Robotic Proximal Ureteropyelostomy After Unsuccessful Endourologic Management of Complicated Proximal Ureteral Stone Disease

Abstract

We present a clinical case of a 66-year-old female with a left ureteropelvic junction impacted renal calculi associated with a tortuous ureter. After a failed combined retrograde and antegrade endoscopic procedure, a robot-assisted laparoscopic ureteropyelostomy was successful.

Robotic Management of Urolithiasis in the Pediatric Population

“…Since 2005, 22 articles for RALS-UL have been published in the adult population for management of various conditions: concomitant management of UPJO and nephrolithiasis (4), concomitant management of caliceal diverticuli with stones (2), pyelolithotomy (2), pyelolithotomy with nephrolithotomy (1), extended pyelolithotomy (4), ureterolithotomy (1 proximal, 1 distal), anatrophic nephrolithotomy (3), and management of stones when ectopic and other renal anomalies are present (2 pelvic kidney, 1 horseshoe kidney, 1 cross-fused ectopic kidney). Of note, many of these studies did not include detailed information regarding the initial patient stone burden.…”

“…It's use in the upper urinary tract with good outcomes has been previously reported (41). In 2015 Olvera-Posada et al (3) reported the case of a 66-year-old female with a history of recurrent ureterolithiasis, recurrent urinary tract infections (UTIs), two large obstructing right proximal ureteral calculi, and a right split renal function of 37%. Despite a remote successful ureteroscopy in the past on that same kidney, the patient underwent failed attempts at antegrade or retrograde access to the stone in this instance; partially due to ureteral tortuosity and significant inflammatory changes.…”

“…Although most patients with kidney or ureteric stones are treated via ureteroscopy (URS) and retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL) or extracorporeal shock wave lithotripsy (ESWL); the use of laparoscopic surgery in stone disease has increased over the last two decades (2), and open surgical interventions such as anatrophic nephrolithotomy and ureterolithotomy are now rarely done. Besides the significant laparoscopic skills needed, drawbacks to laparoscopic stone surgery include challenges with ureteral stenting and suturing, limited dissection and intracorporal reconstruction, as well as increased risk of urinary leak (3–6). The use of the robotic platform allows for improved ergonomics and visualization (magnified, three-dimensional) as well as ease of instrument dexterity that most closely imitates the open technique maintaining the advantages associated with minimally invasive surgery.…”