Robotics in Secondary Ureteropelvic Junction Obstruction

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Summary and Introduction

Patients with recurrent ureteropelvic junction obstruction (UPJO) present a treatment dilemma to urologists. Second-line therapies have previously been shown to fail at a higher rate than the initial therapeutic procedure. We report our experience with robotic-assisted, dismembered pyeloplasty in patients with secondary UPJO.

Since November 2002, 44 robotic-assisted laparoscopic pyeloplasties (RALPs) have been performed at our institution. Of these, seven patients had undergone previous definitive treatment for UPJO. Anderson-Hynes-dismembered pyeloplasty was the preferred reconstructive technique in all patients. The patients were divided into two groups: primary pyeloplasty patients (group 1) and secondary pyeloplasty patients (group 2). Variables examined include operative time, estimated blood loss (EBL), length of hospital stay (LOS) and success rates.

All operations were completed laparoscopically, and there were no conversions to open surgery in either group. Mean operative time was 60 min longer in the secondary pyeloplasty group compared with primary cases, but the EBL, LOS and success rates were similar. A patent UPJ was confirmed in both groups by renal scan and/or excretory urography (intravenous pyelogram) examinations.

RALP is a viable option in select patients with recurrent UPJO after previous endoscopic or open surgical repair. As expected, operative times were longer in these patients due to a more challenging dissection (p < 0.05). However, the magnification afforded by the robot allows for a precise dissection, and subsequently, there was no significant increase in blood loss, hospital stay or perioperative morbidity in our series (p > 0.05).

The acknowledged gold standard for the management of ureteropelvic junction obstruction (UPJO) is open pyeloplasty.^[1,2] Recently, laparoscopic and robotic-assisted pyeloplasties have emerged as alternative approaches to UPJO. Robotic technologies incorporate the advantages of computer augmentation and magnification with the technical aptitude of the surgeon. Robotic-assisted laparoscopic surgery increases the applicability of laparoscopic pyeloplasty by facilitating laparoscopic dissection and suturing.

Although pyeloplasty has a high success rate, failure is always a concern and a challenge to deal with. In such cases, urologists often recommend open pyeloplasty. In this report, we evaluate our management and experience with robotic-assisted laparoscopic pyeloplasty (RALP) in patients with failed primary UPJO treatment.

Cite this: Role of Robotics in the Management of Secondary Ureteropelvic Junction Obstruction - Medscape - Jan 01, 2006.

Patients' Demographics and Perioperative Data
	Primary pyeloplasty (Group 1)	Secondary pyeloplasty (Group 2)
Patients (n)	37	7
Male/female (n)	20/24	2/5
Mean age (year)	32.8 (20-62)	37.8 (17-67)
Side (right/left)	22/15	4/3
Crossing vessel	16 (43%)	2 (28%)
Mean operative time (min)	219.4 (130-345)	279.8 (230-414)
Mean blood loss (cc)	49.5 (10-200)	52.5 (20-100)
Mean length of stay (days)	1.1 (1-2)	1.2 (1-3)
Mean follow-up (months)	13.5 (3-29)	10.7 (3-20)
Open conversion	None	None

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