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Robot-assisted laparoscopic pyeloplasty (RALP) in children with complex pelvi-ureteric junction obstruction (PUJO): results of a multicenter European report

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A Letter to the Editor to this article was published on 03 January 2021

Abstract

Purpose

This study aimed to report a multi-institutional retrospective case series of outcomes after robot-assisted laparoscopic pyeloplasty (RALP) in pediatric patients with complex pelvi-ureteric junction obstruction (PUJO).

Methods

All patients undergoing complex RALP over the last 5 years were included. RALP was defined complex in the following cases of PUJO: anatomic variations including ectopic, malrotated, horseshoe, or duplex kidney and recurrent PUJO after failed open pyeloplasty.

Results

Forty-eight patients underwent complex RALP in four European centers in the study period and included 18 girls and 30 boys with a median age of 8 years (range 5–12). The PUJO was associated with anatomic variations in 35/48 (72.9%), whereas a recurrent PUJO was present in 13/48 (27.1%). A dismembered Anderson–Hynes pyeloplasty was performed in all patients. The median operative time including docking was 178.5 min (range 117–255) and the median anastomotic time was 64.8 min (range 50–76). All patients were discharged on 2nd postoperative day (POD). The median follow-up was 18.2 months (range 14–43). The overall success rate was 95.8% (46/48). Early postoperative complications (< 30th POD) included urinary tract infections (UTIs) and stent-related irritative symptoms in 4/48 (8.3%) [II Clavien], whereas late complications (> 30th POD) included recurrence of PUJO in 2/48 (4.2%), who needed re-operation [IIIb Clavien].

Conclusions

RALP was safe, feasible, and with good mid-term outcome in complex PUJO. An accurate pre-operative planning, a standardized technique, and an experienced surgical robotic team represented key points to manage successfully such complex cases.

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Author information

Authors and Affiliations

  1. Division of Pediatric Urology, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy

    Ciro Esposito & Maria Escolino

  2. Division of Pediatric Urology, Meyer Children Hospital, Florence, Italy

    Lorenzo Masieri

  3. Division of Pediatric Urology, Hôpital Necker-Enfants Malades, Paris, France

    Thomas Blanc & Layla Musleh

  4. Division of Pediatric Surgery, CHU de Limoges, Hopital de la Mère et de l’Enfant, Limoges, France

    Quentin Ballouhey & Laurent Fourcade

Authors
  1. Ciro Esposito
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  2. Lorenzo Masieri
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  3. Thomas Blanc
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  4. Layla Musleh
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  5. Quentin Ballouhey
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  6. Laurent Fourcade
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  7. Maria Escolino
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Contributions

CE: project development, data analysis, and manuscript writing/editing. LM: data collection, data analysis, and manuscript editing. TB: data collection, data analysis, and manuscript editing. LM: data collection, data analysis, and manuscript editing. QB: data collection, data analysis, and manuscript editing. LF: data collection, data analysis, and manuscript editing. ME: project development, data analysis, and manuscript writing/editing.

Corresponding author

Correspondence to Ciro Esposito.

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The authors declare that they have no conflict of interest or financial ties to disclose.

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“Informed consent was obtained from all individual participants included in the study.”

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This article does not contain any studies with human participants or animals performed by any of the authors”.

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Supplementary file1 (MP4 17175 kb) Video 1: RALP in an ectopic pelvic and malrotated kidney

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Esposito, C., Masieri, L., Blanc, T. et al. Robot-assisted laparoscopic pyeloplasty (RALP) in children with complex pelvi-ureteric junction obstruction (PUJO): results of a multicenter European report. World J Urol 39, 1641–1647 (2021). https://doi.org/10.1007/s00345-020-03331-8

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  • DOI: https://doi.org/10.1007/s00345-020-03331-8

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