Concomitant Treatment of Ureteropelvic Junction Obstruction and Renal Calculi With Robotic Laparoscopic Surgery and Rigid Nephroscopy

• Published in: Urology (Ridgewood, N.J.) N.J.), 2014, Vol.83 (1), p.237-242
• Main Authors: Zheng, Ji, Yan, Junan, Zhou, Zhansong, Chen, Zhiwen, Li, Xin, Pan, Jinhong, Li, Weibing
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Endoscopes; Equipment Design; Female; Humans; Kidney Calculi - complications; Kidney Calculi - surgery; Kidney Pelvis - surgery; Kidneys; Laparoscopy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Retrospective Studies; Robotics; Ureteral Obstruction - complications; Ureteral Obstruction - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urologic Surgical Procedures - methods; Urology; Young Adult
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2013.08.008

Introduction The treatment of ureteropelvic junction obstruction (UPJO) and concomitant calculus poses a technically challenging situation. We present our experience with using rigid nephroscopy for renal calculi removal during robot-assisted pyeloplasy (RAP) for UPJO. Technical Considerations From December 2010 to November 2012, 25 patients with UPJO had RAP at our institution; 9 of those had concurrent renal calculi, which were simultaneously treated with rigid nephroscopy. For stone extraction, a rigid ureteroscope was passed through an assistant trocar under laparoscopic vision directly into a previously created pyelotomy. The stones were extracted using a rigid grasper or stone basket through the rigid ureteroscope. For the removal of the stones within the upper and lower calyces, the rigid ureteroscope was introduced into the incised renal pelvis through robotic trocars if the "assistant trocar" route failed. Complete stone clearance was achieved in 8 of 9 patients. Residual calculi in 1 patient were removed with a single session of extracorporeal shock wave lithotripsy. At the mean follow-up of 10.2 months, no patients had obstruction or recurrent stones. The mean operative time was 187.1 minutes, which was 40.9 minutes longer than the mean operative time in patients without renal calculi. There was no significant difference in blood loss, hospital stay, complications, and success rates between patients with and without renal calculi. Conclusion Our data suggest that the use of a concomitant rigid nephroscope and RAP is a safe and feasible option for the treatment of UPJO complicated with renal calculi.