Robot-assisted ileal ureter replacement for complex ureteral strictures: a systematic review and single-arm meta-analysis of surgical and functional outcomes.

Complex, long-segment ureteral strictures present significant reconstructive challenges. While open ileal ureter replacement is the historical gold standard, it carries substantial perioperative morbidity. This systematic review and single-arm meta-analysis evaluate the surgical and functional outcomes of robot-assisted ileal ureter replacement (RIUR). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search of four databases was conducted through September 2026 to identify studies reporting adult RIUR outcomes for complex strictures. Outcomes were pooled using random-effects models. Five retrospective cohort studies comprising 110 patients met the inclusion criteria, with radiation-induced injury representing the predominant etiology (44.5%). The pooled surgical success rate was 93.9% (95% confidence interval [CI]: 87.0-97.2%). The pooled major complication rate (Clavien-Dindo grades III-V) was 10.0% (95% CI: 4.0-24.0%), driven primarily by urinary anastomotic leaks, typically managed with prolonged stenting. Pooled rates for metabolic acidosis requiring supplementation and stricture recurrence were 7.4% and 2.6%, respectively, while renal function remained stable or improved across all evaluated cohorts. Pooled mean operative time and estimated blood loss were 339.1 min (95% CI: 310.5-367.7) and 103.7 mL (95% CI: 54.9-152.6), respectively, while length of hospital stay varied widely by regional institutional pathway (median 3.0 days in early-discharge cohorts to 14.2 days in inpatient testing protocols). Current evidence suggests that RIUR represents a feasible and promising minimally invasive option for complex ureteral defects, with observed success rates meeting historical clinical benchmarks and an acceptable perioperative safety profile.