Stentless pediatric robotic pyeloplasty

Objectives: Open dismembered pyeloplasty remains the standard of care for the correction of ureteropelvic junction obstruction in children. We describe our experience with a tubeless, stentless pediatric robotic pyeloplasty technique. Methods: Between October 2008 and September 2009, 12 consecutive children underwent robotic dismembered pyeloplasty. Ureteral stents or nephrostomy tubes were not used. Operative time, hospital stay, days of Jackson–Pratt drainage, and complications were analyzed. Postoperative renal ultrasonography was obtained at 4–6 weeks after surgery. Results: The mean patient age was 9.1 years (3.5–16). The mean operative and console times were 178 (122–250) and 129 (96–193) minutes, respectively. The Jackson–Pratt drain was removed after a mean of 1.8 days (1–4). The mean hospital stay was 2.4 days (1–4.5). There were no complications. Mean follow up was 16 months (12–24 months). All patients had complete resolution of symptoms. Hydronephrosis either completely resolved or significantly decreased in all cases. In cases without complete resolution of hydronephrosis, 99m Tc-MAG-3 diuretic renography showed preservation of renal function without obstruction. Conclusions: Robot-assisted laparoscopic pyeloplasty can be safely performed without internal indwelling stent drainage. In children, this avoids the need for additional anesthesia and stent-related morbidity.