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Introduction/Objectives
Pyeloplasty is the gold standard for correction of Ureteropelvic Junction Obstruction (UPJO). Most patients with late complications will present with clinical symptoms. Therefore, many patients are discharged from follow up after favorable postoperative imaging one year after surgery.
Objectives
The most important outcomes after RALP are resolution of symptoms and avoidance of additional surgery. Postoperative drainage studies are not always done after RALP. Many families find this study stressful and invasive.
Our goal was reviewing the long-term adverse outcomes after RALP. Primary outcomes reviewed were: 1) additional surgical intervention (re-do pyeloplasty or stent placement), 2) reemergence of symptoms, and 3) need for a postoperative drainage study based on changing ultrasound findings.
Methods
We reviewed the data on patients enrolled in our prospective robotic pyeloplasty registry (March 2009 until November 2013). All patients underwent RALP by one surgeon. This surgeon’s standard postoperative follow up is an annual or biannual renal ultrasound (RUS) until puberty. Patients with ≤6 months followup were excluded. A Kaplan-Meier curve was constructed for all outcomes to identify 3-year event free survival.
Results
Thirty-eight patients, 66% male, with a mean surgical age of 6.2 yrs (SD ± 4.7) were included in the study. Average follow up was 24 months (SD ± 13). 29 of 38 patients (76%) showed resolved or improved hydronephrosis.
Four (10%) patients underwent additional surgical intervention. Two patients underwent redo pyeloplasty at 9 and 10 months post surgery. Two patients underwent additional stent placement at 1 and 6 months post surgery.
Five (13%) patients experienced reemergence of symptoms at a mean of 24 months post surgery (SD ± 13, range 6-54 mos).
Nine (24%) patients underwent additional drainage studies at a mean of 21 months post surgery (SD ± 13, range 4-54 months).
Kaplan-Meier curves show all additional interventions occurred by 1 year post surgery, all additional drainage studies occurred by 2 years post surgery, and the majority of symptom reemergence (4 of 5) occurred by 2 years post surgery
Conclusions
Our prospective series supports the notion that RALP has good success rates. The incidence of late adverse outcomes is low, and often presents soon after surgery. It is arguable if one year is an adequate time frame to capture these outcomes. Our series suggest a time frame closer to two years.