Robotic ureteroplasty with lingual mucosa graft: a multi-institutional experience

Abstract

BACKGROUND: The management of long proximal ureteral strictures poses a significant challenge, with traditional options such as renal autotransplantation or bowel interposition associated with substantial morbidity. This study explores the use of robotic ureteroplasty with lingual mucosal graft (RU-LMG) as a minimally invasive approach for treating complex ureteral strictures. We present a multi-institutional cohort to evaluate its effectiveness in managing proximal and mid-ureteral strictures. METHODS: This multi-center, retrospective study analyzed perioperative data from 76 patients who underwent RU-LMG at three institutions between January 2021 and December 2023. Patients were selected based on the presence of proximal or mid-ureteral strictures not amenable to primary ureteroureterostomy due to periureteral fibrosis or excessive stricture length. Success was defined as the absence of hydronephrosis, flank pain, or imaging-confirmed obstruction. RESULTS: Of the 76 patients, 48 (63.2%) underwent onlay ureteroplasty, while 28 (36.8%) received augmented anastomotic RU-LMG. Omental wrapping or coverage of the reconstructed ureter was performed in 73 patients (96.1%). The average length of the stricture and graft were 4.0 cm (range: 2.0-11.5 cm) and 4.1 cm (range: 2.0-12.0 cm), respectively. The mean operative time was 205.5 minutes (range: 95-380 minutes), with a mean blood loss of 70.9 mL (range: 10-400 mL). There were no open conversions or intraoperative complications. The follow-up period ranged from 13 to 48 months (mean: 27 months), with a 100% success rate (76/76 patients). CONCLUSIONS: RU-LMG is a safe, effective, and feasible technique for managing complex proximal or mid-ureteral strictures, with excellent medium-term outcomes and minimal morbidity.