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Abstract Background: Complex ureteral stricture disease is a challenging surgical problem. Traditional approaches, such as ileal ureter interposition or renal auto-transplantation, have significant associated morbidity. Robotic Buccal Mucosal Graft Ureteroplasty (RBMGU) is an alternative technique for managing complex ureteral stricture disease. This study aims to establish the safety and efficacy of RBMGU in managing Complex Ureteral Stricture Disease (CUSD). Materials & Methods: A retrospective analysis of ten patients with benign CUSD who underwent RBMGU between 2019 and 2023 was conducted. Patient selection criteria included imaging evaluation, patient characteristics, and intraoperative findings. Demographic data, perioperative variables, and follow-up outcomes were analyzed using descriptive statistics. The primary outcome measure was successful stricture repair, defined as resolution of flank pain without the need for secondary intervention. Secondary outcomes included radiographic evidence of upper tract urinary obstruction resolution. Results: All ten patients underwent technically successful RBMGU performed by a single surgeon. Ureterolithiasis was the etiology in nine cases, with one case involving prior retroperitoneal radiation. Prior interventions included ureteroscopy (n=7), ureteral balloon dilation (n=3), and failed robotic pyeloplasty (n=1). Strictures were predominantly in the proximal ureter (n=7). At a median followup of 10 months, 80% of patients reported pain resolution, while the remaining 20% showed improvement. Eight patients exhibited no evidence of obstruction on follow-up MAG3 renal scans. Median stricture length was 3.0 centimeters, with median operating room time of 301 minutes and estimated blood loss of 25 cc. No significant intraoperative complications were observed. Conclusion: These findings indicate that RBMGU is a feasible and effective approach for managing CUSD, suggesting its potential for adoption by community-based robotic urologists.
Hwang et al. (Wed,) studied this question.