Citation
Lee M, Lee Z, Strauss D, Jun MS, Koster H, Asghar AM, Lee R, Chao B, Cheng N, Ahmed M, Lovallo G, Munver R, Zhao LC, Stifelman MD, Eun DD; Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS). Multi-Institutional Experience Comparing Outcomes of Adult Patients Undergoing Secondary versus Primary Robotic Pyeloplasty. Urology. 2020. Nov; 145:275-280 PMID: 32687842
Abstract
To describe surgical techniques and peri-operative outcomes with secondary robotic pyeloplasty (RP), and compare them to those of primary RP. We retrospectively reviewed our multi-institutional, collaborative of reconstructive robotic ureteral surgery (CORRUS) database for all consecutive patients who underwent RP between April 2012 and September 2019. Patients were grouped according to whether they underwent a primary or secondary pyeloplasty (performed for a recurrent stricture after previously failed pyeloplasty). Perioperative outcomes and surgical techniques were compared using nonparametric independent sample median tests and chi-square tests; P < .05 was considered significant. Of 158 patients, 28 (17.7%) and 130 (82.3%) underwent secondary and primary RP, respectively. Secondary RP, compared to primary RP, was associated with a higher median estimated blood loss (100.0 vs 50.0 milliliters, respectively; P < .01) and longer operative time (188.0 vs 136.0 minutes, respectively; P = .02). There was no difference in major (Clavien >2) complications (P = .29). At a median follow-up of 21.1 (IQR: 11.8-34.7) months, there was no difference in success between secondary and primary RP groups (85.7% vs 92.3%, respectively; P = .44). Buccal mucosa graft onlay ureteroplasty was performed more commonly (35.7% vs 0.0%, respectively, P < .01) and near-infrared fluorescence imaging with indocyanine green was utilized more frequently (67.9% vs 40.8%, respectively; P < .01) for secondary vs primary repair. Although performing secondary RP is technically challenging, it is a safe and effective method for recurrent ureteropelvic junction obstruction after a previously failed pyeloplasty. Buccal mucosa graft onlay ureteroplasty and utilization of near-infrared fluorescence with indocyanine green may be particularly useful in the re-operative setting.
Key Points
- Published in Urology in 2020.
- Indexed in PubMed as PMID 32687842.
- Mapped to Ureteral Reconstruction, Urethral Stricture & Urethroplasty, Robotic & Single-Port.
- Abstract available from PubMed and rendered as static text on this page.
Clinical Relevance
This work sits within Dr. Zhao's upper urinary tract reconstruction bibliography, including robotic ureteral repair, buccal mucosa graft ureteroplasty, reimplantation, pyeloplasty failure, and complex salvage reconstruction.