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Introduction:
Two minimally invasive surgical (MIS) options for treatment of vesicoureteral reflux (VUR) are endoscopic Dextranomer Hyaluronic Acid injection (DI) and robotically-assisted laparoscopic ureteral reimplantation (RALUR). We compared outcomes of these MIS operations at our institution.
Materials & Methods:
We performed a retrospective case review of our first 17 extravesical RALUR patients and 17 age matched patients who underwent DI. Voiding cystourethrogram was performed on all patients except one RALUR lost to follow up.
Results:
Median age was 6 years (RALUR) and 5 years 11 months (DI). A total of 50 ureters were treated. Mean follow-up was twelve and ten months in the RALUR and DI group, respectively.
Preoperatively, there was Grade I-II in 30% of RALUR and 41% of DI groups, Grade III in 57% of RALUR and 59% of DI groups, and Grade IV in 13% of RALUR and none of DI groups.
RALUR had a significantly better outcome than DI (p=0.008). RALUR had complete resolution of VUR in 20 ureters (91%) and downgrading in 2 (9%). DI had complete resolution in 16 ureters (59%), downgrading in 3 (11%), and 8 (30%) had no improvement or worsening of VUR.
Mean hospital stay for the RALUR group was 1.26 days; all DI patients were discharged the same day. One RALUR and three DI patients developed contralateral VUR.
Conclusions:
Although small in volume and retrospective, this series revealed better Results with RALUR compared to DI. We are currently enrolling patients prospectively to compare outcomes of DI, RALUR, and open reimplantation.