Current Status and Future Perspectives of Robotic-Assisted Redo Pyeloplasty for Recurrent Ureteropelvic Junction Obstruction.

Recurrent ureteropelvic junction obstruction presents significant surgical challenges due to fibrosis, altered anatomy, and impaired vascularity. Open redo pyeloplasty has traditionally been the gold standard; however, it is associated with considerable morbidity. Minimally invasive options such as endopyelotomy and laparoscopic pyeloplasty offer faster recovery but have lower success rates and greater technical complexity. In this review, we aimed to provide a comprehensive evaluation of the current literature on robot-assisted surgical management of recurrent ureteropelvic junction obstruction. Robot-assisted laparoscopic pyeloplasty has emerged as a promising alternative, providing enhanced visualization, improved dexterity, and precise suturing, even in reoperative cases. Redo robot-assisted laparoscopic pyeloplasty achieves high success rates (75%-100%) with low complication rates and shorter hospital stays compared with open or conventional laparoscopic approaches. Moreover, advanced robotic techniques-including ureterocalicostomy, buccal mucosa graft ureteroplasty, ileal ureter replacement, and renal autotransplantation-have broadened reconstructive options for complex or recurrent cases. Single-port robotic platforms are also gaining interest for their potential to reduce invasiveness and improve cosmetic outcomes. Despite favorable outcomes, existing evidence is primarily limited to retrospective, single-institution studies. Further prospective, multicenter research is needed to validate long-term efficacy and cost-effectiveness. Surgeon expertise, careful patient selection, and adherence to standardized protocols remain essential for optimizing outcomes. As robotic technology continues to evolve, robotic redo pyeloplasty and it's adjunct procedures are increasingly considered preferred treatment modalities for recurrent or anatomically complex ureteropelvic junction obstruction.