Introduction: Robotic-assisted laparoscopic pyeloplasty (RALP) has been demonstrated to have a 90–95% success rate in treating ureteropelvic junction obstruction (UPJO). At present, there is no literature on the outcomes of RALP in a Canadian context. Our objective was to perform a retrospective review of RALP cases at a high-volume Canadian center.

Methods: We performed a retrospective chart review of patients that underwent RALP at St. Michael’s Hospital, between January 2012 and May 2019. Demographics, intraoperative details, and pre- and postoperative imaging results (ultrasounds, computed tomography [CT] scans, and renal Lasix scan [RLS]) were recorded. Patients were excluded if at least one-year followup data was unavailable. Our primary outcome was clinical and radiological improvement defined as: 1) symptom improvement; 2) stable/improved split renal function on RLS; and 3) either improvement in the degree of hydronephrosis on ultrasound or CT, or improved drainage time on RLS. Secondary outcomes included postoperative complications, need for diagnostic intervention (retrograde pyelogram or diagnostic ureteroscopy), and reintervention for recurrent UPJO

Results: A total of 156 patients underwent RALP over the study time frame after exclusions. The median age was 42 years and 66% were female (Table 1). Mean followup was 2.5 years. In terms of our primary outcome, 87% had clinical and radiological improvement. Diagnostic investigation for possible recurrent/persistent obstruction, based on symptoms and/or imaging results, was required in 17% of cases, but only 3% required reintervention for recurrent UPJO. Accordingly, the overall treatment success was 97%. The most common postoperative complication was urinary tract infection (18%), and urine leak was seen in only 2% of patients. 

Conclusions: The results of our retrospective review compare favorably with currently reported outcomes in the literature and demonstrate the safety and high level of success of RALP at a high-volume Canadian center.