Navigating the irradiated ureter: multi-institutional outcomes of robotic ureteral reconstruction for radiation-induced strictures.

BACKGROUND

Surgical management of radiation-induced ureteral strictures may be difficult due to dense peri-ureteral scarring, impaired vascularity, and limited tissue mobility in the irradiated field. We demonstrate outcomes of robotic ureteral reconstruction for management of radiation-induced ureteral strictures.

METHODS

We retrospectively reviewed our multi-institutional Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database to identify all consecutive patients undergoing robotic ureteral reconstruction for surgical management of radiation-induced ureteral strictures between 2018 and 2024. Indications for surgery included patients with strictures secondary to pelvic radiation with associated flank pain, recurrent urinary tract infections and/or decreasing renal function on renal scan. Patients who had prior failed intervention for ureteral stricture disease were included in this cohort. Surgical success was defined as the absence of further intervention required for recurrent stricture disease.

RESULTS

Overall, 42 patients were included in the analysis. Strictures were located in the middle ureter, distal ureter, and pan-ureteral in 3 (7.1%) patients, 33 (78.6%) patients, and 6 (14.3%) patients, respectively. Reconstructive techniques included traditional transecting reimplantation (31.0%), side-to-side reimplantation (35.7%), appendiceal ureteroplasty (11.9%), buccal mucosa graft ureteroplasty (7.1%), and ileal ureter interposition (14.3%). A Boari flap with psoas hitch (11.9%) or psoas hitch (26.2%) was performed in certain cases to help facilitate a tension-free anastomosis. Intravenous or intraureteral indocyanine green under near-infrared fluorescence was utilized in most cases (57.1%). There were three (7.1%) major (Clavien > 2) postoperative complications. At a median follow-up of 18.1 (IQR 3.0-25.5) months, 37 (88.1%) patients were surgically successful.

CONCLUSION

Robotic ureteral reconstruction techniques may be safe and effective in the management of patients with ureteral strictures secondary to pelvic radiation.