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Yang K, Pang KH, Fan S, Li X, Osman NI, Chapple CR, Zhou L, Li X. Robotic ureteral reconstruction for benign ureteral strictures: a systematic review of surgical techniques, complications and outcomes : Robotic Ureteral Reconstruction for Ureteral Strictures. BMC Urol 2023; 23:160. [PMID: 37828505 PMCID: PMC10571348 DOI: 10.1186/s12894-023-01313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 08/29/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Robotic ureteral reconstruction (RUR) has been widely used to treat ureteral diseases. To summarize the surgical techniques, complications, and outcomes following RUR, as well as to compare data on RUR with open and laparoscopic ureteral reconstruction. METHODS Our systematic review was registered on the PROSPERO (CRD42022309364) database. The PubMed, Cochrane and Embase databases were searched for publications in English on 06-Feb-2022. Randomised-controlled trials (RCTs) or non-randomised cohort studies with sample size ≥ 10 cases were included. RESULTS A total of 23 studies were included involving 996 patients and 1004 ureters from 13 non-comparative, and 10 retrospective comparative studies. No RCT study of RUR was reported. The success rate was reported ≥ 90% in 15 studies. Four studies reported 85-90% success rate. Meta-analyses for comparative studies showed that RUR had significantly lower estimated blood loss (EBL) (P = 0.006) and shorter length of stay (LOS) (P < 0.001) than the open approach. RUR had shorter operative time than laparoscopic surgery (P < 0.001). CONCLUSIONS RUR is associated with lower EBL and shorter LOS than the open approach, and shorter operative time than the laparoscopic approach for the treatment of benign ureteral strictures. However, further studies and more evidence are needed to determine whether RUR is more superior.
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Affiliation(s)
- Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Karl H Pang
- Division of Urology, Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
- Division of Urology, Queen Mary Hospital, Hong Kong, China
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Nadir I Osman
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christopher R Chapple
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China.
- Institute of Urology, Peking University, Beijing, China.
- National Urological Cancer Center, Beijing, China.
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Bausch K, Sauter R, Subotic S, Halbeisen FS, Seifert HH, Feicke A. Long-term outcome of non-antireflux robotic-assisted laparoscopic ureter reimplantation in ureteral obstruction. J Endourol 2022; 36:1183-1191. [PMID: 35262405 DOI: 10.1089/end.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Although robotic-assisted laparoscopic ureter reimplantation (RALUR) is a recognized alternative to open and laparoscopic ureter reimplantation in treating distal ureteral obstruction, there are limited data on long-term efficacy and safety outcomes of non-antireflux RALUR. We assessed patients undergoing RALUR, evaluating operative, functional and safety determinants. MATERIALS AND METHODS All consecutive patients undergoing non-antireflux RALUR between April 2015 and January 2020 were included in this retrospective cohort study. The primary outcome endpoint was recurrent distal ureteral obstruction. RESULTS Mean follow-up was 41.3 months (CI 95%, 33.3-49.2). Among the 26 included patients, none developed recurrent distal ureteral obstruction. Kidney function in terms of serum creatinine level (72.0 vs. 71.0 µmol/L, p=0.988) and glomerular filtration rate (92.0 vs. 91.0 mL/min, p=0.831) was stable between the preoperative period and the last follow-up. Renal pelvis dilatation decreased significantly postoperatively, from grade 2 to grade 0 (p<0.001). Most patients (73.1%) remained free from any clinical symptoms of reflux during the follow-up. The rate of postoperative complications (Clavien-Dindo grade ≥II) was 23.1%. All complications resolved without sequelae. No recurring urinary tract infections were reported. CONCLUSIONS Non-antireflux RALUR appears to be safe and effective in the management of distal ureteral obstruction. There was no recurrent ureteral obstruction after RALUR in our cohort during a mean follow-up of more than 3 years. Non-antireflux reimplantation did not seem to have any notable impact on renal function during the follow-up period.
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Affiliation(s)
- Kathrin Bausch
- University Hospital Basel, 30262, Department of Urology, Spitalstrasse 21, Basel, BS, Switzerland, 4031.,University Hospital Basel, 30262, Urology , Basel, Switzerland, 4031;
| | - Raphael Sauter
- Cantonal Hospital Basel-Landschaft, 367307, Liestal, Basel-Landschaft, Switzerland;
| | - Svetozar Subotic
- Cantonal Hospital Basel-Landschaft, 367307, Urology, Liestal, Basel-Landschaft, Switzerland;
| | | | - Hans H Seifert
- Universitätsspital Basel, 30262, Urology, Basel, Switzerland;
| | - Antje Feicke
- University Hospital Basel, 30262, Department of Urology, Basel, BS, Switzerland;
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Abstract
PURPOSE OF REVIEW The purpose of this article is to outline the various therapeutic options of ureteral strictures. RECENT FINDINGS Ureteral strictures with consecutive hydronephrosis can be due to endourological and surgical procedures, inflammatory processes, radiation therapy as well as spontaneous passage of ureteral calculi. When planning surgical correction, stricture length, anatomical location as well as patients' characteristics like age, comorbidities and previous treatment in the peritoneal cavity, retroperitoneum or pelvis should be taken into consideration. Treatment options include not only surgical reconstruction techniques like simple stricture excision, end-to-end anastomosis, ureterolysis with omental wrapping, ureteroneoimplantation, renal autotransplantation and ureter-ileum replacement, but also minimally invasive procedures such as self-expandable thermostents and pyelovesical bypass prosthesis. SUMMARY Various therapeutic options can be offered in the treatment of ureteral strictures, potentially leading to long-term success rate of more than 90% and a rate of significant complications < 5%.
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