Abstract
Introduction: Vesicoureteral reflux (VUR) is a frequent pediatric urological anomaly associated with recurrent urinary tract infections and renal scarring. Evidence on robot-assisted extravesical ureteral reimplantation (RALUR-EV) continues to grow; however, reports from Latin America remain limited. Objectives: We report an initial single-center experience with transperitoneal RALUR-EV (Lich-Gregoir) in a public pediatric hospital in Ecuador, detailing operative metrics, perioperative outcomes, and short-term radiographic efficacy using standardized definitions. Methods: A retrospective, observational study was conducted at a public tertiary referral center in Quito (January 2021-May 2025). Consecutive children (0-17 years) with VUR or ureterovesical junction (UVJ) obstruction who underwent RALUR-EV with the Lich Gregoir technique were included. The primary outcome was radiographic resolution of VUR at 3-6 months on voiding cystourethrogram. Secondary outcomes were operative times (total, console, docking), length of stay, postoperative UTI (culture-confirmed), and complications (Clavien-Dindo). Analyses were descriptive; success was reported as both evaluable-only and intention-to-treat (ITT). The study received institutional ethics approval. Results: Nine children were included (median age 4.4 years; 5 girls). Eight had VUR (5 unilateral, 3 bilateral); one had isolated UVJ obstruction. Procedures were left-sided in 7 cases and right-sided in 2. Median total operative time was 135 min (IQR 129-153); median console and docking times were 120 and 15 min, respectively. No intraoperative complications or conversions occurred. Median length of stay was 4 days (IQR 3-4). Two culture-confirmed postoperative UTIs occurred (2/9; Clavien II); no complications ≥ III were observed. Postoperative imaging was available in 6/9 cases (66.7%): radiographic resolution was 6/6 (100%) overall and 5/5 (100%) among VUR-only. ITT success was 6/9 (66.7%) overall and 5/8 (62.5%) for VUR-only. Conclusions: Transperitoneal RALUR-EV is feasible and safe in a public tertiary setting, with early effectiveness comparable to international series. Standardized pathways, structured follow-up, and multicenter collaboration are warranted to confirm durability and support broader regional adoption.