Robot-Assisted Lingual Mucosa Graft Onlay Reconstruction for Ureteric Strictures Refractory to Endoscopic Treatment

This study describes the detailed technique and initial experience with robot-assisted lingual mucosal graft onlay ureteric reconstruction (RLUR) in patients with ureteric strictures refractory to endoscopic treatment. Preoperative evaluation included contrast-enhanced CT with excretory phase, ureteroscopy, and ureterography. History taking, clinical examination, renal function measurement, and urinary tract echographic evaluation were used for postoperative follow-up. Recurrence of stricture was defined as the presence of ureteric narrowing, as proven by imaging with outflow obstruction above the site of reconstruction. Since 2017, fifteen patients underwent RLUR, with a median age of 53 years and a median stricture length of 3.0 cm. Strictures were located in the upper third (n = 7), mid third (n = 7), and lower third (n = 1) of the ureter, with a median of 3 prior interventions. Seven patients underwent graft-augmented anastomosis, while 8 received "classic" graft onlay. Median operative time was 215 min, with no intraoperative complications and 2 postoperative grade 3a complications (13%). At a median follow-up of 21 months, surgical success was achieved in 13 patients (87%), and the estimated two-year recurrence-free survival rate was 83%. These findings support RLUR as a safe and effective option for refractory ureteric strictures.