Robotic upper urinary tract reconstruction for ureteral stricture: a single-center series

The surgical approach of ureteral stricture has changed dramatically over the past 15 years with the rise of robotic upper urinary tract reconstruction. This study aimed to evaluate the outcomes of all robotic ureteral reconstructions performed at a single academic center for ureteral stricture and to assess the predictive factors of stricture recurrence. The charts of all patients who underwent robot-assisted ureteral reconstruction between 2013 and 2024 at a single academic center were retrospectively reviewed. Many different surgical techniques were used including non-refluxing reimplantation with or without psoas hitch, refluxing ureteral reimplantation (side-to-side), Boari flap, uretero-ureterostomy, ureterolysis and buccal mucosa graft (BMG) ureteroplasty. The primary outcome was the absence of stricture recurrence, defined as no need for repeat surgery, urinary drainage, or symptomatic upper urinary tract dilation at the last follow-up. Sixty patients, accounting for 63 ureteral reconstructions, were included in the final analysis. Twenty-five patients experienced early postoperative complications (40%), the majority being Clavien-Dindo grade 2. There were only three (5%) major complications (Clavien-Dindo grade 3b). Stricture recurrence occurred in six patients (10%), with a median time to recurrence of 2.5 months postoperatively. Radiotherapy was the only factor significantly associated with an increased risk of stricture recurrence. The present series confirm the overall low morbidity and low recurrence rate of robotic ureteral reconstruction using a variety of surgical techniques. Comparative studies with longer follow-up periods are necessary to evaluate outcomes in comparison to traditional surgical approaches.