Robot-assisted pyeloplasty for ureteropelvic junction obstruction: experience from a tertiary referral center.

Abstract

The aim of the study was to describe the surgical outcomes of a series of consecutive patients treated with robot-assisted pyeloplasty (RAP) for ureteropelvic junction obstruction in a single tertiary referral center. We prospectively collected and retrospectively analyzed data of 292 patients submitted to RAP performed from September 2011 to December 2016 by four experienced surgeons. The stenotic ureteropelvic junction was resected according to the Anderson-Hynes technique. Complications' severity was recorded and graded according to the modified Clavien classification system. The mean age was 40.6 years (SD15.5). Median Charlson Comorbidity Index was 0 (IQR 0-1). All interventions were performed with a transperitoneal access and a ureteral stent was always positioned. The mean operative time was 112.8 minutes (SD 48.7). Overall postoperative complications were 29 (9.9%): 24 (8.2%) surgical complications (7.2% Clavien 1, 0.7% Clavien 2 and 0.3% Clavien 3) and 5 (1.7%) medical complications (1% Clavien 1, 0.7% Clavien 2). The mean length of stay (LOS) was 4 days (SD 2.0). Median follow-up was 21 months (range 14-62). Six (2%) patients presented a recurrent obstruction with persistent hydronephrosis with or without symptoms or they had persistent symptoms. They were all submitted to retrograde holmium laser endopyelotomy. One (0.3%) of them required redo RAP for persistence of symptoms 8 months after the endoscopic treatment. In our experience, RAP with Anderson-Hynes technique performed in a tertiary referral center by expert surgeons represent a safe and feasible procedure with an overall low rate of postoperative complications.