Efficacy of Robot-Assisted Ureteroureterostomy in Patients with Complex the Ureteral Stricture after Ureteroscopic Lithotripsy

Ureteral stricture (US) following ureteroscopic lithotripsy (URSL) has emerged as a serious issue due to the widespread use of laser technology. The management of complex US is challenging. This prospective study evaluated the efficacy of robot-assisted uretero-ureterostomy (RAUU) in addressing US following URSL, and analyzed the pathology of transected ureteral tissues to identify the risk factors for US during URSL. Fourteen patients, with a mean age of 49.8 years, were included in this study. The mean stricture length on radiography was 22.66 ± 7.38 mm. Nine (64.2%) patients had experienced failure with previous interventions, including eight patients who underwent endoscopic incision plus balloon dilation. At an average follow-up of 12.8 months, the overall success rates were 92.9% both clinically and radiographically, without major complications. Pathological findings revealed microcalcifications in 57.1% patients and loss of ureteral mucosa in 28.6% patients. In conclusion, this technique of RAUU via end-to-end anastomosis exhibits promise as a viable option for US following URSL in appropriately selected patients, despite serious pathological changes of the ureter. Migration to the site of ureteral perforation may be the most serious factor contributing to the development of US.