Department of Urology, Northwestern University , Chicago , Illinois.
Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago , Illinois.
J Urol. 2019 May;201(5):1005-1011. doi: 10.1016/j.juro.2018.10.021.
Reoperative pyeloplasty is commonly used in children with recurrent obstruction after pyeloplasty. We previously reported on reoperative robot-assisted laparoscopic repair for failed pyeloplasty in 16 children and concluded that short-term and intermediate outcomes were comparable to open reoperative repair. In this updated series we describe longer term outcomes from an extended study.
We retrospectively reviewed outcomes of consecutive children with prior failed primary pyeloplasty who underwent robot-assisted laparoscopic reoperative repair at a single institution from January 2008 to June 2018.
Overall, 36 children 0.6 to 15.2 years old (median 3.7) underwent robot-assisted laparoscopic reoperative repair (pyeloplasty in 31, ureterocalicostomy in 5) at a median of 24.3 months (range 3.9 to 136.7) after primary repair. Median reoperative time was 285.0 minutes (range 207 to 556) and median length of stay was 1 day (1 to 8). Crossing vessels were present in 8 of 30 children (26.7%) with prior open repair and in 0 of 6 with prior minimally invasive repair. Clavien-Dindo grade 1 to 2 perioperative complications occurred in 4 children (11.1%) and grade 3 to 5 complications in 2 (5.6%). Median followup was 35.3 months (range 1.4 to 108.3), with 18 children (50.0%) being followed for more than 3 years. Postoperative ultrasound in 34 children revealed improvement in 31 (91.2%), stability in 2 (5.9%) and worsening hydronephrosis in 1 (2.9%). All 11 children undergoing preoperative and postoperative diuretic renography demonstrated stable or improved differential renal function. All children were symptom-free at last followup.
To our knowledge, this is the largest series of robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children. Our results indicate the feasibility, efficacy, safety and durability of this procedure.
肾盂成形术后再梗阻在儿童中较为常见，常需再次手术。我们之前报道了 16 例儿童肾盂成形术后失败的机器人辅助腹腔镜修复，结论是短期和中期结果与开放再手术修复相当。在本系列更新中，我们描述了一项扩展研究的长期结果。
我们回顾性分析了 2008 年 1 月至 2018 年 6 月在一家单中心因初次手术失败而行机器人辅助腹腔镜再手术的连续儿童患者的结果。
共有 36 例 0.6 至 15.2 岁（中位数 3.7 岁）的儿童接受了机器人辅助腹腔镜再手术（肾盂成形术 31 例，输尿管肾盂成形术 5 例），中位时间为初次修复后 24.3 个月（范围 3.9 至 136.7）。中位再手术时间为 285.0 分钟（范围 207 至 556），中位住院时间为 1 天（1 至 8）。30 例中有 8 例（26.7%）有交叉血管，既往有开放修复，6 例中有 0 例（0%）有微创修复。4 例（11.1%）发生 Clavien-Dindo 分级 1 至 2 级围手术期并发症，2 例（5.6%）发生 3 至 5 级并发症。中位随访时间为 35.3 个月（范围 1.4 至 108.3），18 例（50.0%）随访时间超过 3 年。34 例术后超声显示 31 例（91.2%）改善，2 例（5.9%）稳定，1 例（2.9%）积水加重。所有 11 例行术前和术后利尿剂肾图检查的儿童，其肾功能均表现为稳定或改善。所有患儿末次随访时均无症状。
据我们所知，这是儿童肾盂成形术后失败的机器人辅助腹腔镜再手术最大系列。我们的结果表明，该手术具有可行性、疗效、安全性和耐久性。
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