Robot-Assisted Vs. Laparoscopic Pyeloplasty for UPJO: A Single-Center, Propensity Score-Matched Analysis of Surgical...

To compare perioperative and functional outcomes of laparoscopic pyeloplasty (LP) and robot-assisted pyeloplasty (RAP) for ureteropelvic junction obstruction (UPJO). This study evaluated whether RAP provides outcomes comparable to LP even when performed by surgeons with limited experience, using propensity score matching (PSM) to minimize selection bias.

We retrospectively reviewed 350 consecutive patients undergoing transperitoneal LP or RAP for UPJO at a tertiary center. Intraoperative parameters, including operative time and estimated blood loss, were recorded. Postoperative outcomes included hospital stay, Clavien-Dindo complications, and symptom resolution. Surgical success was evaluated using diuretic renography 6-12 months postoperatively, defined as improved urinary drainage with symptom resolution in symptomatic patients or improved drainage alone in asymptomatic patients.

Initially, 264 patients underwent LP and 86 underwent RAP. After PSM, each group included 77 patients. No significant intergroup differences were observed in operative time, estimated blood loss, or hospital stay. No significant difference was observed in Grade III complications; however, the RAP group exhibited a significantly higher incidence of Grade II complications (primarily urinary tract infections). Complete symptom resolution occurred in all symptomatic patients, and surgical success was equally high (98.7%) in both groups.

RAP is a safe and effective surgical option for UPJO management, with perioperative outcomes and surgical success rates comparable to LP. Despite a higher rate of minor (Clavien-Dindo Grade II) complications, RAP achieved favorable outcomes even when performed by surgeons without prior pyeloplasty experience, supporting its reproducibility and potential role as a standard surgical approach.