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Prospective Analysis of Anti-Reflux Surgery: A Comparison of Three Approaches
Stephanie Rubino, MD, Katherine Herbst, MS, John Makari, MD, Fernando Ferrer, MD, Renee Silvis, BS, Christina Kim, MD.
University of Connecticut, Hartford, CT, USA.

BACKGROUND
Correction of vesicoureteral reflux (VUR) can be done with different surgical approaches. The majority of clinical outcomes from anti-reflux surgery have been reported in a retrospective fashion. Therefore, we initiated a prospective registry of patients receiving surgical intervention for VUR.
METHODS
Between June 2010 and February 2012, fifty-one patients were enrolled in our registry. The purpose of this study was to compare outcomes of Deflux injection, open ureteral reimplantation, and robotic ureteral reimplantation. Categorical comparisons were performed utilizing Fisher's Exact Test, and continuous variables compared utilizing t-test or Mann-Whitney U test as appropriate.
RESULTS
Of fifty-one patients enrolled, forty-five have undergone surgery (twenty-two Deflux injections, eleven open reimplantations, and twelve robotic reimplantations). There was no difference in VUR severity among the surgical groups. Success was defined as complete resolution of VUR on postoperative voiding cystourethrogram (VCUG). Success was 86.4% for Deflux, 92.9% for open reimplantation and 92.9% for robotic reimplantation. Mean length-of-stay (LOS) for robotic surgery (1.1 days; SD +/- 0.32) was significantly shorter than for open surgery (1.9 days; SD +/- 0.83) (p<.05). Mean robotic anesthesia time was statistically similar to open surgery (241 vs 228 minutes).
CONCLUSIONS
Our prospective case series showed a lower success rate with Deflux injection compared to ureteral reimplantation. Robotic ureteral reimplantation had the same success rate as open reimplantation with a decreased LOS. The primary limitation of this study is overall sample size. We continue to enroll patients into this registry and hope to expand to other institutions.


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