Combination of Robotic Pyeloplasty and Percutaneous Renal Surgery for Simultaneous Treatment of Ureteropelvic Junction Obstruction and Calyx Stones

Abstract

Introduction: Ureteropelvic junction obstruction (UPJO) and the simultaneous presence of kidney calyx stones represent a challenge for renal surgery. We present a novel technique for the simultaneous treatment of UPJO by robotic pyeloplasty in combination with the percutaneous endoscopic treatment of kidney calyx stones by flexible nephroscopy. Patients and Methods: Between January 2018 and February 2020, 4 patients were diagnosed with UPJO and simultaneous pelvic or calyceal stones. UPJO was treated by conventional robotic pyeloplasty. After opening the renal pelvis, a flexible 16-French cystoscope was introduced via the 12-mm assistant trocar into the renal pelvis. The kidney calyx stones (n = 1–15) were removed endoscopically through a flexible nephroscope using a Dormia helical basket. Before suturing the anastomosis of the renal pelvis, a ureter stent was inserted. Results: After the procedure, all patients were stone free. Using the Clavien-Dindo classification, no complications were noted. The mean size of the calculi was 6.69 mm (range: 1–25). Up to 15 calyx stones (mean 3.46) were removed per patient. A complete stone clearance confirmed by postoperative X-ray imaging was achieved in all patients. The mean operative time was 149 min (range: 130–178). Mean hospital stay was 7 days (7–8). The urethral stent was removed after 4–6 weeks. Conclusions: Robotic management of UPJO and simultaneous flexible nephroscopy for removal of calyceal stones is an effective treatment in 1 session. Combining robotic surgery with flexible percutaneous renal surgery is a feasible, safe, and effective method of the treatment of UPJO and concomitant calyceal stones.

Effects of Stone Removal via Different Approaches in the Treatment of Incarcerated Upper Ureteral Calculi: A Comparative Study

“…With the development of endoscopic technology, various endoscopic minimally invasive procedures have become the main methods for the treatment of incarcerated upper ureteral calculi, including percutaneous nephrolithotomy, transurethral ureteroscopic lithotripsy, etc. [2,3]. However, the clinical e cacy of the abovementioned two commonly used surgical methods has been controversial and no consensus has been attained [4].…”

Transabdominal laparoscopy and ureteroscopy one‑stage surgery in the treatment of bilateral ureteropelvic junction obstruction combined with bilateral renal stones: A case report

“…However, UPJO is frequently combined with hydronephrosis and kidney stones. The incidence of kidney stones is ~20%, which markedly increases the difficulty and risk of surgery (1). In the present case report, a challenging case is discussed.…”

“…WENBIN FU 1,2 , HAIBIN CHEN 1 , CONGCONG REN 3 and JIANJUN ZHAO 1 1 Department of Urology, Affiliated Hospital of Hebei University of Engineering; 2 Clinical School of Medicine, Hebei University of Engineering, Handan, Hebei 056004; 3 Graduate School, Hebei North University, Zhangjiakou, Hebei 075000, P.R. China complications, such as macrovascular or adjacent organ damage.…”

A combined approach of robot-assisted laparoscopic pyeloplasty and flexible endoscopy to treat concomitant ureteropelvic junction obstruction and calyceal stones in children: Technical considerations and review of the literature

“…There is emerging evidence in adult studies which demonstrate the safety and effectiveness of simultaneous correction of UPJ obstruction and removal of renal calculi via robot-assisted laparoscopic surgery with concurrent nephroscopy by flexible or rigid scope for stones extraction ( 5 , 16 – 18 ). Atug et al in 2005 was the first to report using the combined approach of RALP and flexible endoscopy in adult patients ( 16 ).…”