Modified robot-assisted laparoscopic dismembered pyeloplasty for adult patients with horseshoe kidney: techniques and medium-term outcomes.

Background: The aim of this study was to report our technique and medium-term outcomes of modified robot-assisted laparoscopic dismembered pyeloplasty (RALDP) in the Lithotomy Trendelenburg position for treating adult ureteropelvic junction obstruction (UPJO) with horseshoe kidney (HSK).

Methods: Between March 2021 and March 2023, 11 adult patients with UPJO and HSK underwent modified RALDP in the lithotomy Trendelenburg position. Patient demographic characteristics, perioperative parameters, and follow-up outcomes were collected prospectively and analyzed. A detailed description of the technique and medium-term outcomes were reported.

Results: The median (range) age was 33 (23-50) years. The mean preoperative serum creatinine and preoperative estimated glomerular filtration rate (eGFR) were 74.72±16.20 μmol/L and 100.4±16.5 mL/min/1.73 m, respectively. One patient (9.1%) required an additional right pyelolithotomy. The mean operative duration was 208±70 min. The median (range) estimated blood loss was 20 (20-100) mL. The median (range) drainage-tube removal time was 3 (2-4) days postoperatively. The median (range) postoperative hospitalization period was 5 (3-6) days. No open conversions or intraoperative complications occurred. Postoperative urinary tract infections (Clavien-Dindo grade II) occurred in two patients, managed with oral antibiotics. The median (range) follow-up of 25 (12-36) months achieved an overall success rate of 100%. The mean postoperative serum creatinine and postoperative eGFR were 74.96±17.43 μmol/L and 98.14±18.39 mL/min/1.73 m, respectively.

Conclusions: Our medium-term outcomes indicate that the modified RALDP in the Lithotomy Trendelenburg position was safe and feasible for adult HSK patients. Further prospective studies of larger sample sizes and randomized controlled trials are warranted.