results of outcome following ureteral reimplantation via extravesical approach using robotic approach in pediatric patients who also suffer from bladder and bowel dysfunction. Results of this approach in this group of patient in our series showed that bladder and bowel dysfunction did not negatively affect success rate of the surgery using robotic approach, with similar success rate to open approach.

Our preliminary data suggests that robotic approach is a safe option for ureteral reimplantation in BBD patients, with high success rate, like those reported in open series. . Further studies with larger number and long-term outcomes are needed to reach a solid conclusion.

Continence 2S2 (2022) 100436
DOI: 10.1016/j.cont.2022.100436