Presented by: Leon Chertin MD
Shamir Medical Center

Introduction

To report a  multi-institutional international experience in performing robotic pyeloplasty for complicated cases of ureteropelvic junction obstruction (UPJO) in the pediatric population and assess feasibility and outcomes.

Materials

Retrospective chart review of all pediatric patients who underwent RALP for UPJO in challenging cases between 2013-2021 were included. Demographics, perioperative surgical data, complications, and results are described. Challenging case were defined as: bilateral UPJO, failure of previous open pyeloplasty (thus re-do cases), correction of UPJO in kidneys with anatomical variations, huge hydronephrosis and low weight infants (<6 kg).

Results

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Over an 8-year period, 36 children (62% males and 38% females) met the inclusion criteria for our study. 15 patients underwent RALP for recurrent UPJO amongst them 2 children required simultaneous surgery for renal stones, 3 cases of lower pole UPJO in double collecting system, 3 cases of pelvic and horseshoe kidneys, 10 cases of infants weighing < 6 kg, 3 cases of huge hydronephrosis and 2 case of bilateral UPJO. The median age and weight were 36 month (IQR 14-84) and 12 kg (IQR 10–20.5) respectively. All robotic cases were completed successfully with no conversion to an open procedure. The median operative time was 120 minutes (IQR 90-135). The mean length of hospital stay (LOS) was 2.6 days. 4 patients (17%) had postoperative complications—1 ileus (Clavien-Dindo grade [CDG] I), 3 urinary tract infections (CDG II). No CDG III or higher complications were encountered. At a median follow-up of 36 month, the success rate was 95% with 1 patient requiring another re-do procedure due to recurrent obstruction. 

Conclusion

Our data suggests that RALP is safe and effective even for challenging cases of UPJO  in children.

Funding

None

Co-Authors

Guy Verhovsky, MD
Shamir Medical Center

Jaudat Jaber,
Shaare Zedek Medical Center

Boris Chertin,
Shaare Zedek Medical Center

Amnon Zisman,
Shamir Medical Center

Stanislav Kocherov,
Shamir Medical Center

Amos Neheman,
Meir Medical Center