Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA.
Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
J Pediatr Urol. 2021 Aug;17(4):528.e1-528.e7. doi: 10.1016/j.jpurol.2021.02.016. Epub 2021 Feb 19.
Robot-assisted laparoscopic pyeloplasty (RALP) is a safe and efficacious option for repair of UPJO. We hypothesize that redo-RALP is technically more difficult but has comparable outcomes to primary RALP.
An IRB-approved single institutional registry was utilized to identify all patients undergoing primary or redo RALP from 2012 to 2019. Redo RALP consisted of pyeloplasty and ureterocalicostomy (RALUC). Peri-operative and post-operative details and outcomes were aggregated. Successful reconstruction was defined as resolution of symptoms, improved hydronephrosis and no need for additional procedures.
From 399 patients who underwent UPJO repair at our center, a total of 306 with a median age of 4.9 years at surgery and a median follow-up of 18.5 months were included: 276 primary and 30 redo (21 RALP and 9 RALUC). Redo group had significantly longer procedure time and length of stay compared to the primary group. However, no significant difference was noted in the post-operative complications, need for additional endoscopic procedures or redo reconstruction, and success between the two groups. Multivariate analysis showed that when controlled for age, gender, 30-days post-operative complication and anatomy of obstruction, redo as compared to primary reconstruction did not have a significant effect on success.
This study is the largest controlled cohort in the pediatric population comparing redo RALP with an established control group -primary RALP. This retrospective chart review possesses the biases innate to any retrospective study. The low number of re-operative cases as well as low rate of failure in redo RALP further complicates identification of statistically significant predictors of outcomes following redo RALP.
Redo RALP is an efficient and safe approach for reconstruction of recurrent UPJO, with low complication rate and high success rate, comparable to primary RALP.
机器人辅助腹腔镜肾盂成形术（RALP）是治疗肾盂输尿管连接部梗阻（UPJO）的安全有效方法。我们假设，再次 RALP 在技术上更具挑战性，但与初次 RALP 的结果相当。
利用经机构审查委员会批准的单机构注册处，从 2012 年至 2019 年，确定所有接受初次或再次 RALP 的患者。再次 RALP 包括肾盂成形术和输尿管肾盂吻合术（RALUC）。汇总围手术期和术后的详细信息和结果。成功重建定义为症状缓解、积水改善且无需额外手术。
在我院接受 UPJO 修复的 399 例患者中，共纳入 306 例，手术时的中位年龄为 4.9 岁，中位随访时间为 18.5 个月：276 例初次 RALP 和 30 例再次 RALP（21 例 RALP 和 9 例 RALUC）。与初次 RALP 组相比，再次 RALP 组的手术时间和住院时间明显延长。然而，两组在术后并发症、是否需要额外的内镜手术或再次重建以及成功率方面无显著差异。多变量分析显示，在控制年龄、性别、术后 30 天并发症和梗阻解剖结构后，与初次重建相比，再次重建对成功率没有显著影响。
本研究是儿科人群中比较再次 RALP 与既定对照组（初次 RALP）的最大对照队列研究。这项回顾性图表回顾研究存在任何回顾性研究固有的偏见。再次手术病例数量较少以及再次 RALP 失败率低，进一步增加了识别再次 RALP 后结局的统计学显著预测因素的难度。
再次 RALP 是治疗复发性 UPJO 的有效且安全的方法，并发症发生率低，成功率高，与初次 RALP 相当。
