The Department of Urology has a driving interest in studying prostate cancer, bladder cancer, tissue bioengineering, surgical training through simulation, and new methods of less invasive and robotic surgery.
Ureteropelvic junction obstruction (UPJO) is the most common congenital anomaly of the ureter. A dismembered pyeloplasty represents the gold standard treatment, which can be performed using minimally invasive techniques such as keyhole laparoscopic surgery or robotic surgery.
The Urologic Surgeons at the University of California Irvine have adopted the use of robotic surgery for the repair of UPJO. In a study lead by Dr. Etafy, with the supervision of Dr. Michael Louie and Dr. Elspeth McDougall, our results on the use of the robot for the repair of UPJO will be published in the Journal of Urology June 2011 Issue. The table below is a summary of our results and a comparison of the published literature for robotic pyeloplasty.
We wish to highlight in this table that our definition of success was the most stringent published in the recent literature. Our criteria for overall success required both subjective (pain score) and objective (diuretic renal scan) success. We found this decreased our primary success rate, but we believe that the traditionally quoted success rate of 95% or better may be overstated depending on the criteria for “success”. If we defined success as either an improvement in pain or in diuretic renal scan t ½ clearance time, then our success rate would increase to 93%.
The complication rate is 12.3% which is slightly higher than most reported series, however we used the complication classification system by Clavian classification which includes lower morbidity complications. If we considered only significant complication (as outlined in other studies) ,our major complication rate will be 5%.
Further multi-center study with a standard follow up protocol that includes subjective and objective definitions of success should be performed in order to more accurately counsel patients about the surgical options for treatment of ureteropelvic junction obstruction.
Comparison of Literature on the Robotic Pyeloplasty for UPJO
|Authors / Institution||NO. of patients||Mean age (years)
|Mean OT (min)
|Mean EBL (ml)
|Mean LOS (days)||Mean FU (months)
|CR (%)||Primary SR (%)||Definition of success|
|Etafy / UCI||57||35 (19–51)||335 (247–423)||61 (13- 109)||2 (1.1-2.9)||18 (3-33)||12.3||81||Pain score < 2 & t1/2 <10|
Thomas Jefferson University PA
|18||41.2 (17/82)||196 (120–420)||39 (25–150)||2.2 (NS)||11 (6–17)||11.1||100||Subjective improvement in pain & renogram|
University of Miami
|26||34.5 (17–62)||245 (165–390)||69 (25–200)||2.0 (1–5)||6 (2–10)||11.5||95||t1/2<15 & improvement in pain|
University of Iowa
|31||36.3 (19–47)||299 (181–435)||<100 (NS)||2.0 (1–4)||10 (1–21)||6.4||97||No significant obstruction on renogrem|
|7||32 (25–49)||324 (252–420)||60 (50–100)||2.5 (2–6)||10 (5–15)||6.2||100||Pain score < 2& improvement in renogram|
Mount Sinai medical center
|35||39 (15–69)||216 (161–280)||74 (22–130)||3.8 (1–13)||7.9 (2–11)||0||94||Subjective improvement in pain & renogram|
Urology center of Alabama
|50||31 (16–62)||122 (60–330)||40 (25–100)||1.1 (NS)||12 (1–28)||2||96||NS|
|92||35 (14–74)||108 (72–215)||NS||4.5 (3–11)||39 (3–73)||3||97||improvement in pain & U/S|
|Mufarrij / (three centers)||140||38.5 (7–79)||217 (80–510)||59 (10–600)||2.1 (0.75–7)||29 (3–63)||10||95.7||First renogram
t 1/2 <20
Or prompt nephrogram
CR = Complication rate, EBL = Estimated blood loss, FU = Follow up, LOS = length of hospital stay, NO = Number, OT = Operative time, RT = Robotic pyeloplasty, SR = Success rate, UCI = university of California Irvine, UPJ = ureteropelvic junction, UPJO = ureteropelvic junction obstruction
Dr. Ralph Clayman and his colleagues are world renowned for their expertise as surgeons and researchers in the use of minimally invasive surgery for kidney and other urological diseases. Their research has resulted in more than 500 peer-reviewed papers and book chapters. They also are asked to consult with surgeons worldwide on minimally invasive techniques and are recognized as leaders in providing educational courses on these techniques to other urologists nationwide.
If you are interested in advancing UC Irvine Urologic Research, we invite you to use the donatation methods provided.
Patients benefit from these research findings with less-invasive surgeries, less blood loss and reduced recovery times. Their findings, which have been adapted to the operating room and bedside, include: