Robot-assisted Buccal Mucosa Graft Ureteroplasty for Ureteral Stricture: A European Multicenter Case Series

Background and objective: Robot-assisted buccal mucosa graft (BMG) ureteroplasty was introduced a decade ago and has since gained wide adoption within the urology community. However, available data on the outcomes of robot-assisted BMG ureteroplasty remain limited, and no large European series has been published to date. This study aims to report the outcomes of a multicenter European experience with robot-assisted BMG ureteroplasty (RBMGU) for the management of ureteral strictures. Methods: Medical records of all the patients who underwent RBMGU for ureteral strictures at four European centers between 2018 and 2024 were reviewed retrospectively. The primary outcome was the absence of stricture recurrence at the last follow-up, defined as the lack of need for urinary drainage or repeat surgery, or the presence of symptomatic hydronephrosis. Key findings and limitations: A total of 39 patients were included. The median stricture length was 3 cm, with 36% involving the pelvic ureter. A period of ureteral rest was implemented in 85% of patients. Early postoperative complications occurred in eight patients (21%), with only one major event (3%). After a median follow-up of 12 mo, the overall success rate was 87%. No predictive factors for recurrence were identified. Conclusions and clinical implications: RBMGU for ureteral stricture appears to be a feasible and reproducible technique across multiple surgeons and institutions. The outcomes demonstrate a promising trend, with preliminary results indicating low morbidity and recurrence rates. Further studies with larger cohorts are warranted to identify the risk factors for recurrence and to better define the optimal indications for this procedure. Patient summary: In this report, we present the outcomes of robotic ureteral stricture reconstruction using buccal mucosa grafts across four European centers. The results are encouraging, demonstrating low rates of stricture recurrence and postoperative complications. We emphasize the key advantages of robotic-assisted reconstruction and the broad spectrum of ureteral strictures that may benefit from this approach.