title: Robot-assisted pyeloplasty: outcomes for primary and secondary repairs, a single institution experience.
abstract: BACKGROUND
  Robotic Pyeloplasty (RAP) is a technique for management of ureteropelvic junction obstruction (UPJO).
  
  
  OBJECTIVE
  To report outcomes of RAP for primary and secondary (after failed primary treatment) UPJO.
  
  
  METHODS
  Single institution data of adult RAP performed from 2007 to 2009 was collected retrospectively following approval by our IRB. Database analysis included patient age, race, pre and post-operative imaging studies and perioperative variables including operative time, blood loss, pain and complications.
  
  
  RESULTS
  Fifty-five adult patients underwent RAP (26 left/29 right) for UPJO including 9 secondary procedures from 2007 to 2009. Average follow-up was 16 months (1-36). Mean age was 41 years (18-71) with an average BMI of 27 (17-42); 32 were female. Most patients were diagnosed with preoperative diuretic renal scintigraphy and the obstructed side demonstrated mean function of 41% and t1/2 of 70 minutes. Mean operative time was 194 minutes with average blood loss less than 100 mL. Mean hospital stay was 1.7 days with an average narcotic equivalent dose of 15 mg. RAP for secondary UPJO took longer with more blood loss and had a lower success rate. Failure was defined as the need of another procedure due to persistent pain and/or obstruction after diuretic renal imaging. One patient (2%) with primary UPJO failed and 2 patients (22%) with secondary UPJO failed. One major complication occurred.
  
  
  CONCLUSIONS
  RAP is a good option for the treatment of patients with UPJO. Reported series have established that endopyelotomy has inferior success rate for the treatment of primary UPJO which compromises the success of subsequent treatment as demonstrated in our higher failure rate with secondary UPJO repair.
authors.affiliation: Division of Urologic Surgery, Washington University in St Louis, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Thom
authors.forename: Mohammed
authors.initials: M
authors.lastname: Haseebuddin
authors.forename: Timur M
authors.initials: TM
authors.lastname: Roytman
authors.forename: Brian M
authors.initials: BM
authors.lastname: Benway
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
authors.forename: Robert S
authors.initials: RS
authors.lastname: Figenshau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*; D055815:Young Adult