Simultaneous treatment of ureteropelvic junction obstruction complicated by renal calculi with robotic laparoscopic surgery and flexible cystoscope

Abstract

Objective: To present our experience of combining transperitoneal robot-assisted laparoscopic pyeloplasty (RALP) and concomitant flexible cystoscope lithotomy for ureteropelvic junction obstruction (UPJO) complicated by renal caliceal stones in the same session.

Patients and methods: Between October 2014 and November 2017, RALP combined with flexible cystoscope lithotomy was performed in 16 patients with UPJO and ipsilateral renal caliceal stones. Stone location and size were preoperatively assessed. After pyelotomy with appropriate length (about 8-15 mm), a 16F flexible cystoscope through the assistant trocar or robotic trocar was introduced directly into the renal pelvis under laparoscopic vision. Holmium laser lithotripsy and pressure irrigation via a pump were used for caliceal stone removal. Subsequently, robot-assisted laparoscopic pyeloplasty was undergone in a standard fashion.

Results: The calculi sizes ranged from 5 to 34 mm (mean 18.6 mm) and an average of 3.4 stones per patient was removed (range 1-8 stones). Complete stone clearance confirmed by postoperative imaging was achieved in all patients. Mean operative time was 204.6 min and estimated blood loss was 55.6 mL. Mean hospital stay was 6.7 days (3-17). The stent was removed after 8 weeks. No major intraoperative or postoperative complications were noted during a mean follow-up of 10.4 months (range 6-27 months).

Conclusions: RALP combined with flexible cystoscope lithotomy is safe and effective alternatives for the simultaneous management of UPJO complicated by renal caliceal stones.

Keywords: Flexible cystoscope; Renal calculi; Robotic surgery; Ureteropelvic junction obstruction.