Robotic ileal ureteral reconstruction for radiation-induced ureteral strictures in pelvic malignancy survivors: experience from a multi-institutional database.

BACKGROUND

Chronic double-J stenting or nephrostomy dependence remains the default management for radiation-induced ureteral strictures (RIUS). This study aimed to evaluate the feasibility and clinical efficacy of robotic ileal ureter replacement (IUR) in managing RIUS with prior pelvic malignancy radiotherapy.

METHODS

In our prospective multi-institutional RECUTTER database, 35 patients with a diagnosis of RIUS underwent robotic IUR between March 2019 and April 2024. Unilateral and bilateral procedures were performed with or without augmentation ileocystoplasty. Baseline characteristics, perioperative, and follow-up results of the patients were collected. Postoperative complications were evaluated using the Clavien-Dindo (CD) Classification system.

RESULTS

All patients were female with a mean age of 49.46±8.25 year. Cervical carcinoma was the predominant primary malignancy for radiotherapy (85.7%). The median length of the ileal graft was 28 cm (range 15-45). The mean operative time was 331.6±112.3 min, and the median estimated blood loss was 50 mL (range 20-100). The mean postoperative hospitalization was 12.43±6.00 day. During the median follow-up of 20 months (range 12-74), 34 patients (97.1%) achieved clinical success. One case of surgical failure developed right ureteral restenosis post-bilateral IUR. Complications included short-term (20%: CD grade I 11.4%, grade II 8.6%) and long-term events (22.9%, all grade II). No grade ≥III complications occurred.

CONCLUSIONS

Robotic IUR represents a feasible and effective option-for managing RIUS after pelvic malignancy radiotherapy, addressing surgical challenges posed by dense adhesions, retroperitoneal fibrosis, extensive bilateral strictures, and concurrent bladder contracture.