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Clinical Trial
. 2012 Feb;187(2):522-7.
doi: 10.1016/j.juro.2011.09.158. Epub 2011 Dec 15.

Factors that impact the outcome of minimally invasive pyeloplasty: results of the Multi-institutional Laparoscopic and Robotic Pyeloplasty Collaborative Group

Steven M Lucas  1 , Chandru P Sundaram, J Stuart Wolf Jr, Raymond J Leveillee, Vincent G Bird, Mohamed Aziz, Stephen E Pautler, Patrick Luke, Peter Erdeljan, D Duane Baldwin, Kamyar Ebrahimi, Robert B Nadler, David Rebuck, Raju Thomas, Benjamin R Lee, Ugur Boylu, Robert S Figenshau, Ravi Munver, Timothy D Averch, Bishoy Gayed, Arieh L Shalhav, Mohan S Gundeti, Erik P Castle, J Kyle Anderson, Branden G Duffey, Jaime Landman, Zhamshid Okhunov, Carson Wong, Kurt H Strom
Affiliations
Clinical Trial

Factors that impact the outcome of minimally invasive pyeloplasty: results of the Multi-institutional Laparoscopic and Robotic Pyeloplasty Collaborative Group

Steven M Lucas et al. J Urol. 2012 Feb.

Abstract

Purpose: We compared laparoscopic and robotic pyeloplasty to identify factors associated with procedural efficacy.

Materials and methods: We conducted a retrospective multicenter trial incorporating 865 cases from 15 centers. We collected perioperative data including anatomical and procedural factors. Failure was defined subjectively as pain that was unchanged or worse per medical records after surgery. Radiographic failure was defined as unchanged or worsening drainage on renal scans or worsening hydronephrosis on computerized tomography. Bivariate analyses were performed on all outcomes and multivariate analysis was used to assess factors associated with decreased freedom from secondary procedures.

Results: Of the cases 759 (274 laparoscopic pyeloplasties with a mean followup of 15 months and 465 robotic pyeloplasties with a mean followup of 11 months, p <0.001) had sufficient data. Laparoscopic pyeloplasty, previous endopyelotomy and intraoperative crossing vessels were associated with decreased freedom from secondary procedures on bivariate analysis, with a 2-year freedom from secondary procedures of 87% for laparoscopic pyeloplasty vs 95% for robotic pyeloplasty, 81% vs 93% for patients with vs without previous endopyelotomy and 88% vs 95% for patients with vs without intraoperative crossing vessels, respectively. However, on multivariate analysis only previous endopyelotomy (HR 4.35) and intraoperative crossing vessels (HR 2.73) significantly impacted freedom from secondary procedures.

Conclusions: Laparoscopic and robotic pyeloplasty are highly effective in treating ureteropelvic junction obstruction. There was no difference in their abilities to render the patient free from secondary procedures on multivariate analysis. Previous endopyelotomy and intraoperative crossing vessels reduced freedom from secondary procedures.

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