Robotic-assisted Lingual Mucosal Graft Ureteroplasty for the Repair of Complex Ureteral Strictures: Technique Description and the Medium-term Outcome

• Published in: European urology 2022-05, Vol.81 (5), p.533-540
• Main Authors: Yang, Kunlin, Fan, Shubo, Wang, Jie, Yin, Lu, Li, Zhihua, Xiong, Shengwei, Han, Guanpeng, Meng, Chang, Zhang, Peng, Li, Xuesong, Zhou, Liqun
• Format: Article
• Language: English
• Subjects: Constriction, Pathologic - surgery; Female; Humans; Lingual mucosa; Male; Mouth Mucosa - transplantation; Reconstructive surgery; Retrospective Studies; Robotic Surgical Procedures - adverse effects; Robotic ureteroplasty; Treatment Outcome; Ureter - surgery; Ureteral Obstruction - etiology; Ureteral Obstruction - surgery; Ureteral stricture
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2022.01.007

Robotic ureteroplasty with lingual mucosa graft ureteroplasty provides one more option for the management of long complex ureteral strictures. Ventral onlay anastomosis or posteriorly ureteral augmented anastomotic technique is commonly used. Robot-assisted autologous graft ureteroplasty provides another treatment option for complex ureteral strictures, circumventing ileal ureter or renal autotransplantation. To report the medium-term outcome of robotic ureteroplasty with a lingual mucosal graft (RU-LMG) for managing complex ureteral strictures. Between June 2019 and September 2020, 12 patients underwent RU-LMG. The perioperative variables were prospectively collected, and the outcomes were assessed. After ureteral stricture dissection, the narrow segment was cut longitudinally, and a lingual mucosal graft (LMG) of the required length was harvested, followed by double-J stent placement and LMG ventral onlay anastomosis. If the diseased ureter required transection, posteriorly augmented ureteral anastomosis could be performed before LMG harvest. Finally, the anastomotic area was wrapped by the omental flap. A descriptive statistical analysis was performed. The criteria for complete success included the absence of both clinical symptoms and obstruction on radiography. Seven patients (58%) had a history of failed ureteral reconstruction. The mean (range) stricture length was 4.7 (3–6.5) cm, LMG length was 4.4 (3–7) cm, LMG width was 1.5 (1–2) cm, operative duration was 197.1 (130–346) min, estimated blood loss was 49.2 (10–200) ml, and the duration of postoperative hospitalization was 6 (4–14) d. No open conversions and intraoperative complications occurred. The median follow-up time was 15 mo (range: 13–27 mo). The overall success rate was 92% (11/12). These medium-term follow-up results demonstrate that RU-LMG is a safe and feasible technique for repairing ureteral strictures. Our study proves that robotic ureteroplasty with a lingual mucosal graft is a safe and feasible technique for ureteral reconstruction that can serve as another choice for managing long, complex ureteral strictures.