957 The non-transecting technique for bulbar urethral strictures

Abstract

METHODS: A retrospective chart review of all RALPs at Indiana University from October 2002 to July 2014 was performed. RALP success was defined as resolution of symptoms of UPJ obstruction, improved hydronephrosis radiographically, or resolution of obstruction on follow-up Lasix renogram, IVP, or Whitaker test. RALP failure was defined as persistence of symptoms with obstruction demonstrated on functional imaging or requirement for a subsequent UPJ procedure. RESULTS: A total of 133 evaluable patients were identified with an average age of 34 years. 12% had undergone previous failed UPJ procedure (including balloon dilation, endopyelotomy, or pyeloplasty) and 48% had a ureteral stent or nephrostomy placed prior to surgery. Stented RALP was performed in 81.2% of cases while 18.8% were stentless repairs. 89.5% of pyeloplasties were performed with a dismembered technique, while 10.5% were nondismembered Fenger, Y-V, or flap pyeloplasties. 5 intraoperative complications (Clavien I-IIIb) and 18 postoperative complications (Clavien I-IIIa) were described. 129 patients received follow up for an average of 15.7 months (range 1-115 months). 98.3% of patients who were followed for at least twelve months underwent postoperative Lasix renogram. The average increase in split renal function was 1.7% and average decrease in clearance half-time was 23.2 minutes for the ipsilateral kidney in all patients who received preand postoperative Lasix renograms. RALP was determined to be successful in 97.7% of cases. Three failures were noted, all were symptomatic with continued obstruction on functional imaging. Of these failures, one was managed with long-term ureteral stent placement and two required ipsilateral nephrectomy. CONCLUSIONS: Robot-assisted laparoscopic pyeloplasty is an excellent minimally invasive method for correction of UPJ obstruction, resulting in lasting improvement in symptoms and resolution of obstruction for most patients.