Comment on: Dirie NI, Ahmed MA, Wang S. Is secondary robotic pyeloplasty safe and effective as primary robotic pyeloplas
- PDF / 348,986 Bytes
- 1 Pages / 595.276 x 790.866 pts Page_size
- 29 Downloads / 118 Views
LETTER TO THE EDITOR
Comment on: Dirie NI, Ahmed MA, Wang S. Is secondary robotic pyeloplasty safe and effective as primary robotic pyeloplasty? A systematic review and meta‑analysis. J Robotic Surg 2020;14:241–8 Victor Srougi1,2 · Pedro F. S. Freitas1 · Ricardo J. Duarte1 Received: 9 April 2020 / Accepted: 15 April 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Dear Editor, We read with interest the recent meta-analysis by Dire et al. [1], evaluating the outcomes of robotic pyeloplasty in primary and secondary UPJO. Robotic surgery offers obvious advantages for challenging reconstructive surgeries, such as redo pyeloplasties. Open surgery was once preferred in this scenario. However, the benefit of minimally invasive surgery on convalescence made the robotic approach embraced by urologists and patients. Of note, the authors reported a significant mean difference in the duration of the procedure (30 min) and estimated blood loss (30 ml) between groups. These findings represent minimal harm to the patient in detriment of a successful procedure. The obstruction resolution for primary and secondary pyeloplasty was 98% and 94%, respectively. The alternative to a redo pyeloplasty would be endopyelotomy, which has a success rate below 80% [2]. The authors must be commended for their diligent review. Problems to be told, the outcomes of pyeloplasty reported by the existing series are hard to compare. It has been decades since the first pyeloplasty was performed and there is still a lack of a uniform follow-up. The definition of success varies among studies, which utilizes different criteria extracted from image exams and renal scintigraphy. For instance, Pouliot et al. [3] found that the success rate could range from 61 to 93% in the same cohort, depending on which parameter of the renal scintigraphy was considered. Hydronephrosis is also hard to interpret since residual dilation might be confounded with obstruction. In this way, a comparison of outcomes
between studies could be impaired, as pointed by Dire et al. [1]. Robot-assisted pyeloplasty is here to stay. Now, efforts should be made to develop a standard recommendation on how to follow the patients.
Author contributions All authors contributed to the conception and writing of this manuscript. All authors read and approved the final version.
Compliance with ethical standards Conflict of interest The authors declare that they do not have any conflict of interest.
References 1. Dirie NI, Ahmed MA, Wang S (2020) Is secondary robotic pyeloplasty safe and effective as primary robotic pyeloplasty? A systematic review and meta-analysis. J Robotic Surg 14:241–248 2. Vannahme M, Mathur S, Davenport K, Timoney AG, Keeley FX Jr (2014) The management of secondary pelvi-ureteric junction obstruction—a comparison of pyeloplasty and endopyelotomy. BJU Int 113:108–112 3. Pouliot F, Lebel MH, Audet JF, Durjardin T (2010) Determination of success by objective scintigraphic criteria after laparoscopic pyeloplasty. J Endourol 24:299–304 Publisher’s Note Sprin
Data Loading...
