Introduction: Robotic-assisted laparoscopic pyeloplasty has been demonstrated to be safe and effective in infants. Here we demonstrate the steps to a left robotic pyeloplasty of a ureteropelvic junction obstruction in the lower pole moiety in a 2 month old with a duplicated left collecting system using a CPU stent.
Methods: Prenatal detection of left hydronephrosis and postnatal imaging confirmed grade 4 left hydronephrosis. Renal scan demonstrated significant obstruction of the left kidney, preserved renal function on the left (45%), and a possible duplex system on the left. Voiding cystourethrogram showed no ureteral reflux. The patient had not had any UTIs and was on antibiotic prophylaxis. After discussion with the patient’s parents, they elected to undergo a robotic left pyeloplasty to protect the patient’s renal function.
Results: The patient was found to have a duplicated system on the left with a high grade stenosis of the lower pole ureteropelvic junction and a dilated lower pole renal pelvis. The procedure was able to be completed in the standard fashion after the two ureters were dissected apart. The patient recovered well and was discharged on post op day 1. CPU stent was removed on post op day 12. He did suffer a superficial infection of the umbilical surgical site that resolved with antibiotics. At 6 weeks post-op, the patient was doing well and renal ultrasound showed a decompressed, but still hydronephrotic, left kidney.
Conclusions: This video demonstrates that a robotic-assisted laparoscopic pyeloplasty with the use of a CPU stent can safely and effectively be performed in infants, even with duplicated systems. The CPU stent allows for stent removal in the office, avoiding a second round of anesthesia for the patient.