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Introduction:
Ureteroureterostomy (UU) is a useful surgical option for the management of duplication anomalies and obstructed single systems. We aimed to evaluate the safety, efficacy, and outcomes of robotic-assisted laparoscopic UU (RALUU) compared to open UU (OUU) in children.
Methods:
A retrospective review was performed at two institutions including six surgeons’ experience with all cases of RALUU and OUU from January 2005 to June 2014. Indications for surgery included duplex systems with an upper pole ectopic ureter, obstructed ureterocele or lower pole vesicoureteral reflux, and obstruction in a single system. Transureteroureterostomy, laparoscopic UU, and major reconstruction cases where UU was the secondary procedure were excluded.
Results:
25 RALUU and 19 OUU cases were included (Table1). RALUU were more likely to be performed proximally (p=0.01) and with the use of cystoscopy and stent placement (p=<0.0001). Post-operative complications included four febrile urinary tract infections in each group, one recurrence of non-febrile urinary tract infection in the open group, and one post-operative obstruction at the ureterovesical junction requiring nephrostomy tube placement in the open group. RALUU had shorter hospital stays (p=0.04) and higher rates of hydronephrosis resolution/improvement or improved drainage compared to OUU on initial follow-up imaging (p=0.01).
Conclusions:
RALUU is a safe alternative to OUU in children with duplication anomalies and single system obstructed ureters. Operative times, length of hospitalization, success rates, and complication rates were comparable.

Table 1. Patient demographics, surgical technique, and outcomes.

	RALUU (n=25)	OUU (n=19)	P value
Patient demographics
Mean age (years)	6.15.1	3.94.3	0.18
Males:females	1:2.6	1:2.8	0.89
Mean weight (kg)	23.523.3	17.712.2	0.27
Indication for surgery Ectopic ureter Obstructed ureterocele Lower pole vesicoureteral reflux Ureteral stricture/stenosis	18 (72%) 3 (12%) 0 (0%) 4 (16%)	10 (53%) 4 (21%) 3 (16%) 2 (11%)	0.19 0.68 0.07 0.68
Surgical technique
Side Left Right Bilateral	11 (44%) 13 (52%) 1 (4%)	11 (58%) 7 (37%) 1 (5%)	0.36 0.32 0.99
Ureteral anastomosis Upper to lower ureter Lower to upper ureter Proximal to distal ureter	23 (92%) 0 (0%) 2 (8%)	16 (84%) 3 (16%) 0 (0%)	0.64 0.07 0.50
Location Proximal Mid Distal	16 (64%) 1 (4%) 8 (32%)	5 (26%) 2 (11%) 12 (63%)	0.01 0.57 0.04
Cystoscopy included	25 (100%)	4 (21%)	<0.0001
Use of stent	25 (100%)	8 (42%)	<0.0001
Mean stent duration (days)	18.812.2	26.730.4	0.52
Need for second procedure for stent removal	6 (24%)	4 (21%)	0.99
Use of penrose drain	0 (0%)	14 (74%)	<0.0001
Outcomes
Mean operative time (minutes)	158.048.5	176.793.8	0.49
Mean cystoscopy time (minutes)	27.719.2	16.77.6	0.10
Mean total operative time (minutes)	186.352.7	161.558.5	0.17
Mean estimated blood loss (mL)	6.45.6	8.110.6	0.54
Mean length of hospital stay (days)	1.60.7	2.10.8	0.04
Complications (Based on Clavien classification) Grade 1 Grade 2 Grade 3 Grade 4	0 (0%) 4 (16%) 0 (0%) 0 (0%)	0 (0%) 5 (26%) 1 (5%) 0 (0%)	0.99 0.47 0.43 0.99
Hydronephrosis or drainage on follow-up imaging Resolved/improved Stable Worse No imaging Mean time of imaging following surgery (weeks)	22 (88%) 2 (8%) 0 (0%) 1 (4%) 10.211.9	10 (53%) 5 (26%) 1 (5%) 3 (16%) 7.95.0	0.01 0.21 0.43 0.30 0.42
Mean follow-up (months)	16.418.0	11.614.1	0.30