Comparison of the Efficacy of Robot-Assisted and Laparoscopic Anderson-Hynes Pyeloplasty in Pediatric Patients with Ureteropelvic Junction Obstruction

Background Comparative evidence on robot-assisted laparoscopic pyeloplasty (RALP) versus laparoscopic pyeloplasty (LP) in pediatric ureteropelvic junction obstruction (UPJO), particularly regarding postoperative anatomical changes, differential renal function (DRF), and urinary tract dilation (UTD) stratification, remains limited.Methods We retrospectively reviewed 63 children with UPJO who underwent Anderson-Hynes pyeloplasty at a tertiary center between 2018 and 2022, including 21 RALP and 42 LP cases. Patients were classified as UTD P1–P3. Perioperative outcomes, recovery, imaging findings, DRF, complications, and follow-up results were compared.Results Median follow-up was 16 months. Both groups showed significant improvements in anteroposterior pelvic diameter (APD), renal pelvic dilation, and renal cortical thickness (all p < 0.05). Compared with LP, RALP was associated with less blood loss (p = 0.002), smaller postoperative APD (p = 0.005), and higher postoperative DRF (p = 0.002), but longer operative time (p = 0.048). Complication rates were comparable.Conclusion Both RALP and LP provided favorable short- to mid-term outcomes in children with UPJO. RALP may offer advantages in blood loss and postoperative anatomical and functional recovery, although its longer operative time and the retrospective design warrant cautious interpretation. Larger prospective multicenter studies are needed.