{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T02:47:00Z","timestamp":1767494820236,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T00:00:00Z","timestamp":1731024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Robot-assisted extravesical ureteral reimplantation (REVUR) has been described as valuable alternative to open reimplantation in the pediatric population. This study aimed to report the outcome of REVUR in children with complex obstructed megaureter (COM) needing ureteral dismembering and\/or tapering. Materials and Methods: The records of patients with COM, who received REVUR with ureteral dismembering and\/or tapering over the last 3 years (2021\u20132024), were retrospectively reviewed. The inclusion criteria for COM included previous surgery, paraureteral diverticula, or ectopic megaureter. Results: A total of 16 patients (15 boys), with a median age of 7.8 years (range 2\u201316), were treated over the study period. COM was associated with paraureteral diverticula (n = 6), previous failed endoscopic balloon dilation (n = 4), ectopic megaureter (n = 2), and previous bulking agent endoscopic injection causing iatrogenic ureteral obstruction (n = 4). Presentation symptoms included febrile urinary tract infections (n = 8), flank pain (n = 4), hematuria (n = 2), and pseudo-incontinence (n = 2). All surgical procedures were accomplished robotically without conversions or intra-operative complications. Ureteral tapering was performed in 7\/16 (43.7%). The median operative time (including robot docking) was 220 min (range 155\u2013290). The median length of stay was 3.8 days (range 3\u20137). The indwelling double J stent was removed 4\u20136 weeks postoperatively. Clavien 2 grade complications occurred postoperatively in 2\/16 (12.5%). At median follow-up of 34.5 months, all patients were asymptomatic and showed improved hydroureteronephrosis on ultrasound and improved drainage on diuretic renogram. Conclusions: This study demonstrates that robot-assisted extravesical ureteral reimplantation is a safe and effective treatment for primary obstructive megaureter and other complex ureteral anomalies in our patient cohort. The procedure showed low complication rates, high success rates, and favorable long-term outcomes, supporting the feasibility and effectiveness of robotic surgery for these conditions.<\/jats:p>","DOI":"10.3390\/medicina60111837","type":"journal-article","created":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T06:05:41Z","timestamp":1731045941000},"page":"1837","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Robotic Management of Complex Obstructive Megaureter Needing Ureteral Dismembering and\/or Tapering in Children: A Single-Center Case Series"],"prefix":"10.3390","volume":"60","author":[{"given":"Ciro","family":"Esposito","sequence":"first","affiliation":[{"name":"Division of Pediatric Surgery, Federico II University Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Masieri","sequence":"additional","affiliation":[{"name":"Division of Pediatric Urology, Meyer Children University Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Carraturo","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Federico II University Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annalisa","family":"Chiodi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Federico II University Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3760-1714","authenticated-orcid":false,"given":"Claudia","family":"Di Mento","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Federico II University Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgia","family":"Esposito","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Federico II University Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Porcaro","sequence":"additional","affiliation":[{"name":"Division of Pediatric Radiology, Federico II University Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniella","family":"Araiza Kelly","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, An\u00e1huac University, Mexico City 52786, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3256-7576","authenticated-orcid":false,"given":"Maria","family":"Escolino","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Federico II University Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jpurol.2013.09.018","article-title":"British Association of Paediatric Urologists consensus statement on the management of the primary obstructive megaureter","volume":"10","author":"Farrugia","year":"2014","journal-title":"J. Pediatr. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1046\/j.1464-410x.2000.00922.x","article-title":"Primary megaureter: Current trends in diagnosis and treatment","volume":"86","author":"Shokeir","year":"2000","journal-title":"BJU Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.jpurol.2007.11.013","article-title":"Long-term follow up of antenatally diagnosed megaureters","volume":"4","author":"Chertin","year":"2008","journal-title":"J. Pediatr. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s11934-024-01214-8","article-title":"Advancements in Surgical Management of Megaureters","volume":"25","author":"Boswell","year":"2024","journal-title":"Curr. Urol. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1089\/lap.2016.0456","article-title":"Laparoscopic-Assisted Extravesical Ureteral Reimplantation and Extracorporeal Ureteral Tapering Repair for Primary Obstructive Megaureter in Children","volume":"27","author":"Lopez","year":"2017","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.urology.2021.06.043","article-title":"Robot-assisted laparoscopic extravesical ureteral reimplantation (ralur\/revur) for pediatric vesicoureteral reflux: A systematic review of literature","volume":"1","author":"Esposito","year":"2021","journal-title":"Urology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jpurol.2023.09.005","article-title":"Endoscopic dilatation\/incision of primary obstructive megaureter. A systematic review. On behalf of the EAU paediatric urology guidelines panel","volume":"20","author":"Skott","year":"2024","journal-title":"J. Pediatr. Urol."},{"key":"ref_8","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_9","doi-asserted-by":"crossref","first-page":"107","DOI":"10.4103\/iju.iju_276_22","article-title":"Pediatric robotic urologic procedures: Indications and outcomes","volume":"39","author":"Hou","year":"2023","journal-title":"Indian J. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.21037\/tp-22-533","article-title":"Robot-assisted reconstructive surgery of lower urinary tract in children: A narrative review on technical aspects and current literature","volume":"12","author":"Upasani","year":"2023","journal-title":"Transl. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1089\/lap.2021.0246","article-title":"Ureteral Reimplantation for Primary Obstructive Megaureter in Pediatric Patients: Is It Time for Robot-Assisted Approach?","volume":"32","author":"Sforza","year":"2022","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_12","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_13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4111\/icu.2017.58.1.3","article-title":"Lessons learned over a decade of pediatric robotic ureteral reimplantation","volume":"58","author":"Baek","year":"2017","journal-title":"Investig. Clin. Urol."},{"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","unstructured":"Loubersac, T., Alliot, H., Vatta, F., and Leclair, M.D. (2024). Extraperitoneal robotic approach to the uretero-vesical junction in children: Initial experience and a step-by-step video presentation. J. Pediatr. Urol., In Press.","DOI":"10.1016\/j.jpurol.2024.09.020"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"98","DOI":"10.4103\/jiaps.jiaps_131_23","article-title":"Robot-assisted Foley Tie Ureteric Tapering and Reimplantation","volume":"29","author":"Ansari","year":"2024","journal-title":"J. Indian. Assoc. Pediatr. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"136.e1","DOI":"10.1016\/j.jpurol.2022.10.024","article-title":"Pediatric robot-assisted extravesical ureteral reimplantation (revur) in simple and complex ureter anatomy: Report of a multicenter experience","volume":"19","author":"Esposito","year":"2023","journal-title":"J. Pediatr. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"547.e1","DOI":"10.1016\/j.jpurol.2021.05.029","article-title":"Outcomes of complex robot-assisted laparoscopic ureteral reimplantation after failed ipsilateral endoscopic treatment of vesicoureteral reflux","volume":"17","author":"Janssen","year":"2021","journal-title":"J. Pediatr. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"169.e1","DOI":"10.1016\/j.jpurol.2015.11.007","article-title":"Outcomes of complex robot-assisted extravesical ureteral reimplantation in the pediatric population","volume":"12","author":"Arlen","year":"2016","journal-title":"J. Pediatr. Urol."},{"key":"ref_20","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_21","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1016\/j.juro.2010.12.072","article-title":"Pediatric robotic extravesical ureteral reimplantation: Comparison with open surgery","volume":"185","author":"Smith","year":"2011","journal-title":"J. Urol."},{"key":"ref_22","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-V) vesicoureteral reflux","volume":"20","author":"Sforza","year":"2023","journal-title":"J. Pediatr. Urol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.jpurol.2017.09.013","article-title":"Robot-assisted laparoscopic megaureter tapering with ureteral reimplantation: Tips and tricks","volume":"13","author":"Li","year":"2017","journal-title":"J. Pediatr. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.urology.2020.10.015","article-title":"Utilization of Robot-assisted Surgery for the Treatment of Primary Obstructed Megaureters in Children","volume":"149","author":"Mittal","year":"2021","journal-title":"Urology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1089\/end.2022.0055","article-title":"Long-Term Outcome of Non-antireflux Robotic-Assisted Robot-Assisted Laparoscopic Ureter Reimplantation in Ureteral Obstruction","volume":"36","author":"Bausch","year":"2022","journal-title":"J. Endourol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"103.e1","DOI":"10.1016\/j.jpurol.2015.08.017","article-title":"\u2018Mini reimplantation\u2019 for the management of primary obstructed megaureter","volume":"12","author":"Babu","year":"2016","journal-title":"J. Pediatr. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"256.e1","DOI":"10.1016\/j.jpurol.2019.01.004","article-title":"\u201cMini\u201d extravesical reimplant with \u201cmini\u201dtapering for infants younger than 6 months","volume":"15","author":"Villanueva","year":"2019","journal-title":"J. Pediatr. Urol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/11\/1837\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:28:48Z","timestamp":1760113728000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/11\/1837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,8]]},"references-count":28,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["medicina60111837"],"URL":"https:\/\/doi.org\/10.3390\/medicina60111837","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2024,11,8]]}}}