Purpose: To summarize our experience in the management of congenital anomalies in the kidney and urinary tract (CAKUT) in adults. Materials and methods: We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021. Results: The study included 102 patients with a median age of 25 (interquartile range, 23–36.5). Of these, 85 (83.3%) patients reported normal prenatal ultrasound, and the remaining 17 (16.7%) patients were diagnosed with antenatal hydronephrosis. These patients were followed-up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care. All studied adult patients presented with the following pathologies: 67 ureteropelvic junction obstructions, 14 ectopic ureters, 9 ureteroceles, and 6 primary obstructive megaureters, and the remaining 6 patients were diagnosed with vesicoureteral reflux. Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles. Notably, 67% of patients underwent pyeloplasty, 9% underwent endoscopic puncture of ureterocele, 3% underwent ureteral reimplantation, 6% underwent endoscopic correction of reflux, 7% underwent partial nephrectomy of non-functioning moiety, and the remaining 9% underwent robotic-assisted laparoscopic ureteroureterostomy. The median follow-up period after surgery was 33 months (interquartile range, 12–54). Post-operative complications occurred in 5 patients (Clavien-Dindo 1–2). Conclusions: Patients with CAKUT present clinical symptoms later in life. Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility, and children should be appropriately counseled when they enter adolescence. Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.

To evaluate whether renal pelvis reduction improves outcomes in pediatric pyeloplasty, comparing open and robotic-assisted laparoscopic pyeloplasty (RALP). We conducted a multicenter retrospective cohort study at three tertiary centers (2006-2024). Records of children undergoing open pyeloplasty or RALP for UPJO were reviewed. Cases were classified as reduction (RP) or non-reduction pyeloplasty (NRP). Demographics, peri-operative data, and follow-up imaging were extracted. Surgical success was the primary endpoint. Secondary endpoints were operative time, SFU grade, APD, SRF, and 12-month complications (Clavien-Dindo). Predictors of failure were examined with multivariate logistic regression. Of 450 renal units, 34 % underwent open surgery and 66 % RALP. PR was performed in 98.6 % of open cases but only 9.9 % of RALP cases (167 RP, 283 NRP). Redo pyeloplasty was uncommon and similar (6.6 % RP vs 5.5 % NRP, p=0.68). RP appeared faster overall (78 min vs 120 min, p<0.001) likely due to the reduction coinciding with inherently quicker open procedures. Post-operative SFU grade (median 2), APD (14.8 mm RP vs 14.0 mm NRP, p=0.40), SRF (47 % vs 46 %, p=0.68) and complication rates (24.0 % vs 22.9 %, p=0.82) were equivalent. PR was not a predictor of failure, whereas open surgery independently predicted redo (OR 13.4, 95 % CI 1.03-173.0, p=0.047). Routine renal-pelvis reduction provides no functional or radiologic benefit in either open or robotic pediatric pyeloplasty. Except in rare scenarios such as giant hydronephrosis, omission may avoid unnecessary suturing and, in RALP, shorten operative time.