Success of Laparoscopic Robot-Assisted Approaches to Ureteropelvic Junction Obstruction Based on Preoperative Renal Function

Gwen M. Grimsby, Micah A. Jacobs, Patricio C. Gargollo

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Abstract

Background and Purpose: No literature exists examining the risk factors for failure after robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO) in children. The goal of this study was to compare the success of robot-assisted pyeloplasty between UPJO kidneys with preoperative renal function <30% versus >30%. Methods: We performed a retrospective review of all patients who underwent a robot-assisted laparoscopic pyeloplasty for UPJO at a single institution from June 2009 to September 2013 by four surgeons. A failed procedure was defined as necessitating a second surgery for the UPJO, nonresolution of symptoms with no improvement of washout on postoperative mercaptoacetyltriglycine (MAG)-3 scan, and/or a reduction in renal function of the obstructed kidney to <10%. Success was compared between patients with <30% and >30% preoperative differential renal function via the Fisher exact test. Results: There were 116 patients who were included. At a mean follow-up of 507 days after the surgical procedure, there were eight (8%) failures. The majority of the failures (5/8) were in kidneys whose preoperative function was <30%. There was a significant difference in the success of procedures performed on kidneys with >30% (86/89, 97%) versus <30% (7/12, 58%) preoperative renal function (P=0.0005). Conclusions: In this large cohort of patients, kidneys with preoperative function >30%, robot-assisted pyeloplasty had a 97% success rate. This was significantly different than the success of robot-assisted pyeloplasty (58%) in kidneys with preoperative function <30%. This information is useful for patient counseling as these patients may be at higher risk for a secondary procedure such as a subsequent nephrectomy or may benefit from a preoperative trial of nephrostomy tube drainage.

Original languageEnglish (US)
Pages (from-to)874-877
Number of pages4
JournalJournal of Endourology
Volume29
Issue number8
DOIs
StatePublished - Aug 1 2015

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Kidney
Nephrectomy
Counseling
Drainage

ASJC Scopus subject areas

  • Urology

Cite this

Success of Laparoscopic Robot-Assisted Approaches to Ureteropelvic Junction Obstruction Based on Preoperative Renal Function. / Grimsby, Gwen M.; Jacobs, Micah A.; Gargollo, Patricio C.

In: Journal of Endourology, Vol. 29, No. 8, 01.08.2015, p. 874-877.

Research output: Contribution to journalArticle

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abstract = "Background and Purpose: No literature exists examining the risk factors for failure after robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO) in children. The goal of this study was to compare the success of robot-assisted pyeloplasty between UPJO kidneys with preoperative renal function <30{\%} versus >30{\%}. Methods: We performed a retrospective review of all patients who underwent a robot-assisted laparoscopic pyeloplasty for UPJO at a single institution from June 2009 to September 2013 by four surgeons. A failed procedure was defined as necessitating a second surgery for the UPJO, nonresolution of symptoms with no improvement of washout on postoperative mercaptoacetyltriglycine (MAG)-3 scan, and/or a reduction in renal function of the obstructed kidney to <10{\%}. Success was compared between patients with <30{\%} and >30{\%} preoperative differential renal function via the Fisher exact test. Results: There were 116 patients who were included. At a mean follow-up of 507 days after the surgical procedure, there were eight (8{\%}) failures. The majority of the failures (5/8) were in kidneys whose preoperative function was <30{\%}. There was a significant difference in the success of procedures performed on kidneys with >30{\%} (86/89, 97{\%}) versus <30{\%} (7/12, 58{\%}) preoperative renal function (P=0.0005). Conclusions: In this large cohort of patients, kidneys with preoperative function >30{\%}, robot-assisted pyeloplasty had a 97{\%} success rate. This was significantly different than the success of robot-assisted pyeloplasty (58{\%}) in kidneys with preoperative function <30{\%}. This information is useful for patient counseling as these patients may be at higher risk for a secondary procedure such as a subsequent nephrectomy or may benefit from a preoperative trial of nephrostomy tube drainage.",
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