BACKGROUND: Success rates for pediatric pyeloplasty are reported to be greater than 90%. However, due to these low failure rates, there remains limited series by which to compare management approaches to treating the failed pyeloplasty. In our study, we seek to compare our institutional outcomes comparing open (ORP) vs robotic redo pyeloplasties (RRP).
METHODS: We retrospectively reviewed our prospectively collected institutional pyeloplasty database, to review peri- and postoperative outcomes of redo pyeloplasty. Statistical analysis was performed using Fisher exact tests and Mann-Whitney tests, to assess for statistical significance.
RESULTS: 282 patients underwent pyeloplasty at our institution between 2012 and 2023, of which 178 were performed robotically. 19 patients underwent redo pyeloplasty, while one underwent ureterocalcycostomy. Of the 19 redo pyeloplasty cases, four were performed via ORP, while 15 were performed via RRP. The mean length of stay for RRP (1.53 nights) was significantly shorter than that of ORP (2.75 nights) (p = 0.0011). Though not found to achieve statistical significance, median operative time for RRP was 213 minutes, whereas ORP were 239.5 minutes. Sonographic SFU hydronephrosis improvement was noted in 66% of RRP cases, compared to only 25% of ORPs. 25% of ORPs had a postoperative complication, while only 7% of RRPs had a complication. The only Clavien III complication- an anastomotic leak requiring ureteral stent placement- occurred in the ORP cohort. Estimated blood loss for both approaches was reported similarly, near 5cc per case.
CONCLUSION: Redo pyeloplasty by way of robotic approach appears to be at, a minimum, non-inferior to an open approach. Though limited by our small sample size, our data suggests that RRP may offer shorter operative times, shorter hospital stays, reduced complications, and better clinical outcomes postoperatively than ORP. Through the lens of offering cost-effective care, this may cumulatively add to significant cost-improvements across the US healthcare system. Further investigation is warranted.
