Robotic Appendiceal Ureteroplasty for Complex Right-sided Ureteral Strictures: Technical Approaches and Midterm Outcomes

Background Reconstruction of complex ureteral strictures remains challenging. The appendix provides an autologous alternative for ureteral reconstruction, distinguished from oral mucosal grafts by its intrinsic vascularity. Objective To describe robotic appendiceal ureteroplasty (RAU) techniques and evaluate their midterm outcomes. Design, setting, and participants From May 2019 to September 2024, 31 patients with right-sided complex ureteral strictures underwent RAU at a single institution. All procedures were performed using a robotic single-docking approach. Perioperative and follow-up data were prospectively collected. Intervention Robotic appendiceal ureteroplasty (RAU) using four different surgical techniques (single-docking approach), depending on stricture location and length. Outcome measurements and statistical analysis Outcomes included operative time, estimated blood loss, length of hospital stay, perioperative complications, and overall success rate (symptom relief and radiographic patency). Descriptive statistics were used; success rate is reported with 95% confidence interval. Results and limitations Ureteral strictures were located between the ureteropelvic junction and mid-ureter in 29 patients (93.5%). Mean (range) stricture length was 5.5 (3–25) cm. Mean operative time was 176.4 (99–265) min, estimated blood loss was 42.7 (10–200) ml, and postoperative hospitalization was 4.5 (3–12) days. No open conversions or major perioperative complications occurred. Median (range) follow-up was 28 (12–67) months. The overall success rate was 100% (30/30; 95% CI 88.4%–100%). Limitations include the single-center design, lack of a control group, and limited sample size. Conclusions RAU is a safe and effective approach for managing complex right-sided ureteral strictures; however, careful patient selection is essential, taking into account both the characteristics of the stricture and the condition of the appendix.