A novel surgical technique for obstructed megaureter: Robotic Assisted Laparoscopic Dismembered Extravesical Cross-trigonal Ureteral Reimplantation (RADECUR) - Short-term assessment.

Purpose To describe our experience with robotic assisted laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation (RADECUR) - A novel minimally invasive surgical technique for treatment of obstructed megaureter. Materials and methods A retrospective review of our prospectively collected data, of all pediatric patients who underwent unilateral RADECUR for the treatment of primary or secondary obstructed megaureter at two medical centers during a three-year period. Patient demographics, perioperative data, surgical technique, complications and results are described. Results Thirty-five pediatric patients underwent RADECUR between January 2016- May 2019. Median age and weight at surgery were 28 months (IQR 20-58) and 20 kg (IQR 13-27) respectively. There were no conversions to an open procedure. Median console time was 100 minutes. (IQR 90-125) Ten patients underwent intracorporeal excisional tapering of the obstructed ureter. Mean pre and post-operative ureteral diameters were 14.5 mm (IQR 12-18) and 7 mm (IQR 0-10) respectively (p<0.0001). All but one patient demonstrated a reduction in hydronephrosis and ureteral diameter on follow-up ultrasound. Grade 1-2 Clavien-Dindo complications occurred in five patients (14%) and another patient developed a Grade 3 complication. Three patients developed post-operative febrile urinary tract infection, one of them was diagnosed with high grade reflux and subsequently underwent open ureteral reimplantation. Conclusions Unilateral robotic extravesical cross-trigonal ureteral reimplantation for treatment of obstructed megaureter in the pediatric population is safe and effective. Further larger scale comparative studies to other surgical techniques are needed to determine the role of RADECUR in the armamentarium of treatment for distal ureteral obstruction.