Comparison of robot-assisted and laparoscopic pyeloplasty with flexible ureteroscopy for managing concomitant ureteropelvic junction obstruction and renal calculi in children.

BACKGROUND

Ureteropelvic junction obstruction (UPJO) with renal calculi is a common cause of renal impairment in pediatric patients. Surgical intervention, including laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) combined with flexible ureteroscopy, are frequently employed to address both the obstruction and stones. This study aims to compare the safety and efficacy of RALP and LP combined with flexible ureteroscopy in treating pediatric UPJO with renal calculi.

METHODS

We conducted a retrospective study of pediatric patients with UPJO and renal calculi treated between March 2018 and June 2023. All patients underwent either RALP or conventional LP combined with flexible ureteroscopy. Preoperative imaging and standardized postoperative follow-up were used to assess surgical outcomes.

RESULTS

A total of 25 patients were included, with 11 undergoing RALP and 14 undergoing LP. Stone clearance rates were 90.9% for RALP and 85.7% for LP (P=0.25), and both groups achieved a 100% success rate in obstruction resolution. RALP was associated with a longer operative time (212.7±15.4 . 185.0±13.8 min, P=0.03) but less blood loss (48.2±9.5 . 60.2±11.3 mL, P=0.01). The RALP group also had a trend toward shorter hospital stays (6.5±1.2 . 7.7±1.6 days, P=0.07).

CONCLUSIONS

Both RALP and LP combined with flexible ureteroscopy are effective for treating pediatric UPJO with renal calculi. RALP offers benefits in terms of reduced blood loss and hospital stay, while LP remains a cost-effective alternative. Further studies with larger samples and longer follow-up are needed to validate these findings.