Abdelhalim Ahmed, Elbakry Amr, Eldabek Khaled, Al-Omar Osama
The Department of Urology, West Virginia University, Morgantown, WV; The Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
The Department of Urology, West Virginia University, Morgantown, WV.
Urology. 2025 Feb;196:241-248. doi: 10.1016/j.urology.2024.10.063. Epub 2024 Oct 30.
To examine the need to routinely obtain voiding cystourethrogram (VCUG) to confirm vesicoureteral reflux (VUR) resolution following robotic-assisted laparoscopic ureteral reimplantation (RALUR) in children.
A single-center, prospectively maintained database was reviewed for patients <18 years old who underwent RALUR for VUR. Patient charts were reviewed for baseline characteristics and surgical details. Patients were routinely followed up by renal bladder ultrasound at 6-8 weeks and VCUG at 3 months postoperatively. The primary endpoint was radiological success defined as the absence of VUR on postoperative VCUG. The secondary endpoints were clinical success, defined as the absence of postoperative febrile urinary tract infection, postoperative urinary retention, and reoperation for persistent VUR or RALUR complications.
Between 2018 and 2023, 42 children (48 refluxing ureters) underwent extravesical RALUR at the study institution at a mean age of 70.4 + 23.7 months. A majority of 81% were females, and 85.7% had associated bladder and bowel dysfunction. Six patients (14.3%) had bilateral RALUR. Of the ureters, 83.4%(40/48) had grade III or higher VUR, and 20.8%(10/48) had duplex kidneys. Postoperative VCUG was completed in 36(85.7%) patients. Radiological reflux resolution was confirmed in 87.5%(35/40) of ureters. The remaining five ureters had VUR downgrading to grade I or II; all remained asymptomatic, and none required reoperation. One patient required ureteral stenting for 6 weeks for an unidentified unilateral ureteral injury without long-term consequences. Postoperative urine retention requiring short-term catheterization occurred in three patients. The clinical success rate was 97.6%.
After bypassing the learning curve, VCUG is not routinely indicated following RALUR for VUR.
探讨儿童机器人辅助腹腔镜输尿管再植术（RALUR）后是否有必要常规进行排尿性膀胱尿道造影（VCUG）以确认膀胱输尿管反流（VUR）已消除。
回顾了一个单中心前瞻性维护的数据库，纳入了18岁以下因VUR接受RALUR的患者。查阅患者病历以了解基线特征和手术细节。患者在术后6 - 8周常规接受肾脏膀胱超声检查，术后3个月接受VCUG检查。主要终点是放射学成功，定义为术后VCUG显示无VUR。次要终点是临床成功，定义为术后无发热性尿路感染、术后尿潴留以及因持续性VUR或RALUR并发症而再次手术。
2018年至2023年期间，42名儿童（48条反流输尿管）在研究机构接受了膀胱外RALUR，平均年龄为70.4 ± 23.7个月。大多数（81%）为女性，85.7%伴有膀胱和肠道功能障碍。6名患者（14.3%）接受了双侧RALUR。在输尿管中，83.4%（40/48）有III级或更高等级的VUR，20.8%（10/48）有重复肾。36名（85.7%）患者完成了术后VCUG检查。87.5%（35/40）的输尿管经放射学检查证实反流已消除。其余5条输尿管的VUR降级为I级或II级；所有患者均无症状，无一例需要再次手术。1名患者因不明原因的单侧输尿管损伤接受了6周的输尿管支架置入，无长期后果。3名患者发生了需要短期导尿的术后尿潴留。临床成功率为97.6%。
在度过学习曲线后，RALUR治疗VUR后通常无需进行VCUG检查。
