Single-port robotic non-transecting Y-V flap pyeloplasty with stricturoplasty for ureteropelvic junction obstruction: a case series

PURPOSE: To report perioperative and short-term outcomes of single-port (SP) robotic vascular-preserving (non-transecting) Y-V flap pyeloplasty with stricturoplasty for ureteropelvic junction obstruction (UPJO). The most commonly performed pyeloplasty technique is the dismembered Anderson-Hynes technique; however, transection of the ureter compromises its blood supply and makes revision surgery more complex. Non-transecting pyeloplasty preserves the longitudinal ureteral blood supply and serves as an alternative to transecting techniques. METHODS: All patients who underwent SP robotic-assisted non-transecting Y-V flap pyeloplasty with stricturoplasty for primary UPJO between December 2020 and December 2024 were retrospectively reviewed. Surgical success was defined as the absence of secondary intervention (endoscopic or surgical), resolution or improvement of symptoms, and stable or improved postoperative imaging findings. RESULTS: A total of 21 cases met the inclusion criteria. Median operative time was 109 min. Median follow-up was 73 weeks. Overall surgical success was achieved in 95% of patients. There were no intraoperative complications, and the median estimated blood loss was 15 mL. Most patients were discharged the same day (18/21, 86%), with no Clavien-Dindo grade ≥ III complications. Postoperative renal scintigraphy was obtained in 8 patients, all of whom demonstrated improved drainage (T½ <20 min). The remaining patients were followed with clinical assessment and postoperative imaging. One patient developed recurrent obstruction after stent removal and was successfully managed with secondary endopyelotomy. CONCLUSIONS: SP robotic non-transecting Y-V flap pyeloplasty with stricturoplasty appears feasible and safe in selected patients with primary UPJO, with favorable short-term outcomes in this single-surgeon retrospective series. Further study with standardized functional follow-up is needed to define durability and appropriate patient selection.