Early Outcomes of Single-Port Robot-Assisted Buccal Mucosa Graft Ureteroplasty and Pyeloplasty: A Single-Center Experience.

BACKGROUND

Buccal mucosa graft (BMG) ureteroplasty and pyeloplasty have emerged as effective reconstructive options for complex ureteral and ureteropelvic junction (UPJ) strictures not amenable to primary excision and anastomosis. The advent of the single-port robotic platform enables a retroperitoneal approach while preserving the advantages of robotic reconstruction. We report early outcomes of single-port robot-assisted BMG ureteroplasty and pyeloplasty from a single-center experience.

METHODS

We retrospectively reviewed 16 consecutive patients who underwent single-port robot-assisted ureteroplasty or pyeloplasty with BMG between September 2020 and June 2025, performed by a single surgeon. Indications included complex ureteral strictures or redo pyeloplasty. The primary outcome was clinical success, defined as freedom from ureteral stenting and/or percutaneous nephrostomy at 90 days. Perioperative outcomes, complications, and short-term follow-up were analyzed.

RESULTS

The cohort had a mean age of 45 ± 14.9 years and a median stricture length of 3 cm (interquartile range [IQR]: 2-3). Most procedures were performed via a retroperitoneal low anterior access (75%). Reconstructive procedures included ureteroplasty (50%), pyeloplasty (43.8%), and combined reconstruction (6.3%). Median operative time was 183 minutes (IQR: 150-215), with minimal blood loss and a median length of stay of 11 hours (IQR: 8-29). At 90 days, 87.5% of patients were stent-free and 93.7% were nephrostomy-free. Thirty-day complications occurred in 25% of patients, predominantly Clavien-Dindo grade IIIa. The median follow-up was 14.5 months (IQR: 4.8-18.5).

CONCLUSIONS

Single-port robot-assisted BMG ureteroplasty and pyeloplasty are feasible and effective for complex ureteral and UPJ strictures, including redo cases. This approach offers acceptable perioperative morbidity, favorable short-term functional outcomes, and a high rate of outpatient management using a retroperitoneal approach. Larger prospective studies are warranted to assess long-term durability and comparative effectiveness.