{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T02:13:28Z","timestamp":1770257608503,"version":"3.49.0"},"reference-count":21,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health & Welfare, Republic of Korea","award":["RS-2024-00335457"],"award-info":[{"award-number":["RS-2024-00335457"]}]},{"name":"Ministry of Health & Welfare, Republic of Korea","award":["HR21C0198"],"award-info":[{"award-number":["HR21C0198"]}]},{"name":"Ministry of Science and ICT of the Republic of Korea and the National Research Foundation of Korea","award":["2022R1F1A107478211"],"award-info":[{"award-number":["2022R1F1A107478211"]}]},{"name":"Korea government","award":["25C0102L1"],"award-info":[{"award-number":["25C0102L1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Robot-assisted laparoscopic ureteral reimplantation via an extravesical approach (RALUR-EV) is an established minimally invasive option for vesicoureteral reflux (VUR); however, surgical success remains variable, and detrusorraphy technique is a key determinant of reflux resolution. This study evaluated whether a refined detrusorraphy technique is associated with improved surgical outcomes following RALUR-EV. Methods: We retrospectively reviewed patients who underwent RALUR-EV performed by a single surgeon between August 2013 and February 2023. A technique modification introduced in November 2021 incorporated ureteral adventitia inclusion during detrusorraphy and a distal-first detrusorraphy suture. Patients were divided into two groups according to the surgical period. Surgical success was defined as radiographic resolution of VUR on postoperative voiding cystourethrography without ureteral obstruction. Results: A total of 62 patients (96 ureters) were included. The modified technique group demonstrated significantly higher surgical success rates than the conventional group at both the ureter level (97.8% vs. 76.5%, p = 0.002) and the patient level (96.6% vs. 69.7%, p = 0.006). On patient-level multivariable analysis, the modified detrusorraphy technique was independently associated with a reduced risk of surgical failure. Conclusions: A refined detrusorraphy technique is associated with improved early radiographic success after RALUR-EV without increasing perioperative morbidity.<\/jats:p>","DOI":"10.3390\/jcm15031221","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T12:51:56Z","timestamp":1770209516000},"page":"1221","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Refining Robotic Extravesical Ureteral Reimplantation: Impact of Ureteral Adventitia Inclusion and Distal-First Detrusorraphy"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3457-0816","authenticated-orcid":false,"given":"Sangmin","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaeyoung","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyenghyun","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun Suk","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea"},{"name":"Department of Urology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu-si 11759, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4888-483X","authenticated-orcid":false,"given":"Sang Hoon","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1111\/iju.14223","article-title":"Guidelines for the medical management of pediatric vesicoureteral reflux","volume":"27","author":"Miyakita","year":"2020","journal-title":"Int. J. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1038\/s41598-024-52161-w","article-title":"Risk factors for new renal scarring in children with vesicoureteral reflux receiving continuous antibiotic prophylaxis","volume":"14","author":"Su","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.eururo.2023.12.005","article-title":"Update and Summary of the European Association of Urology\/European Society of Paediatric Urology Paediatric Guidelines on Vesicoureteral Reflux in Children","volume":"85","author":"Gnech","year":"2024","journal-title":"Eur. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.eururo.2012.05.059","article-title":"EAU Guidelines on Vesicoureteral Reflux in Children","volume":"62","author":"Riedmiller","year":"2012","journal-title":"Eur. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s00383-023-05426-w","article-title":"Endoscopic injection of bulking agents in pediatric vesicoureteral reflux: A narrative review of the literature","volume":"39","author":"Escolino","year":"2023","journal-title":"Pediatr. Surg. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s11701-017-0703-3","article-title":"Global trends in paediatric robot-assisted urological surgery: A bibliometric and Progressive Scholarly Acceptance analysis","volume":"12","author":"Cundy","year":"2018","journal-title":"J. Robot. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1016\/j.urology.2011.10.052","article-title":"Prospective long-term analysis of nerve-sparing extravesical robotic-assisted laparoscopic ureteral reimplantation","volume":"79","author":"Kasturi","year":"2012","journal-title":"Urology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1016\/j.juro.2017.01.062","article-title":"Multi-Institutional Review of Outcomes and Complications of Robot-Assisted Laparoscopic Extravesical Ureteral Reimplantation for Treatment of Primary Vesicoureteral Reflux in Children","volume":"197","author":"Boysen","year":"2017","journal-title":"J. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1007\/s00345-019-02766-y","article-title":"Robot-assisted laparoscopic ureteral reimplantation in children: A valuable alternative to open surgery","volume":"38","author":"Gerber","year":"2020","journal-title":"World J. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.jpurol.2023.11.006","article-title":"A multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV\u2013V) vesicoureteral reflux","volume":"20","author":"Sforza","year":"2024","journal-title":"J. Pediatr. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.1016\/j.juro.2010.12.069","article-title":"Robotic assisted laparoscopic ureteral reimplantation in children: Case matched comparative study with open surgical approach","volume":"185","author":"Marchini","year":"2011","journal-title":"J. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1089\/end.2021.0083","article-title":"Robot-Assisted Ureteral Reimplantation: A Single-Center Comparative Study","volume":"35","author":"Carbonara","year":"2021","journal-title":"J. Endourol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.urology.2021.06.043","article-title":"Robot-Assisted Laparoscopic Extra-Vesical Ureteral Reimplantation (Ralur\/Revur) for Pediatric Vesicoureteral Reflux: A Systematic Review of Literature","volume":"156","author":"Esposito","year":"2021","journal-title":"Urology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.21037\/tp-23-336","article-title":"Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): A narrative review","volume":"13","author":"Essamoud","year":"2024","journal-title":"Transl. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1016\/j.juro.2008.01.062","article-title":"Nerve sparing robotic extravesical ureteral reimplantation","volume":"179","author":"Casale","year":"2008","journal-title":"J. Urol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1111\/iju.12483","article-title":"Extravesical robot-assisted laparoscopic ureteral reimplantation for vesicoureteral reflux: Initial experience in Japan with the ureteral advancement technique","volume":"21","author":"Hayashi","year":"2014","journal-title":"Int. J. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1089\/end.2014.0815","article-title":"Robot-Assisted Laparoscopic Extravesical Ureteral Reimplantation in Children: Top-Down Suturing Technique Without Stent Placement","volume":"29","author":"Silay","year":"2015","journal-title":"J. Endourol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1016\/j.eururo.2016.02.065","article-title":"Robot-assisted Laparoscopic Extravesical Ureteral Reimplantation: Technique Modifications Contribute to Optimized Outcomes","volume":"70","author":"Gundeti","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1002\/bjs5.50353","article-title":"Shortening surgical training through robotics: Randomized clinical trial of laparoscopic versus robotic surgical learning curves","volume":"4","author":"Gall","year":"2020","journal-title":"BJS Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1089\/end.2005.19.618","article-title":"Intravesical robotically assisted bilateral ureteral reimplantation","volume":"19","author":"Peters","year":"2005","journal-title":"J. Endourol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/MOU.0b013e32835b0ad2","article-title":"Current controversies in pediatric urologic robotic surgery","volume":"23","author":"Trevisani","year":"2013","journal-title":"Curr. Opin. Urol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1221\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T13:04:11Z","timestamp":1770210251000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,4]]},"references-count":21,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15031221"],"URL":"https:\/\/doi.org\/10.3390\/jcm15031221","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,4]]}}}