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A Robotic Approach for Severe Vesicoureteral Reflux

A Robotic Approach for Severe Vesicoureteral Reflux

At the age of 5, Reese Bender began to suffer urinary tract infections with high fevers for three months. Her pediatrician referred her to pediatric urology at Johns Hopkins Children’s Center, which diagnosed severe hydronephrosis—a swelling of the kidney due to urine build-up—and recurring vesicoureteral reflux, which untreated can lead to kidney failure. The recommended treatment? Surgery, but not the standard-of-care open procedure that requires a large incision, a three-night stay in the hospital and a six-week recovery at home. Reese’s mother, Kendra Bender, learned that Johns Hopkins pediatric urologic surgeon Ardavan Akhavan offers patients like Reese a less-invasive robotic approach that usually requires only a one-night hospital stay and a one-week recovery at home.

“We were thrilled that she was a candidate for the robotic procedure,” says her mom, Kendra Bender, of Adamstown, Md.

Akhavan explains that the open procedure, despite its 95 percent success rate, is the most painful option and often requires an epidural. In the robotic approach, Akhavan looks through a 3-D virtual reality display in a console on one side of the room, where he is able to control the robotic instruments inside the patient. In addition to three tiny incisions that leave minimal scarring, the advantages include a 10-fold magnification of visualization and a tremor filter for a safer procedure and less painful recovery. Studies report that up to 45 percent of patients undergoing open ureteral reimplantation report severe pain, whereas only nine percent of patients undergoing robotic reimplantation report a similar degree of discomfort.

Following her robotic surgery, Bender required no narcotic pain medicine and was discharged the following morning. Her one-month follow-up showed a stable renal ultrasound and no worsening of hydronephrosis. At three months after her surgery, she suffered no residual vesicoureteral reflux.

“We’ve done about 20 robotic surgeries for this condition in children here, with 20 successes,” says Akhavan. “All patients are very happy and doing really well.”

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