Feasibility and short-term outcomes of robotic distal ureteroureterostomy for benign obstruction

Distal ureteral obstruction has classically been managed by ureteroneocystostomy (UNC). The feasibility and success of robotic primary ureteroureterostomy (UU) for benign obstruction appears promising with several benefits over UNC but is poorly studied. Robotic repair offers superior visualization and precision, allowing for minimal ureteral dissection. Here we report on our experience and short-term outcomes.

We identified patients who underwent robotic distal ureteroureterostomy for benign distal ureteral obstruction at our institution from 2020-2024. Etiology, stricture length, and post-operative outcomes were recorded. All patients had renal ultrasound (US), diuretic renography, or cross-sectional imaging within 6 months of repair.

Seven patients underwent distal UU from 2020-2024, with one case of bilateral repair for a total of 8 anastomoses. Iatrogenic injury from hysterectomy represented 5/8 injuries. The mean time between injury and repair was 3.5 months. All defects were 1-1.5 cm in length. At follow-up imaging, there was no evidence of obstruction in any patient with a median follow-up of 10 months, including diuretic renography in 5 of 7 patients. One patient had mild hydronephrosis on their initial renal US but with normal drainage on subsequent diuretic renography. All patients reported no flank pain at follow-up.

Robotic UU is feasible for short, benign distal ureteral obstruction in carefully selected patients. Advantages over traditional UNC include a significantly shorter catheter time, no risk of vesicoureteral reflux, no effect on bladder capacity or function, and the ability to retain the native ureteral orifice. Continued research will elucidate the long-term efficacy of this approach.