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This multi-institutional retrospective review evaluated robotic intracorporeal ileal ureter replacement (RIUR) in 48 patients (64.6% unilateral, 35.4% bilateral) with complex ureteral strictures (median length 20cm). Surgical success, defined as absence of flank pain/obstruction and freedom from re-intervention at ≥6 months, was achieved in 91.7% of patients at a median follow-up of 24 months, although major complications occurred in 18.8% of patients. Prior radiation was associated with a significantly lower success rate (76.9% vs 100%).
Robotic ileal ureter replacement demonstrates a high success rate in complex ureteral reconstruction, but surgeons should be aware of the significant major complication rate, particularly in patients with prior radiation.
BACKGROUND AND OBJECTIVE To report our multi-institutional outcomes with robotic intracorporeal ileal ureter replacement (RIUR). METHODS We performed a retrospective review of patients who underwent RIUR at three institutions from April 2016 to June 2025. Surgical success was defined as the absence of flank pain and of ureteral obstruction on functional imaging and/or endoscopic evaluation, and freedom from operative intervention related to RIUR at ≥6-mo follow-up. KEY FINDINGS AND LIMITATIONS Of 48 patients, 31 (64.6%) had unilateral and 17 (35.4%) had bilateral reconstruction. Twenty (41.7%) had a history of radiation. Median stricture length was 20 cm (interquartile range [IQR] 20-25). In 19 patients (39.6%), a concomitant abdominopelvic reconstruction was performed (9 bladder augmentations, 5 contralateral ureteral reconstructions, and 5 other procedures). Median operative time was 359 min (IQR 292-418), estimated blood loss was 100 ml (IQR 50-175), and length of stay was 5 d (IQR 4-7). There were nine (18.8%) major (Clavien grade ≥III) 30-d complications: five urinary anastomotic leaks, two intra-abdominal abscesses, one small bowel leak that required exploratory laparotomy, and one renal bleed requiring angioembolization. Thirty-six patients (75%) had ≥6-mo follow-up, which confirmed surgical success in 33/36 (91.7%) at median follow-up of 24 mo (IQR 14-35). All three failures were in the radiation subgroup, which had a significantly lower rate of surgical success (76.9% vs 100%; p = 0.031). CONCLUSIONS AND CLINICAL IMPLICATIONS RIUR is an effective and durable treatment for patients with devastating ureteral injuries. However, the procedure is challenging and associated with a significant major complication rate. PATIENT SUMMARY This study looked at a complex surgery in which a piece of intestine is used to rebuild the urinary tube that drains urine from the kidney to the bladder. Across three hospitals, the procedure worked well for the large majority of patients, and helped to restore function and relieve symptoms.
