Robotic-assisted laparoscopic pyeloplasty (RALP), for ureteropelvic junction obstruction (UPJO), is an alternative to open pyeloplasty in the pediatric population

Abstract

We aimed to evaluate the safety and efficacy of RALP for UPJO in a heterogeneous pediatric population. The medical records of all patients with UPJO who underwent RALP over the last 6 years and completed at least 6 months of follow-up, were retrospectively reviewed. Data included age, sex, laterality, weight, preoperative and postoperative ultrasound and renal scintigraphy results, operation time, complications, length of hospital stay. We separately examined two groups: low-weight children (< 10 kg) and those who underwent RALP after failed pyeloplasty. One hundred patients with a median age of 18 months (range 2-216) underwent RALP. The median weight was 10 kg (range 4-90). The median operative time, including docking and console time, was 75 min (range 40-183). The median hospital stay was one day (range: 1-3). Ninety-eight percent of the patients showed improvement or stable hydronephrosis on postoperative imaging, with a better drainage curve on dynamic radionuclide scans. In two patients, the hydronephrosis worsened. One patient's ipsilateral UVJ was obstructed, and the other patient's UPJO recurred. The operative time was shorter in the low-weight group (p < 0.001), but the length of hospital stay and success rate were not different. Neither the hospital stay nor the success rate of redo RALP patients differed significantly from a control group of primary RALP patients. Our data show that RALP might be utilized as a universal approach in pediatric patients with UPJO.

Interstitial Cells of Cajal and P2X3 Receptors at Ureteropelvic Junction Obstruction and Their Relationship with Pain Response

“…In addition, symptomatic children were significantly older than asymptomatic patients. Utilizing the median age as a reference point, we stratified the cohort into two distinct groups: those below two years of age and those equal to or above two years of age, in alignment with the existing literature [31,32]. These results may lead to the hypothesis that the expression of ICCs may increase with patient age, as well as with maturity and the development of mechanisms that provide appropriate sensation and function of the urinary tract [30].…”

Our experience with management of congenital urological pathologies in adulthood: What pediatric urologists should know and adult urologists adopt in pediatric practice experience

“…The approach to duplex kidney anomalies has evolved over the last few years in pediatric urology practice from partial nephrectomy to uretero-ureteral anastomosis, frequently leaving poorly or even non-functioning moieties in place and simply fixing the underlying pathology. [3,10,[17][18][19][20] Robot-assisted laparoscopic surgery is increasingly being adopted for the treatment of duplex anomalies, and recent studies have reported excellent results with RALUU. Our experience coincides with the evolution of worldwide approaches to these anomalies.…”

Pediatric robotic urologic procedures: Indications and outcomes

“…[ 5 ] More recent studies from the past 5 years have continued to show that RALP is comparable to the alternative approaches [ Table 1 ], and has been suggested by some groups as a universal approach for pediatric patients with UPJO. [ 6 ]…”