Robot-assisted laparoscopic transperitoneal pyeloplasty case report

Abstract

: Ureteropelvic junction obstruction (UPJO) can be caused by various anatomic abnormalities impairing drainage of urine from the kidney to the ureter. Patients often develop hydronephrosis and caliectasis which can lead to decreased function and eventually failure of the ipsilateral renal unit. Our patient presented with right sided abdominal pain and associated nausea. Classically, these symptoms are colicky in nature, can progress to emesis, and are often provoked by episodes of diuresis. Diagnosis involves a nuclear medicine renal scan with administration of Lasix to ascertain renal function and presence of obstruction. Indications for intervention are nuanced but T1/2 greater than 20 minutes and decreased function of the affected side less than 40% are typical. Our patient demonstrated a T1/2 of 23 minutes with preserved renal function. Robotic dismembered pyeloplasty is becoming the standard of care for urologists given its minimally invasive approach, faster recovery time and superior success to endoscopic approach and comparative success to open surgery. This case adds a visual walk-through of a robotic pyeloplasty to the scientific literature and addresses debated perioperative management strategies such as comparison of surgical approaches and length of trans-anastomotic drainage. Post-operative imaging with repeat nuclear medicine renal scan with Lasix administration to confirm resolution of obstruction is typically performed. Our case concluded with patient becoming symptom free and a Lasix renal scan demonstrating no evidence of post-renal obstruction.