Robotic ureteroplasty with appendiceal onlay flap: an update on the outcomes of 18-month follow-up

Abstract

Background: To describe our technical experience of robotic appendiceal onlay flap ureteroplasty (RAUP) for complex ureteral stricture disease and report the updated analysis of 18-month follow-up outcomes.Methods: Since May 2019, nine patients with right ureteral strictures have undergone RAUP in our medical centre. Patients' perioperative data and follow-up information were collected prospectively. Patients were excluded in present study if the postoperative follow-up time was less than 6 months.Results: Eight patients were recruited. Proximal ureteric strictures were present in 5 patients, and 3 patients had middle ureteric strictures. The mean stricture length was 4.3 cm (range, 3.0-6.0 cm). Nephrostomy was performed in 4 patients, and 4 patients had indwelling double-J ureteral stents before they were admitted to our hospital. All operations were implemented successfully without intraoperative complications. The mean operation time was 162 minutes (range, 135-211 minutes), and the mean estimated blood loss was 78 mL (range, 30-200 mL). The mean postoperative hospital stay was 8 days (range, 4-12 days).No patients had high-grade postoperative complications (Clavien-Dindo III and IV) 30 days after surgery.At a mean follow-up of 18 months (range, 6-28 months), all patients were not needed further surgical intervention and could be considered successful. But 2 cases still have stable mild hydronephrosis without symptoms such as flank pain or fever.Conclusions: RAUP is a workable option for managing long-segment (3-6 cm) proximal and middle ureteral strictures of the right side. The outcomes of 18-month follow-up are satisfactory.