Robot-Assisted Laparoscopic Distal Ureteroureterostomy for Distal Benign Ureteral Strictures with Long-Term Follow-Up

Objectives: To demonstrate feasibility of robot-assisted laparoscopic (RAL) ureteroureterostomy (UU) for benign distal ureteral strictures (DUS) in our robotic reconstruction series with long-term follow-up. Patients and Methods: In a retrospective review of our prospectively maintained RAL ureteral reconstruction database, we followed patients between June 2012 and February 2019 who underwent a UU for DUS. In addition to patient demographics, we recorded the etiology, stricture length, and recurrence rates. Recurrence was defined as findings of recurrent or persistent obstruction by postoperative mercaptoacetyltriglycine diuretic renal scan or the need for additional intervention with ureteral drainage or revisional surgery. Results: We identified 22 patients who underwent a RAL-UU for DUS of benign etiologies. Median age was 42 years (interquartile range [IQR] 39-57) and 20 of 22 patients (90.1%) were women. Median stricture length was 1.5 cm (IQR 1-2). Iatrogenic surgical injury was noted in 16 patients (73%). All ureteral reconstruction was performed using RAL. Postoperative imaging consisted of renal ultrasonography, diuretic renal scan, or cross-sectional radiology within 3 months of the index operation. Further imaging was dependent on clinical judgment. Twenty patients (90.1%) had success with median follow-up time of 54.6 months with two recurrences necessitating RAL ureteroneocystostomy (UNC). Conclusion: RAL-UU for DUS is technically viable and shows promising efficacy in properly selected patients. This technique may serve a niche for preserving the natural anatomical drainage of the bladder and ureter in addition to obviating the sequela of vesicoureteral reflux as seen in UNC.