Is a Drainage Placement Still Necessary After Robotic Reconstruction of the Upper Urinary Tract in Children? Experience from a Tertiary Referral Center.

Sforza, Simone; Di Maida, Fabrizio; Mari, Andrea; Zaccaro, Claudia; Cini, Chiara; Tellini, Riccardo; Carini, Marco; Minervini, Andrea; Masieri, Lorenzo

Purpose: To compare the surgical outcomes of children submitted to robot-assisted reconstruction with or without drainage placement performed by a single surgeon in a tertiary referral center. Materials and Methods: Patients submitted to robot-assisted reconstruction, including pyeloplasty for ureteral pelvic junction obstruction, end-to-end anastomosis for retrocaval ureter, and reimplantation for vesical ureter reflux (VUR) from January 2016 to November 2018, were included. Patients with ureteral pelvic junction obstruction or retrocaval ureter were selected for surgery according to the presence of symptoms and/or evidence of obstruction on diagnostic imaging. The criteria for reimplantation included breakthrough urinary tract infections, progressive renal scarring, and persistent VUR despite watchful waiting. Results: Overall, 31 children composed the no drain placement (DP) group and 29 the DP group. Preoperative feature of the two groups were comparable. Overall, only 1 (3.3%) postoperative complication occurred in no DP group and 2 (6.9%) in the placement group (P = .512). Length of stay was 3 (interquartile range [IQR]: 3-4) and 4 (IQR: 4-4) days, respectively (P = .651). At last follow-up, overall success rate was 100% in the no DP group and 96.6% in the DP group (P = .297). Conclusions: Robot-assisted reconstruction represents a safe minimally invasive approach with optimal surgical outcomes for the treatment of upper urinary tract. Expert robotic surgeons could avoid drainage placement after surgery as this does not undermine perioperative outcomes and postoperative success rate. Our study, first in literature, proves the interest in assessing the safety of no drainage placement also in the pediatric field.

URINARY organs; URINARY tract infections; DRAINAGE; WATCHFUL waiting; ROBOTICS; URETER surgery; REIMPLANTATION (Surgery); SURGICAL complications; PLASTIC surgery; URETERIC obstruction; VESICO-ureteral reflux; SPECIALTY hospitals; SURGICAL robots; TREATMENT effectiveness; RETROSPECTIVE studies; SURGICAL anastomosis; MEDICAL drainage

Journal of Laparoendoscopic & Advanced Surgical Techniques, 2019, Vol 29, Issue 9, p1180

1092-6429

Academic Journal

10.1089/lap.2019.0302