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Intermediate-term outcomes after robotic ureteral reconstruction for long-segment (≥4 centimeters) strictures in the proximal ureter: A multi-institutional experience

Investigative and Clinical Urology 2021년 62권 1호 p.65 ~ 71
Lee Matthew, Lee Ziho, Koster Helaine, Jun Minsuk, Asghar Aeen M., Lee Randall A., Strauss David, Patel Neel, Kim Daniel, Komaravolu Sreeya, Drain Alice, Metro Michael J., Zhao Lee C., Stifelman Michael, Eun Daniel D.,
소속 상세정보
 ( Lee Matthew ) - Temple University Lewis Katz School of Medicine Department of Urology
 ( Lee Ziho ) - Temple University Lewis Katz School of Medicine Department of Urology
 ( Koster Helaine ) - Hackensack University Medical Center Department of Urology
 ( Jun Minsuk ) - New York University Langone Medical Center New York University Grossman School of Medicine Department of Urology
 ( Asghar Aeen M. ) - Temple University Lewis Katz School of Medicine Department of Urology
 ( Lee Randall A. ) - Temple University Lewis Katz School of Medicine Department of Urology
 ( Strauss David ) - Temple University Lewis Katz School of Medicine Department of Urology
 ( Patel Neel ) - Hackensack University Medical Center Department of Urology
 ( Kim Daniel ) - Hackensack University Medical Center Department of Urology
 ( Komaravolu Sreeya ) - Hackensack University Medical Center Department of Urology
 ( Drain Alice ) - New York University Langone Medical Center New York University Grossman School of Medicine Department of Urology
 ( Metro Michael J. ) - Temple University Lewis Katz School of Medicine Department of Urology
 ( Zhao Lee C. ) - New York University Langone Medical Center New York University Grossman School of Medicine Department of Urology
 ( Stifelman Michael ) - Temple University Lewis Katz School of Medicine Department of Urology
 ( Eun Daniel D. ) - Temple University Lewis Katz School of Medicine Department of Urology

Abstract


Purpose: To report our intermediate-term, multi-institutional experience after robotic ureteral reconstruction for the management of long-segment proximal ureteral strictures.

Materials and Methods: We retrospectively reviewed our Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database to identify all patients who underwent robotic ureteral reconstruction for long-segment (≥4 centimeters) proximal ureteral strictures between August 2012 and June 2019. The primary surgeon determined the specific technique to reconstruct the ureter at time of surgery based on the patient's clinical history and intraoperative findings. Our primary outcome was surgical success, which we defined as the absence of ureteral obstruction on radiographic imaging and absence of obstructive flank pain.

Results: Of 20 total patients, 4 (20.0%) underwent robotic ureteroureterostomy (RUU) with downward nephropexy (DN), 2 (10.0%) underwent robotic ureterocalycostomy (RUC) with DN, and 14 (70.0%) underwent robotic ureteroplasty with buccal mucosa graft (RU-BMG). Median stricture length was 4 centimeters (interquartile range [IQR], 4?4; maximum, 5), 6 centimeters (IQR, 5?7; maximum, 8), and 5 centimeters (IQR, 4?5; maximum, 8) for patients undergoing RUU with DN, RUC with DN, and RU-BMG, respectively. At a median follow-up of 24 (IQR, 14?51) months, 17/20 (85.0%) cases were surgically successful. Two of four patients (50.0%) who underwent RUU with DN developed stricture recurrences within 3 months.

Conclusions: Long-segment proximal ureteral strictures may be safely and effectively managed with RUC with DN and RU-BMG. Although RUU with DN can be utilized, this technique may be associated with a higher failure rate.

키워드

Reconstructive surgical procedures; Robotic surgical procedures; Ureter

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