Editorial comment regarding: Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): Outcomes and complications.
The authors should be commended for their multi-institutional collaboration. Such undertakings are rare in our field and, although very valuable when successfully executed, can present significant logistical challenges. To that end this group has shown that such partnerships can reach meaningful observations regarding important and unanswered questions, and again this is highly laudable. There is no question that robot-assisted laparoscopic ureteral reimplantation (RALUR) is a feasible option for the treatment of VUR. The controversy arises when one examines RALUR in comparison to endoscopic therapy or traditional ‘open’ ureteral reimplantation. In that context the unanswered questions become: What are the indications for surgery? What are the efficacy, safety, and success of the different surgical modalities? What is the morbidity associated with the different procedures, including operative times, anesthetic exposure, complications, length of stay, postoperative pain, and cosmetic appearance of the incisions? And, of increasing importance in this fiscally aware medical environment, what is the cost to benefit associated with the different techniques? Critical analyses of these variables allow the surgeon to make the most informed decision possible in the management of their patients. Several interesting points are raised by this paper and deserve further examination and discussion. The authors acknowledge that a limitation of their study is the lack of a standardized protocol. Perhaps, most importantly, the indications for surgery were site-specific. This raises perhaps the most important question, which is: which reflux should be treated and when? Although there are perhaps clearer