title: Success of Laparoscopic Robot-Assisted Approaches to Ureteropelvic Junction Obstruction Based on Preoperative Renal Function.
abstract: OBJECTIVE
  No literature exists examining the risk factors for failure after robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO) in children. The goal of this study was to compare the success of robot-assisted pyeloplasty between UPJO kidneys with preoperative renal function <30% versus >30%.
  
  
  METHODS
  We performed a retrospective review of all patients who underwent a robot-assisted laparoscopic pyeloplasty for UPJO at a single institution from June 2009 to September 2013 by four surgeons. A failed procedure was defined as necessitating a second surgery for the UPJO, nonresolution of symptoms with no improvement of washout on postoperative mercaptoacetyltriglycine (MAG)-3 scan, and/or a reduction in renal function of the obstructed kidney to <10%. Success was compared between patients with <30% and >30% preoperative differential renal function via the Fisher exact test.
  
  
  RESULTS
  There were 116 patients who were included. At a mean follow-up of 507 days after the surgical procedure, there were eight (8%) failures. The majority of the failures (5/8) were in kidneys whose preoperative function was <30%. There was a significant difference in the success of procedures performed on kidneys with >30% (86/89, 97%) versus <30% (7/12, 58%) preoperative renal function (P=0.0005).
  
  
  CONCLUSIONS
  In this large cohort of patients, kidneys with preoperative function >30%, robot-assisted pyeloplasty had a 97% success rate. This was significantly different than the success of robot-assisted pyeloplasty (58%) in kidneys with preoperative function <30%. This information is useful for patient counseling as these patients may be at higher risk for a secondary procedure such as a subsequent nephrectomy or may benefit from a preoperative trial of nephrostomy tube drainage.
authors: 1 Division of Pediatric Urology, Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.|2 Children's Health , Dallas, Texas.
authors: Gwen M
authors: GM
authors: Grimsby
authors: 1 Division of Pediatric Urology, Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.|2 Children's Health , Dallas, Texas.
authors: Micah A
authors: MA
authors: Jacobs
authors: 3 Texas Children's Hospital/Baylor College of Medicine , Houston, Texas.
authors: Patricio C
authors: PC
authors: Gargollo
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000379:methods*; D017211:Treatment Failure; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000601:surgery*; D055815:Young Adult