Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, NY, USA.
Creighton University School of Medicine, Omaha, NE, USA.
World J Urol. 2023 Jul;41(7):1959-1965. doi: 10.1007/s00345-023-04445-5. Epub 2023 Jun 7.
To evaluate the outcome of robotic-assisted laparoscopic pyeloplasty (RAP) in symptomatic patients with ureteropelvic junction obstruction (UPJO) versus patients who were incidentally found to have UPJO.
We retrospectively reviewed the records of 141 patients who underwent RAP at Massachusetts General Hospital between 2008 and 2020. Patients were categorized into symptomatic group and asymptomatic group. We compared patient demographics as well as preoperative and postoperative symptoms and functional renal scans.
The study population included 108 patients in the symptomatic group and 33 patients in the asymptomatic group. Mean age was 46 ± 17 years with average follow-up time of 12 ± 18 months. Asymptomatic patients had significantly higher rate of definite obstruction (80% versus 70%) and equivocal obstruction (10% versus 0.9%) on preop renogram (P: 0.001). There was no significant difference in the preop split renal function in symptomatic versus asymptomatic group (39 ± 13 versus 36 ± 13 P: 0.3). Following RAP, 91% of symptomatic patients achieved symptom resolution, while four asymptomatic patients (12%) developed new symptoms postoperatively. Compared to preoperative renogram, RAP resulted in improvement in renogram indices in 61% of symptomatic versus 75% of asymptomatic patients (P: 0.2).
Although asymptomatic patients had worse obstructive indices on renogram, both symptomatic and asymptomatic groups had comparable improvement in renal function following robotic pyeloplasty. RAP is a safe and efficacious minimally invasive option to offer symptom resolution in symptomatic patients and improve obstruction in both symptomatic and asymptomatic patients with UPJO.
评估机器人辅助腹腔镜肾盂成形术（RAP）治疗症状性肾盂输尿管连接部梗阻（UPJO）患者与偶发性 UPJO 患者的治疗效果。
我们回顾性分析了 2008 年至 2020 年期间在马萨诸塞州总医院接受 RAP 的 141 例患者的病历。患者分为症状组和无症状组。我们比较了两组患者的人口统计学资料，以及术前和术后症状和肾功能扫描结果。
研究人群包括 108 例症状组患者和 33 例无症状组患者。平均年龄为 46±17 岁，平均随访时间为 12±18 个月。无症状组患者术前肾动态显像中明确梗阻（80%比 70%）和可疑梗阻（10%比 0.9%）的发生率明显更高（P=0.001）。症状组和无症状组患者术前分肾功能无显著差异（39±13 比 36±13，P=0.3）。RAP 术后，91%的症状性患者症状得到缓解，而 4 例无症状患者（12%）术后出现新症状。与术前肾动态显像相比，RAP 使 61%的症状性患者和 75%的无症状患者的肾动态显像指数得到改善（P=0.2）。
尽管无症状患者的肾动态显像梗阻指数较差，但症状性和无症状性两组患者在接受机器人肾盂成形术后肾功能均有类似程度的改善。RAP 是一种安全有效的微创治疗方法，可缓解症状性患者的症状，并改善症状性和无症状性 UPJO 患者的梗阻。
