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Robot-Assisted Vesical Mucosal Graft Ureteroplasty for Long Ureteral Strictures: Mid-term Patency and Donor-Site
Jiahuan Yu1, Yin Chen2, Haoqing Shi2
1Department of Health Management Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China.
Purpose:
To evaluate midterm patency, recovery, and donor-site outcomes after robot-assisted vesical mucosal graft (VMG) ureteroplasty for long ureteral strictures.
Materials And Methods:
This retrospective cohort included 46 VMG procedures and 21 clinically allocated buccal mucosal graft (BMG) reference procedures. The primary outcome was intervention-free patency at last follow-up. Secondary outcomes included workflow, recovery, donor-site morbidity, 30-day complications, hydronephrosis, and renal function. Continuous outcomes were assessed using adjusted models.
Results:
Mean follow-up was 41.4 months after VMG and 42.7 months after BMG; intervention-free patency was 93.5% and 90.5%, respectively. All five recurrent obstructions were detected at 3-6 months and required endoscopic reintervention. Hydronephrosis regressed and differential renal function remained stable. Adjusted differences favored VMG for graft preparation, operative time, hospital stay, regular diet, and day 1 harvest-site pain. Differences were -23.1 minutes (95% confidence interval -32.0 to -14.2) for operative time and -1.9 points (-2.4 to -1.4) for pain. Regular diet resumed 2.1 days earlier in the adjusted analysis. Additional donor-site medication was required in 8.7% versus 61.9%; 30-day grade I-II complications occurred in 10.9% versus 61.9%. Four BMG recipients had oral bleeding; paresthesia persisted at 6 months in three. No VMG recipient had urinary leak, impaired bladder healing, or persistent bladder-related functional complaints. No grade ≥III complication occurred within 30 days.
Conclusions:
Robot-assisted VMG ureteroplasty achieved durable midterm drainage and enabled recipient-defect-driven graft sizing within a single operative field. Its broad native urothelial donor surface avoided oral harvest, reduced donor-site burden, and accelerated recovery.
