Ureteroenteric repair for strictures after radical cystectomy and urinary diversion: Comparison of the open and robotic approaches.

INTRODUCTION

Ureteroenteric anastomotic stricture (UES) is one of the main complications after radical cystectomy (RC) with urinary diversion, regardless of the surgical approach. The standard surgical treatment for these strictures is usually an open ureteroenteric repair. The use of robotic-assisted surgery is developing as a less invasive alternative. The aim of this study was to compare the results of open and robotic approaches for UES repair.

METHODS

A retrospective single-center study was conducted including all patients who underwent ureteroenteric repair for stricture after RC from 2015 to 2024. The primary endpoint was surgical success, defined as the absence of clinical or radiological stricture recurrence at the last follow-up. Complication and stricture recurrence rates were compared between both groups.

RESULTS

Twenty-six patients were included: 11 underwent robotic-assisted repair and 15 underwent open repair. No differences between both groups were observed except for the indication of the cystectomy which was more often for oncologic reasons in the open group (80 vs. 36.4%; P=0.04). The median time to UES occurrence was 101 days. The anastomosis used for surgical repair differed significantly in both groups with Bricker being prevalent in the open group (73.3 vs. 9.1%) and side-to-side anastomosis being used only in the robotic group (45.5 vs. 0%; P=0.001). The mean operative time tended to be shorter in the open group but without statistical significance (151.3 vs. 191.8; P=0.15). Conversely the median length of hospital stay tended to be shorter in the robotic group (8 vs. 7 days; P=0.21). The median time to return of bowel function was significantly shorter in the robotic group (3 vs. 2 days; P=0.03). No significant differences were observed in terms of 30-day complication rate (13.3 vs. 27.3%; P=0.62). The success rate of ureteroenteric repair was 100% (P=0.99) in both groups, with a median follow-up of 18.5 months.

CONCLUSION

Open and robotic ureteroenteric repair for strictures have a comparable success rate and appears to provide excellent functional results with low morbidity. These results suggest that minimally invasive surgery is a promising alternative, even in patients primary operated in open approach. Larger studies are required to confirm these results.