Robot-assisted laparoscopic upper urinary tract reconstruction for ureteropelvic junction obstruction combined with congenital renal anomalies: a single-center retrospective case series of 38 patients

Background: Ureteropelvic junction obstruction (UPJO) associated with congenital renal anomalies presents unique anatomical challenges for upper urinary tract reconstruction, and evidence regarding the feasibility and outcomes of robot-assisted laparoscopic (RAL) surgery remains limited. This study aimed to evaluate the efficacy and perioperative outcomes of RAL upper urinary tract reconstruction for UPJO associated with congenital renal anomalies and to summarize key surgical considerations in this anatomically complex population.

Methods: We retrospectively reviewed consecutive patients with UPJO combined with congenital renal anomalies who underwent RAL upper urinary tract reconstruction at our center between March 2018 and November 2023 using data from the prospectively maintained Reconstruction of Urinary Tract: Technology, Epidemiology, and Result (RECUTTER) database. Eligible patients had UPJO associated with horseshoe kidney, solitary kidney, renal malrotation, duplex kidney, or ectopic kidney, and presented with recurrent flank pain, hydronephrosis with recurrent urinary tract infection, or obstruction-related renal function deterioration. Patients with previous failed upper urinary tract reconstruction, those requiring lower urinary tract reconstruction, and those with incomplete clinical data or loss to follow-up were excluded. Surgical success was defined as symptom improvement or resolution, reduction or resolution of hydronephrosis on imaging, and improved renal function compared with preoperative status. Surgical failure was defined as persistent or worsening symptoms with progressive hydronephrosis requiring secondary surgical intervention. The primary outcome was surgical success; secondary outcomes included postoperative complications and changes in renal function.

Results: A total of 38 patients were included, and all completed follow-up. The congenital renal anomalies included horseshoe kidney in 21 patients, solitary kidney in 7, renal malrotation in 4, duplex kidney in 3, and ectopic kidney in 3. Thirty patients underwent modified dismembered pyeloplasty, 7 underwent modified flap pyeloplasty, and 1 underwent lingual mucosal graft ureteroplasty. Thirty-three procedures were performed using the da Vinci robotic surgical system and 5 using the KangDuo system. The mean follow-up duration was 3.25±1.51 years. Two patients experienced surgical failure, resulting in an overall success rate of 94.74% (36/38). Eight perioperative complications occurred, including 6 Clavien-Dindo grade I complications and 2 grade IIIa complications. At the last follow-up, renal function showed a significant increase in estimated glomerular filtration rate compared with preoperative values (103.17±17.56 vs. 94.12±17.44, P<0.05) and a significant decrease in blood urea nitrogen (3.42±0.90 vs. 5.02±1.09, P<0.01). Blood creatinine showed a trend toward improvement, although the difference was not statistically significant (70.89±17.50 vs. 79.62±19.24, P=0.053).

Conclusions: In this single-center retrospective case series, RAL upper urinary tract reconstruction was feasible for selected patients with UPJO combined with congenital renal anomalies and was associated with acceptable perioperative outcomes and favorable symptomatic, imaging, and renal functional outcomes during follow-up. Careful preoperative anatomical evaluation and individualized reconstruction strategies may be important in this complex patient population. Further studies with larger cohorts and comparative designs are needed to confirm long-term efficacy.