Robot-assisted Pyeloureterostomy in the Treatment of the Lower Pole Ureteropelvic Junction Obstruction in an Incomplete Duplicated System.

Purpose To describe the surgical treatment of a patient harboring a ureteropelvic junction obstruction (UPJO) in the lower unit of an incomplete duplicated collecting system. Methods A female patient with 32-years old presented a progressively increasing left lumbar pain for 1 year and urinary tract infections (UTI) for the past 10 years. Computed tomography demonstrated a UPJO in the lower unit of an incomplete duplicated urinary collecting system. Results The patient underwent a robot-assisted pyeloureterostomy. The surgical time was 118 minutes and there was no intraoperative complication. During surgery, anomalous vessels crossing to the lower pole of the kidney were identified. The bladder catheter and abdominal drain were removed at the first and second postoperative days. The length of the hospital stay was 2 days and the post-operative course was uneventful. The double-J stent was retrieved 4 weeks after surgery. At 18 months of follow-up, the patient had complete pain resolution and no new episodes of UTI. The control image exam revealed minimal residual hydronephrosis. Conclusion Robot-assisted pyeloureterostomy was an effective approach to the present case. Many times, the surgical strategy for patients with anatomic variants is determined intra-operatively. The surgeon must have a wide range of skills and be prepared for a timely decision.