Robotic Ureteral Reconstruction Using Buccal Mucosa Grafts: A Multi-institutional Experience

Area of Science:

• Urology
• Minimally Invasive Surgery
• Reconstructive Surgery

Background:

• Treating long, multifocal ureteral strictures or failed pyeloplasty presents significant challenges.
• Robot-assisted buccal mucosa graft ureteroplasty (RBU) provides a minimally invasive alternative, avoiding the morbidity associated with bowel interposition or autotransplantation.

Purpose of the Study:

• To evaluate the outcomes of RBU in patients with revision ureteropelvic junction obstruction and long or multifocal ureteral strictures.
• To assess the feasibility and efficacy of RBU across multiple tertiary referral centers.

Main Methods:

• A retrospective analysis of 19 patients who underwent RBU between October 2013 and July 2016 at three high-volume centers.
• RBU was performed using either an onlay graft or an augmented anastomotic repair, with omental reinforcement in most cases.
• Data collected included preoperative, intraoperative, and postoperative variables, with a descriptive statistical analysis.

Main Results:

• The onlay technique was used in 79% of cases; the augmented anastomotic technique in the remainder.
• Median stricture length was 4.0 cm, with proximal strictures in 74% of patients.
• The overall success rate was 90% at a median follow-up of 26 months, with no intraoperative complications.

Conclusions:

• Robot-assisted buccal mucosa graft ureteroplasty (RBU) is a feasible and effective surgical option.
• RBU demonstrates high success rates for complex proximal and mid ureteral strictures.
• This technique offers a valuable reconstructive approach for challenging ureteral conditions.