Robotic-assisted ureteral reconstruction in renal transplant recipients: a multi-Institutional review of outcomes and complications.

BACKGROUND

Robotic-assisted techniques in ureteral reconstruction during renal transplantation have emerged as a promising minimally-invasive approach for managing urologic complications after transplant. This study aims to evaluate the outcomes of robotic ureteral reconstruction of transplant kidney ureteral anastomotic strictures analyzing complication rates, outcomes and the feasibility of the robotic assisted approach.

METHODS

Data from renal transplant recipients who underwent ureteral reconstruction between 2014 and 2024 were analyzed. Information recorded included etiology, prior treatments, postoperative management, surveillance data, and complications.

RESULTS

Thirty patients underwent robotic-assisted ureteral reconstruction for anastomotic strictures, with most cases attributed to ischemic (33%) or idiopathic (33%) causes, and 20% related to post-transplant urine leaks. A previous attempt at balloon dilation was made in 30% of patients. Nearly all patients were managed pre-operatively with a nephrostomy (PCN). Ureteroneocystostomy was the most common repair (90%). The median operative time was 234 min, with a median length of stay of 2 days. Reintervention for obstruction was not required in any patients, with a 100% success rate for a median follow-up of 6.5 months. Complications were mainly urinary tract infections, requiring antibiotic treatment. Most urinary tract infections were multi-resistant bacteria with only intravenous antibiotic options. 45% (10/22) of patients with positive pre-operative urine cultures developed a symptomatic UTI within 30 days after surgery.

CONCLUSIONS

Robotic ureteral reconstruction in renal transplant recipients is an effective and safe approach for the management of transplant ureteral strictures. In this high-risk immunocompromised patient population, the minimally invasive robotic assisted approach offers a highly successful and reproducible outcome with expedited patient recovery and minimal complications.