PURPOSE - To characterize the utilization of open (OR), laparoscopic (LUR), and robot-assisted laparoscopic (RALUR) ureteral reimplantation in the United States from 2000-2012.
MATERIALS AND METHODS - We used the Kids' Inpatient Database to identify patients who underwent UR for primary VUR.
Prior to 2009, LUR and RALUR are referred to together as minimally-invasive UR (MIR). A detailed analysis of OR vs. RALUR was performed for 2009 and 2012.
RESULTS - In total, 14,581 URs were performed. The number of URs per year decreased by 14. 3%, however the proportion of MIRs increased from 0. 3% to 6. 3%. In 2012, 125 RALURs were performed (81. 2% of MIRs) representing 5. 1% of all URs, increased from 3. 8% in 2009. In 2009 and 2012, mean age was 5. 7±3. 6 years for RALUR vs. 4. 3±3. 3 years for OR (p<0. 0001). LOS was 1. 6±1. 3 days for RALUR vs. 2. 4±2. 6 for OR (p<0. 0001). Median charges were $22,703 for OR vs. $32,409 for RALUR (p<0. 0001). These relationships maintained significance on multivariate analyses. On multivariate analysis, RALUR utilization was associated with public insurance status (p=0. 04) and geographic region outside of the South (p=0. 02). Only 50 of 456 hospitals performed both OR and RALUR, and only 6 hospitals reported 5 or more RALURs during 2012.
CONCLUSIONS - Treatment of primary VUR with UR is decreasing. RALUR is becoming more prevalent but remains relatively uncommon. LOS is shorter for RALUR, but charges are higher. Nationally, RALUR appears to still be in its adoption phase and is clustered at a small number of hospitals.
The Journal of urology. 2016 Feb 12 [Epub ahead of print]
Diana K Bowen, Mark A Faasse, Dennis B Liu, Edward M Gong, Bruce W Lindgren, Emilie K Johnson
Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University. , Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University. , Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University. , Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University. , Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University. , Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University.