Robot-Assisted Vesical Mucosal Graft Ureteroplasty for Long Ureteral Strictures: Mid-term Patency and Donor-Site Outcomes.

PURPOSE: To evaluate midterm patency, recovery, and donor-site outcomes after robot-assisted vesical mucosal graft (VMG) ureteroplasty for long ureteral strictures.

MATERIALS AND

METHODS

This retrospective cohort included 46 VMG procedures and 21 clinically allocated buccal mucosal graft (BMG) reference procedures. The primary outcome was intervention-free patency at last follow-up. Secondary outcomes included workflow, recovery, donor-site morbidity, 30-day complications, hydronephrosis, and renal function. Continuous outcomes were assessed using adjusted models.

RESULTS

Mean follow-up was 41.4 months after VMG and 42.7 months after BMG; intervention-free patency was 93.5% and 90.5%, respectively. All five recurrent obstructions were detected at 3-6 months and required endoscopic reintervention. Hydronephrosis regressed and differential renal function remained stable. Adjusted differences favored VMG for graft preparation, operative time, hospital stay, regular diet, and day 1 harvest-site pain. Differences were -23.1 minutes (95% confidence interval -32.0 to -14.2) for operative time and -1.9 points (-2.4 to -1.4) for pain. Regular diet resumed 2.1 days earlier in the adjusted analysis. Additional donor-site medication was required in 8.7% versus 61.9%; 30-day grade I-II complications occurred in 10.9% versus 61.9%. Four BMG recipients had oral bleeding; paresthesia persisted at 6 months in three. No VMG recipient had urinary leak, impaired bladder healing, or persistent bladder-related functional complaints. No grade ≥III complication occurred within 30 days.

CONCLUSIONS

Robot-assisted VMG ureteroplasty achieved durable midterm drainage and enabled recipient-defect-driven graft sizing within a single operative field. Its broad native urothelial donor surface avoided oral harvest, reduced donor-site burden, and accelerated recovery.