Robot-assisted laparoscopic ureteral reimplantation and boari flap with anti-reflux technique: do postoperative reflux related symptoms matter.

OBJECTIVE

To assess the efficacy and safety of robot-assisted ureteral reimplantation (RUR) ± psoas hitch/Boari flap using anti-reflux techniques for distal ureteral stenosis, with a focus on the prevalence and clinical significance of postoperative reflux-related symptoms.

METHODS

This prospective study included 76 patients who underwent RUR ± psoas hitch/Boari flap with an anti-reflux technique between November 2018 and November 2023. Anti-reflux methods included submucosal tunneling or nipple valve reconstruction. Patient demographics, symptoms, laboratory findings, imaging results, perioperative data, complications, and follow-up outcomes were analyzed. Surgical success was defined as symptom relief, improved or stable hydronephrosis, and preserved renal function.

RESULTS

All 76 procedures were completed successfully, with a median operative time of 141 min and a median blood loss of 20 mL. The overall surgical success rate was 94.5%. During a median follow-up of 13.9 months, 50 patients experienced complete symptom resolution, while 22 reported symptom improvement. Eleven patients reported reflux-related symptoms, such as flank pain during urination, while postoperative vesicoureteral reflux (VUR) was detected in 5 patients via cine magnetic resonance urography. No patients required secondary surgical intervention, and symptoms either improved or remained stable over time.

CONCLUSION

Robot-assisted ureteral reimplantation ± psoas hitch/Boari flap with an anti-reflux technique is a safe and effective treatment for distal ureteral stenosis. Postoperative reflux-related symptoms do not necessarily indicate VUR and should not be the sole criterion for further intervention.