Long-term Outcomes of Robot-assisted Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction

Abstract

To describe the long-term outcomes of robot-assisted laparoscopic pyeloplasty (RALP) for the correction of ureteropelvic junction (UPJ) obstruction. A retrospective electronic medical record review of RALPs from October 2002 to July 2014 was performed, with additional follow-up for patients released from regular urological care obtained by phone. RALP success was defined as resolution of symptoms of UPJ obstruction, improved hydronephrosis radiographically, or resolution of obstruction on follow-up Tc-99m mercaptoacetyltriglycine renal scan, intravenous pyelogram, or Whitaker test. RALP failure was defined as persistence of symptoms with obstruction demonstrated on functional imaging or requirement for a subsequent UPJ procedure. A total of 129 cases were identified, with an average patient age of 34.3 years. Stented RALP was performed in 80.6% of cases whereas 19.4% of patients underwent stentless RALP. A dismembered technique was performed in 90.7% of pyeloplasties, whereas 9.3% were nondismembered Fenger, Y-V, or flap pyeloplasties. Five intraoperative complications and 18 postoperative complications (Clavien I-IIIb) were described. One hundred twenty-nine patients received follow-up for a mean of 33.8 months (range 1-147 months). RALP was successful in 125/129 (96.9%), with an 8-year failure-free survival of 91.5%. When considering only stented pyeloplasties, the 8-year failure-free survival was 96.3%. RALP is a safe and effective minimally invasive method for correction of UPJ obstruction, resulting in lasting improvement in symptoms and resolution of obstruction for most patients.