Robotic ureterocalicostomy in the pediatric population

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Urologic Oncology

Background:

• Ureteropelvic junction obstruction (UPJO) can be challenging, particularly in pediatric cases with recurrent obstruction or complex renal pelvis anatomy.
• Traditional pyeloplasty may not be suitable for all UPJO cases, necessitating alternative surgical techniques.
• Ureterocalicostomy is an option for specific UPJO presentations, including failed prior surgeries or exaggerated intrarenal pelves.

Purpose of the Study:

• To present the technique of robotic ureterocalicostomy in pediatric patients.
• To evaluate its efficacy as a primary treatment for exaggerated intrarenal collecting systems.
• To assess its utility for secondary UPJO after failed pyeloplasty.

Main Methods:

• Nine pediatric patients (age 3-15) underwent transperitoneal robotic ureterocalicostomy for UPJO.
• Indications included recurrent UPJO (6 patients) and exaggerated intrarenal collecting systems (3 patients).
• Outcomes measured: operative time, hospital stay, and resolution of obstruction via diuretic radionuclide imaging at 6 and 12 months.

Main Results:

• Mean operative time for ureterocalicostomy was 168 minutes; additional time for pyelolithotomy in two patients.
• Mean hospital stay was 21 hours.
• All patients showed no evidence of obstruction on diuretic radionuclide imaging at 6 and 12 months postoperatively.

Conclusions:

• Robotic ureterocalicostomy is a technically feasible and viable treatment for pediatric UPJO.
• It is a successful option for recurrent UPJO and complex intrarenal ureteropelvic junctions.
• This approach provides a valuable alternative for challenging UPJO cases in children.