Robot-assisted laparoscopic pyeloplasty is a valid option for ureteropelvic junction obstruction repair in adults with congenital renal abnormalities: a case series study
Tóm tắt
Congenital renal anomalies are rare but may be associated with obstruction of the ureteropelvic junction. Given the rarity of simultaneous ureteropelvic junction obstruction [UPJO] and renal anomalies in the adult population, there is limited literature on approaching these patients. We report our experience with robotic assisted laparoscopic pyeloplasty for UPJO repair in this subset of patients. Data on adult patients with simultaneous congenital renal abnormalities and UPJO who underwent robotic assisted laparoscopic pyeloplasty between 2008 and 2020 was reviewed. Pre-operative data, intraoperative parameters as well as post-operative data including symptom resolution and radiologic findings were recorded. Ten patients, 4 female and 6 males, with a mean age of 47 years were identified as having simultaneous congenital renal abnormalities and UPJO. Anomalies identified were horseshoe kidney in four patients, duplex kidney with obstruction of one moiety in two patients, malrotated kidney in two patients, and pelvic kidney in two patients. Eight out of ten were symptomatic at presentation with flank pain being the most common symptom. Eight patients underwent robotic pyeloplasty via the dismembered technique, while two underwent robotic Y-V pyeloplasty. With a mean follow up time of 13 months, 8/9 (88%) symptomatic patients enjoyed symptom resolution. Post-op renogram was available for nine patients and showed resolution of obstruction in all patients (100%). One patient developed a urine leak which was managed successfully with drainage. Robotic assisted laparoscopic pyeloplasty is a safe, feasible and effective surgical approach in management of adult patients with concomitant UPJO and renal anomalies.
Tài liệu tham khảo
Barakat AJ, Drougas JG. Occurrence of congenital abnormalities of kidney and urinary tract in 13,775 autopsies. Urology. 1991;38(4):347–50.
Sanna-Cherchi S, Ravani P, Corbani V, Parodi S, Haupt R, Piaggio G, et al. Renal outcome in patients with congenital anomalies of the kidney and urinary tract. Kidney Int. 2009;76(5):528–33.
Patel MN, Kaul SA, Bhandari A, Menon M, Peabody JO, Elder JS, et al. Robot-assisted management of congenital renal abnormalities in adult patients. J Endourol. 2010;24(4):567–70.
Monn MF, Bahler CD, Schneider EB, Sundaram CP. Emerging trends in robotic pyeloplasty for the management of ureteropelvic junction obstruction in adults. J Urol. 2013;189(4):1352–7.
Bove P, Ong AM, Rha KH, Pinto P, Jarrett TW, Kavoussi LR. Laparoscopic management of ureteropelvic junction obstruction in patients with upper urinary tract anomalies. J Urol. 2004;171(1):77–9.
Wang P, Xia D, Ma Q, Wang S. Retroperitoneal laparoscopic management of ureteropelvic junction obstruction in patients with horseshoe kidney. Urology. 2014;84(6):1351–4.
Rasool S, Singh M, Jain S, Chaddha S, Tyagi V, Pahwa M, et al. Comparison of open, laparoscopic and robot-assisted pyeloplasty for pelviureteric junction obstruction in adult patients. J Robot Surg. 2020;14(2):325–9.
Belmont S, Stav K, Zisman A, Chertin B, Dubrov V, Bondarenko S, et al. Minimal invasive approach for lower pole ureteropelvic junction obstruction (UPJO) in duplication anomaly: a multi-institutional study. J Pediatr Surg. 2021;56(12):2372–6.
Liu W, Zhang L, Ma R, Wu R. The morphology and treatment of coexisting ureteropelvic junction obstruction in lower moiety of duplex kidney. Int J Surg. 2016;34:23–7.
Foley FE. A new plastic operation for stricture at the uretero-pelvic junction. Report of 20 operations. 1937. J Urol. 2002;167(2 Pt 2):1075–95. discussion 96.
Uhlig A, Uhlig J, Trojan L, Hinterthaner M, von Hammerstein-Equord A, Strauss A. Surgical approaches for treatment of ureteropelvic junction obstruction - a systematic review and network meta-analysis. BMC Urol. 2019;19(1):112.
Stamm AW, Akapame S, Durfy S, Du CC, Kozlowski PM. Outcomes after robotic-assisted pyeloplasty in patients presenting with Pain Versus Nonpain presenting symptoms. Urology. 2019;125:111–7.
Nayyar R, Gupta NP, Hemal AK. Robotic management of complicated ureteropelvic junction obstruction. World J Urol. 2010;28(5):599–602.
Hopf HL, Bahler CD, Sundaram CP. Long-term outcomes of Robot-assisted laparoscopic pyeloplasty for Ureteropelvic Junction obstruction. Urology. 2016;90:106–10.
Fontenot PA, Capoccia TR, Wilson B, Arthur A, Duchene DA. Robotic-assisted laparoscopic pyeloplasty: analysis of symptomatic patients with equivocal renal scans. Urology. 2016;93:92–6.
Lee D, Link RE. Recurrent symptoms following pyeloplasty with a normal endoscopic evaluation: assessment and outcomes of a challenging patient cohort. Urology. 2014;84(1):227–31.
Chammas M, Feuillu B, Coissard A, Hubert J. Laparoscopic robotic-assisted management of pelvi-ureteric junction obstruction in patients with horseshoe kidneys: technique and 1-year follow-up. BJU Int. 2006;97(3):579–83.
VanderBrink BA, Cain MP, Gilley D, Meldrum KK, Rink RC. Reconstructive surgery for lower pole ureteropelvic junction obstruction associated with incomplete ureteral duplication. J Pediatr Urol. 2009;5(5):374–7.
Mason MD, Peters CA, Schenkman NS. Robot-assisted upper pole nephrectomy in adult patients with duplicated renal collecting systems. J Endourol. 2012;26(7):838–42.
Sahai A, Raghuram S, Minarik L, Khan MS, Dasgupta P. Laparoscopic pyeloplasty and pyelopyelostomy for ureteropelvic junction obstruction in a duplicated collecting system. Urology. 2006;67(1):199.
Eid S, Iwanaga J, Loukas M, Oskouian RJ, Tubbs RS. Pelvic kidney: a review of the literature. Cureus. 2018;10(6):e2775.
Cinman NM, Okeke Z, Smith AD. Pelvic kidney: associated diseases and treatment. J Endourol. 2007;21(8):836–42.
Allen D, Bultitude MF, Nunan T, Glass JM. Misinterpretation of radioisotope imaging in pelvic kidneys. Int J Clin Pract Suppl. 2005;147:111–2.
Tasian GE, Wiebe DJ, Casale P. Learning curve of robotic assisted pyeloplasty for pediatric urology fellows. J Urol. 2013;190(4 Suppl):1622–6.
Sorensen MD, Delostrinos C, Johnson MH, Grady RW, Lendvay TS. Comparison of the learning curve and outcomes of robotic assisted pediatric pyeloplasty. J Urol. 2011;185(6 Suppl):2517–22.