Comparative Analysis of Efficacy and Complications of Robot-Assisted vs Open Dismembered Ureteral Reimplantation for Primary Obstructive Megaureter

Introduction and Objective: Dismembered ureteral reimplant (DUR) is done to treat primary obstructive megaureter (POM). To describe and compare outcomes between open dismembered ureteral reimplant (ODUR) vs robot-assisted laparoscopic dismembered ureteral reimplant (RALDUR). Methods: An IRB-approved registry was used to retrospectively identify all patients who underwent DUR for POM between 2015 and 2022. Demographics, preoperative, perioperative, and long-term outcomes were analyzed. p-Values were two sided, and a p < 0.05 was considered significant. Results: Our cohort consisted of 50 patients: 14 (28%) underwent ODUR, and 36 (72%) underwent RALDUR. Preoperatively, no differences were noted between RALDUR and ODUR in terms of antenatal hydronephrosis (p = 1.00), febrile urinary tract infection (p = 0.09), and reflux grade on preoperative voiding cystourethrogram (p = 0.53). Ipsilateral kidney function was 37% in the RALDUR group compared with 32% in the ODUR, with no difference between them (p = 0.74). RALDUR was associated with a longer procedure time (278 minutes vs 191 minutes, p = 0.001) and a similar rate of ureteral tapering (61% vs 86%, p = 0.18). Both cohorts had similar length of stay (p = 0.33) and IV morphine use (p = 0.84). Postoperatively, only three (6%) had Clavien Dindo grade 3b complications-one in the ODUR group who required percutaneous nephrostomy tube (PCN) placement by IR and two in the RALDUR group, one had a port-site hernia s/p repair, and one had a retained JP drain requiring removal. During follow-up, 34 (94.4%) patients in the RALDUR group had stable/improved hydronephrosis in their most recent ultrasound compared with 14 (100%) in the ODUR. Neither group underwent a reintervention procedure. Conclusion: RALDUR is shown to have comparable success and efficacy to ODUR. A longer procedure time is reported in RALDUR.