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Robot-assisted management of congenital renal abnormalities in adult patients.

INTRODUCTION
Congenital anomalies of the genitourinary tract are usually diagnosed and corrected in childhood. Robot-assisted management of congenital urologic abnormalities in adult patients has not been described previously. We present a series of patients with congenital renal abnormalities diagnosed in adulthood and managed using a robotic approach.


METHODS
Four patients at our institution were identified with congenital renal abnormalities diagnosed in adulthood. One had a duplicated collecting system with hydronephrosis of a thinned out upper pole moiety and underwent heminephroureterectomy. A second had right hydronephrosis, complete atrophy of the right renal cortex, and a dilated tortuous ureter with obstructing ureterocele and underwent simple nephrectomy. A third patient had a duplicated system with distal ureteral reflux and an ureterocele and underwent ureteroureterostomy and distal ureterectomy. The fourth had a duplicated collecting system with ureterovaginal fistula of the upper pole moiety. Perioperative variables were collected including operative time, estimated blood loss, length of hospital stay, and change in estimated creatinine clearance.


RESULTS
Mean age was 35 years (range 16-54), mean body mass index was 30.9 kg/m(2) (21.8-42.5), and mean baseline estimated creatinine clearance was 147.7 mL/minutes (107.7-214.6). Mean operative time was 258 minutes (151-374) and mean estimated blood loss was 44 mL (25-50). Postoperative estimated creatinine clearance was 133.1 mL/minutes (115.9-160.9), which was not statistically different from preoperative values (p = 0.608). All patients were discharged by postoperative day 2. There were no perioperative complications.


CONCLUSIONS
Robot-assisted management of congenital renal abnormalities is a feasible and efficacious treatment modality in adult patients with low morbidity and good outcomes.