Safety of robotic-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction in older patients

While age has previously been demonstrated to not be a contraindication for pyeloplasty, the association of age and outcomes has been mixed. We analyzed rates of diverse subjective and objective outcome measures in older adults after robotic-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO).

We conducted an observational retrospective study of patients who underwent robotic-assisted laparoscopic pyeloplasty at our two-center hospital system from 2015 to 2023. Stratified by age (≥ 65 vs. < 65), patients were compared by pre- and intraoperative characteristics as well as postoperative outcomes: rate of complications, ED visits, and reoperation, as well as change in flank pain, hydronephrosis, half-life of clearance, split renal function, and creatinine.

Of 214 adults who underwent pyeloplasty for treatment of UPJO, 52 (24.3%) patients were aged ≥ 65. Patients aged ≥ 65 presented more frequently with hypertension (75.0% vs. 32.1%), cardiovascular disease (67.3% vs. 21.0%), previous abdominal surgery (76.9% vs. 47.5%). By age, no significant differences were observed in laterality of UPJO, surgical approach, presence of crossing vessel, estimated blood loss, drain duration, stent size or length, rate of minor or major complications, or length of stay. By age, no differences were observed in any postoperative outcomes.

Although patients over 65 who underwent robotic-assisted laparoscopic pyeloplasty for UPJO more frequently presented with hypertension, cardiovascular disease, prior abdominal surgery, risk of poor outcomes remained similar to that of younger patients. Future research should focus on establishing standardized success criteria to further enhance care and facilitate comparability across studies.