Robot-assisted laparoscopic pyeloplasty with and without a ureteral stent

Robot-assisted laparoscopic pyeloplasty (RALP) has been shown to be an efficacious treatment for ureteropelvic junction obstruction. Although the use of a ureteral stent is commonplace, the water-tight anastomosis possible with robotic assistance may obviate its need. We report a feasibility study of unstented RALPs and present our experience with both the stented (SRP) and unstented (URP) approach.

A retrospective review of RALPs completed at our institution from 2003 to 2008 was performed. Thirty-five patients had postoperative stents. Seventeen RALPs were completed without ureteral stents. Narcotic requirements, operative time, estimated blood loss, daily drain output, length of stay, and complications were examined.

Fifty-two patients underwent RALP without conversion to open procedure (35 SRP, 17 URP). Operative time was significantly less in the URP group (p = 0.01). URPs required less narcotics and had shorter length of stay. Three complications were reported after SRP, whereas two patients with URP experienced transient ureteral obstruction, which resolved after 4 weeks with an indwelling ureteral stent. Postoperative renograms showed improved drainage in all but four patients (two SRPs and two URPs), each of whom had subjective improvement in symptoms postoperatively.

Our data suggest that URP is a safe and feasible procedure for the treatment of ureteropelvic junction obstruction. There were no clinically significant differences between the stented and unstented groups. Further prospective evaluation is needed; however, URP can be performed by an experienced surgeon in a carefully selected patient.