Robotic-assisted ureteroenteric reimplantation for ureteroenteric stricture after radical cystectomy: a systematic review and dual meta-analysis

Abstract

BACKGROUND AND OBJECTIVE: Benign ureteroenteric stricture (UES) is a well-documented long-term complication that can occur after radical cystectomy with urinary diversion (UD). This meta-analysis evaluates the safety and feasibility of Robotic-assisted Ureteroenteric Reimplantation (RUER), with a focus on distinguishing outcomes between Open Ureteroenteric Reimplantation (OUER) and RUER. METHODS: We performed an extensive search across multiple databases, including PubMed, Scopus, and Web of Science, to identify studies that assessed outcomes for RUER alone or in comparison to OUER. Relevant data were systematically extracted and recorded in an Excel sheet. Data analysis was performed using OpenMeta [Analyst] and Review Manager Software. RESULTS: This review included 277 UES patients (244 RUER, 33 OUER) with 289 and 35 reimplantations, respectively. RUER had 91.7% success rate and a 7.1% stricture recurrence rate. Intraoperative complications, Clavien-Dindo ≥3 complications, conversion to open approach, and hospital readmission rates were 2.3%, 9.5%, 2.5%, and 7.8%, respectively. Compared to OUER, RUER showed similar success (RR =1.01, p=0.83) and stricture recurrence rates (RR = 0.89, p=0.72) but significantly lower intraoperative (RR =0.13, p=0.01), postoperative (RR = 0.53, p = 0.004), and Clavien-Dindo ≥3 complications (RR =0.27, p =0.01). RUER significantly reduced hospital stay (MD = -3.18 days, p = 0.0002) but showed no significant reduction in operative time (MD= -24.98 min, p=0.29). CONCLUSIONS: RUER offers comparable success to OUER with significantly lower complication rates and shorter hospital stays, making it a safe and feasible minimally invasive alternative for strictures ranging from 1 to 3 cm.