Ureteric stricture rates and management after robot-assisted radical cystectomy: a single-centre observational study

Benign ureterointestinal anastomosis (BUIA) stricture is a recognized complication after open radical cystectomy. The evidence for stricture rates following robot-assisted radical cystectomy (RARC) is limited. This article reports stricture rates from a single high-volume RARC centre.

Between December 2003 and December 2015, 371 patients underwent RARC with a totally intracorporeal urinary diversion. All patients received a ureteric anastomosis utilizing the 'Wallace plate' with a running suture technique. Monofilament suture was used in the first 81 patients (22%) and a barbed suture (Quill™) in the remaining 290 patients (78%).

Median follow-up was 33 months and minimum follow-up was 7.9 months. The median time to stricture formation was 165 days (range 10-495 days). Twenty-four patients (6.5%) developed BUIA strictures. Six of 81 patients (7.4%) in the monofilament group and 18 of 290 (6.2%) in the barbed suture group developed strictures (p = .22). Fifteen patients (63%) had a stricture on the left side, seven (29%) on the right side and two patients (8%) developed bilateral ureteric strictures (p = .002). Strictures occurred in 11 of 131 patients (8.3%) with an orthotopic neobladder and 13 of 240 (5.4%) with an ileal-conduit urinary diversion (p = .17).

The overall incidence of ureteric strictures is low in patients undergoing RARC with totally intracorporeal urinary diversion. Strictures were more common on the left side, which has been described in open series and is probably related to the increased mobilization on the left side required to cross the ureter to the right side.