Division of Urologic Surgery, Washington University in St Louis, USA.
Int Braz J Urol. 2012 Jan-Feb;38(1):77-83. doi: 10.1590/s1677-55382012000100011.
Robotic Pyeloplasty (RAP) is a technique for management of ureteropelvic junction obstruction (UPJO).
To report outcomes of RAP for primary and secondary (after failed primary treatment) UPJO.
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.
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.
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.
机器人肾盂成形术（RAP）是治疗肾盂输尿管连接部梗阻（UPJO）的一种技术。
报告原发性和继发性（原发性治疗失败后）UPJO 行 RAP 的结果。
本研究回顾性收集了 2007 年至 2009 年期间在我院行成人 RAP 的单中心数据，该研究已获得我院 IRB 批准。数据库分析包括患者年龄、种族、术前和术后影像学研究以及围手术期变量，包括手术时间、失血量、疼痛和并发症。
2007 年至 2009 年，55 例成人 UPJO 患者行 RAP（左侧 26 例，右侧 29 例），其中 9 例为继发性手术。平均随访时间为 16 个月（1-36 个月）。平均年龄为 41 岁（18-71 岁），平均 BMI 为 27（17-42）；32 例为女性。大多数患者术前诊断为利尿剂肾闪烁显像，梗阻侧平均功能为 41%，t1/2 为 70 分钟。平均手术时间为 194 分钟，失血量平均少于 100 毫升。平均住院时间为 1.7 天，平均阿片类等效剂量为 15 毫克。继发性 UPJO 的 RAP 手术时间较长，失血量较多，成功率较低。失败定义为利尿剂肾显像后持续疼痛和/或梗阻需要再次手术。1 例（2%）原发性 UPJO 患者失败，2 例（22%）继发性 UPJO 患者失败。发生 1 例严重并发症。
RAP 是治疗 UPJO 患者的一种较好选择。已发表的系列研究表明，对于原发性 UPJO 的治疗，经皮肾盂切开术的成功率较低，这会影响后续治疗的成功率，正如我们在继发性 UPJO 修复中更高的失败率所显示的那样。
