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

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.