Preoperative Drainage Strategy in Robot-Assisted Adult Pyeloplasty

The optimal preoperative drainage strategy for ureteropelvic junction obstruction remains controversial. This study compares the outcomes between different preoperative urinary drainage methods in robot-assisted pyeloplasty (RAPY).

This retrospective study was conducted on 45 patients who underwent RAPY from 2020 to 2024 and categorised by clinical presentation: flank pain with hydronephrosis requiring preoperative urinary drainage double-J ureter catheter (DJ) or percutaneous nephrostomy (PCN) or renal function deterioration (no-drain) scheduled for pyeloplasty. The patients were divided into three groups: DJ (n = 10), PCN (n = 10) and no preoperative catheter (n = 25). Primary endpoint was the occurrence of complications within 90 days after surgery. Secondary endpoints included console time, hospitalisation rates, improvement in glomerular filtration rate (GFR) (compared between baseline GFR and GFR at discharge) and readmission rates.

The immediate GFR improvement after surgery was 2.57 mL/min/1.73 m² (p = 0.62). Complications were observed in 30% of the PCN group, 32% of the no-drain group (p = 0.18) and none in the DJ group (0%). Five major complications occurred, four of them in the no-drain group. One was incisional hernia, and one was subcutaneous hematoma. In three patients, the intraoperatively inserted DJ catheter had to be replaced postoperatively. All replacements took place in the no-drain group. Six patients were readmitted within 90 days postoperatively (three each in the PCN and no preoperative catheter groups).

Short-term, preoperative, X-ray-guided DJ catheter placement appears to be a safe approach for adult pyeloplasty preparation to prevent postoperative complications associated with blind DJ insertion. It can also help in avoiding the effects of long-term stenting. Placing a nephrostomy catheter is another reasonable option. Further prospective studies are needed to validate our findings.