Robot-Assisted Laparoscopic Ureterocalicostomy in the Setting of Ureteropelvic Junction Obstruction: A Multi-Institutional Cohort

• Published in: The Journal of urology Vol. 208; no. 1; pp. 180 - 185
• Main Authors: Mittal, Sameer, Aghababian, Aznive, Eftekharzadeh, Sahar, Saxena, Sonam, Janssen, Karmon, Lombardo, Alyssa, Adamic, Brittany, Dinardo, Lauren, Weaver, John, Fischer, Katherine, Andolfi, Ciro, Long, Christopher, Weiss, Dana, Kirsch, Andrew, Srinivasan, Arun, Gundeti, Mohan, Shukla, Aseem R.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Wolters Kluwer 01.07.2022
• Subjects: Child; Cicatrix; Female; Humans; Kidney Pelvis - surgery; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Retrospective Studies; Robotics; Treatment Outcome; Ureter; Ureteral Obstruction - complications; Ureteral Obstruction - surgery; Urologic Surgical Procedures - methods; robotic surgical procedures; postoperative complications; minimally invasive surgical procedures; urogenital abnormalities; hydronephrosis
• ISSN: 0022-5347; 1527-3792; 1527-3792
• DOI: 10.1097/JU.0000000000002484

Purpose:Recurrent ureteropelvic junction obstruction (UPJO) after failed pyeloplasty is a complex surgical dilemma. The robot-assisted laparoscopic ureterocalicostomy (RALUC) is a potential surgical approach, but widespread adoption is limited due to the perceived technical challenge of the procedure. We present a multi-institutional pediatric cohort undergoing RALUC for recurrent or complex UPJO, and hypothesize that the procedure is reproducible, safe and efficacious.Materials and Methods:A 3-center multi-institutional collaboration was initiated and medical records of children undergoing RALUC between 2012 and 2020 were retrospectively reviewed. The details on baseline demographics, perioperative characteristics and postoperative outcomes were aggregated.Results:During the study period 24 patients, 7 (29%) females and 17 (71%) males, were identified. Of the patients 21 (86%) had a history of previous pyeloplasty prior to RALUC, of whom 5 (24%) had 2 prior failed ipsilateral pyeloplasties. The reason for performing RALUC was short ureter in 3 (13%), intrarenal pelvis in 5 (21%) and extensive scarring at the ureteropelvic junction locus in 16 (67%) patients. The median age of patients at time of surgery was 5.1 years (IQR: 1.9, 14.7). Of the patients 9 (38%) had percutaneous nephrostomy prior to surgery; if percutaneous nephrostomy tubes were placed for relief of obstruction, an antegrade contrast study was done postoperatively to confirm resolution of obstruction. No 30-day Clavien-Dindo Grade III-V complications were noted. During the median followup of 16.1 months (IQR: 6, 47.5), 22 (92%) had improved symptoms and hydronephrosis with no further intervention; 2 (8%) patients underwent endoscopic interventions after RALUC and both ultimately underwent nephrectomy.Conclusions:This multi-institutional cohort demonstrates that RALUC is a safe and efficacious salvage option for failed pyeloplasty or complex anatomy with an acceptable success profile, especially in cases of extensive scarring at the UPJO or an intrarenal pelvis.