Robotic-assisted laparoscopic pyeloplasty and nephropexy for ureteropelvic junction obstruction and nephroptosis

A 22-year-old female was referred with right flank pain and recurrent urinary infections. Flank pain was persistent while standing and relieved upon supine position. Intravenous urography demonstrated change of position with descent approximately 6-7 cm as the patient moved from the supine to the erect position. Diuretic renography corroborated the finding of right ureteropelvic junction obstruction (UPJO). A robotic-assisted laparoscopic dismembered pyeloplasty with simultaneous nephropexy was performed. The proximal ureter appeared to course posterior to the renal vein and then anterior to the lower pole renal artery. There was a significant "nutcracker effect" to the proximal ureter, which was causing the patient's UPJO, and the concomitant nephroptosis contributed to increase the degree of obstruction. The robotic-assisted laparoscopic pyeloplasty and nephropexy offer advantages for patients and surgeons and can be used in challenging cases with an efficacy similar to that of open repair. The robotic-assisted laparoscopic pyeloplasty is the evolving standard for UPJO, especially in the presence of crossing vessels.