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Preoperative Bladder Bowel Dysfunction is the Most Important Predictive Factor for Postoperative Urinary Retention after Robot Assisted Laparoscopic Extravesical Ureteral Reimplantation: a Multi- ~ |
| Urology, Asan Medical Center, University of Ulsan College of Medicine, Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, and Scott Department of Urology, Baylor College of Medicine, Houston, TX, Urology, Korea University Ansan Hospital, Urology, Asan Medical Center, University of Ulsan College of Medicine, Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, and Scott Department of Urology, Baylor College of Medicine, Houston, TX, Division of Pediatric Urology, Stanford Medicine, Palo Alto, California, Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, and Scott Department of Urology, Baylor College of Medicine, Houston, TX, Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, and Scott Department of Urology, Baylor College of Medicine, Houston, TX, Urology, Samsung Medical Center, Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, and Scott Department of Urology, Baylor College of Medicine, Houston, TX |
| Sang Hoon Song, Il-Hwan Kim, Jae Hyeon Han, Kun Suk Kim, Esther J. Kim, Kunj Sheth, Jonathan Gerber, Vinaya Bhatia, Minki Baek, Chester J. KOH |
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Background: Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) has been reported as a viable minimally invasive surgical option for vesicoureteral reflux (VUR) with comparable success rates to open reimplantation at several pediatric hospitals. Postoperative acute urinary retention (pAUR) is a known occurrence after robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV). We hypothesized that the risk factor of pAUR after RALUR-EV might be similar to that of pAUR after open reimplantation. / Objectives: We aimed to perform a retrospective multi-institutional study to evaluate the risk factors for pAUR after RALUR-EV. / Materials and Methods: Perioperative data collected from two tertiary referral hospitals (hospitals A and B) included demographics and perioperative variables such as bladder bowel dysfunction (BBD) status, vesicoureteral reflux (VUR) grade, and laterality. pAUR was defined as the need for urethral catheter replacement after removal of the initial postoperative catheter. In patients with pAUR, the urethral catheter was left in place for two weeks then subsequently removed. BBD included lower urinary tract dysfunction and bowel dysfunction and was evaluated using the Bristol Stool Scale and voiding function questionnaires. Univariate and multivariate analyses were performed to identify risk factors for pAUR. / Results and Conclusion: A total of 117 patients (174 renal units), 97 from hospital A and 20 from hospital B, were enrolled in this study. The mean age at the time of surgery was 6.1 ± 3.9 years. Bilateral RALUR-EV was performed in 57 (48.7%) cases. pAUR rate was 3.4% in all patients and 7.0% in 57 patients with bilateral VUR. All 4 cases of pAUR occurred after bilateral surgery. Univariate analysis showed age (p = 0.037), weight (p = 0.039), height (p = 0.040), and bilaterality (p = 0.037) as risk factors of pAUR. In a multivariate analysis, BBD was the only significant risk factor of pAUR (p = 0.037). The cohorts from hospitals A and B had differences in weight, height, gender ratio, BBD ratio, preop hydronephrosis severity, VUR grade, console time, detrusorrhaphy stitches, and morphine equivalent analgesics usage. After the propensity score matching, patients from hospitals A and B showed no difference in age, weight, height, and gender ratio (Table 1). Similarly, in the matched cohorts, age (p = 0.001), weight (p < 0.001) and height (p = 0.006) were risk factors of pAUR in a univariate analysis. Likewise, BBD was also the only significant risk factor of pAUR (p = 0.035) in a multivariate analysis of the matched cohorts. In conclusion, urinary retention after RALUR-EV occurred less frequently when compared to the previously reported open surgery series. pAUR was seen only in bilateral cases in our series. Younger age, lower weight and height, bilaterality, and preoperative history of BBD, but not male gender or length of surgical time, were risk factors of pAUR after RALUR-EV. |
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keywords : vesicoureteral reflux; reimplantation; bladder bowel dysfunction |
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