Department of Urology, Kaiser Permanente Medical Center, Walnut Creek, California, USA.
J Endourol. 2011 Feb;25(2):239-43. doi: 10.1089/end.2010.0192. Epub 2011 Jan 23.
Robot-assisted laparoscopic pyeloplasty (RALP) has been shown to be an efficacious treatment for ureteropelvic junction obstruction. Although the use of a ureteral stent is commonplace, the water-tight anastomosis possible with robotic assistance may obviate its need. We report a feasibility study of unstented RALPs and present our experience with both the stented (SRP) and unstented (URP) approach.
A retrospective review of RALPs completed at our institution from 2003 to 2008 was performed. Thirty-five patients had postoperative stents. Seventeen RALPs were completed without ureteral stents. Narcotic requirements, operative time, estimated blood loss, daily drain output, length of stay, and complications were examined.
Fifty-two patients underwent RALP without conversion to open procedure (35 SRP, 17 URP). Operative time was significantly less in the URP group (p = 0.01). URPs required less narcotics and had shorter length of stay. Three complications were reported after SRP, whereas two patients with URP experienced transient ureteral obstruction, which resolved after 4 weeks with an indwelling ureteral stent. Postoperative renograms showed improved drainage in all but four patients (two SRPs and two URPs), each of whom had subjective improvement in symptoms postoperatively.
Our data suggest that URP is a safe and feasible procedure for the treatment of ureteropelvic junction obstruction. There were no clinically significant differences between the stented and unstented groups. Further prospective evaluation is needed; however, URP can be performed by an experienced surgeon in a carefully selected patient.
机器人辅助腹腔镜肾盂成形术（RALP）已被证明是治疗肾盂输尿管连接部梗阻的有效方法。虽然使用输尿管支架很常见，但机器人辅助下的水密吻合可能使其不再需要。我们报告了无支架 RALP 的可行性研究，并介绍了我们在有支架（SRP）和无支架（URP）两种方法中的经验。
回顾性分析了 2003 年至 2008 年在我们机构完成的 RALP。35 例患者术后有支架。17 例 RALP 无输尿管支架。检查了阿片类药物需求、手术时间、估计出血量、每日引流量、住院时间和并发症。
52 例患者成功完成 RALP，无中转开放手术（35 例 SRP，17 例 URP）。URP 组手术时间明显缩短（p=0.01）。URP 需要的阿片类药物较少，住院时间较短。SRP 后报告了 3 例并发症，而 2 例 URP 患者出现短暂性输尿管梗阻，4 周后留置输尿管支架后缓解。术后肾图显示除 4 例患者（2 例 SRP 和 2 例 URP）外，所有患者的引流均有所改善，其中 2 例患者术后症状均有主观改善。
我们的数据表明，URP 是治疗肾盂输尿管连接部梗阻的一种安全可行的方法。支架组和无支架组之间没有临床意义上的差异。需要进一步的前瞻性评估；然而，有经验的外科医生可以在精心选择的患者中进行 URP。
