Robot-assisted pyeloplasty and pyelolithotomy in patients with ureteropelvic junction stenosis

Objective: Approximately one in five patients with ureteropelvic junction stenosis (UPJS) also present with renal or ureteral stones. For patients with UPJS, the European Association of Urology guidelines currently recommend that robot-assisted pyeloplasty (RAP) and pyelolithotomy are performed as two separate procedures. The aim of the present study was to evaluate the feasibility and safety of RAP with concomitant pyelolithotomy (RAP+P) in patients diagnosed with UPJS and renal stones. Materials and methods: In total, 56 RAP procedures and 18 RAP+P procedures were performed between December 2012 and January 2014. Patient records were retrospectively reviewed for operation time (OT), estimated blood loss (EBL), length of hospital stay (LOS), complications, stone burden and stone-free rates at 1, 3 and 6 months following surgery. Results: A significant difference in the OT was demonstrated between RAP and RAP+P, with a median of 120min [interquartile range (IQR) 100-134min] and 151min (IQR 128-185min), respectively (p<0.0001). In contrast, no difference in LOS [median 2 days (IQR 2-3 days) vs 3 days (2-4 days), p=0.50) or EBL [median 0ml (IQR 0-50ml) vs 20ml (0-50ml), p=0.64] was observed between RAP and RAP+P. The median total stone burden was 1.5cm (IQR 1.0-4.3cm; range 1-10cm). The stone-free rate at 1, 3 and 6 months was 94%, 83% and 72%, respectively. No grade 3-5 complications were observed in the RAP+P group. Conclusions: RAP+P can safely be offered to patients with UPJS and renal stones, with an acceptable stone-free rate.