Abstract
BackgroundManagement of recurrent ureteral stricture is challenging. Consensus on the best surgical choice has not been demonstrated. In this study, we aim to report our experience in treating recurrent ureteral stricture and demonstrate whether robot-assisted procedure for redo ureteral surgery is as effective as open procedure while remaining less invasive.MethodsWe retrospectively assessed 41 patients (22 robot-assisted surgeries and 19 open surgeries) who underwent consecutive robot-assisted and open procedures for redo ureteral surgery from January 2014 to 2018 in our institution. Perioperative outcomes, including demographics, operative time, estimated blood loss, complications, pain scores, success rate and cost, were compared between two groups.ResultsThere was no significant intergroup difference in terms of age, body mass index, gender composition and American Society of Anesthesiologists scores. A total of 31 patients underwent redo pyeloplasty and ten underwent redo uretero-ureterostomy. Compared with open group, robot-assisted group showed shorter operative time (124.55 min vs. 185.11 min, p < 0.0001), less estimated blood loss (100.00 mL vs. 182.60 mL, p = 0.008) and higher cost (61161.77¥ vs. 39470.79¥, p < 0.0001). Complication rate and pain scores were similar between two groups. Median follow-up periods were 30 and 48 months for robot-assisted and open group respectively. Success rate in the robot-assisted (85.71%) and the open group (82.35%) was not significantly different.ConclusionsRobot-assisted surgery for recurrent stricture after previous ureteral reconstruction is as effective as open procedure and is associated with shorter operative time and less estimated blood loss.
Highlights
Management of recurrent stricture after previous ureteral reconstruction is challenging, both in terms of decision-making and surgical technique
We retrospectively identified consecutive robot-assisted and open procedures performed from January 2014 to 2018 in our institution for recurrent stricture with previous ureteral reconstruction
Hematuria was detected in one patient and the stricture was confirmed to be benign with pathological assessment
Summary
Management of recurrent stricture after previous ureteral reconstruction is challenging, both in terms of decision-making and surgical technique. Management of recurrent ureteral stricture: a retrospectively comparative study with robot-assisted laparoscopic surgery versus open approach. Redo ureteral surgery is difficult due to scar formation, altered anatomic planes and decreased vascularity of the ureter In such cases, open surgery is an excellent choice and the success rate of open redo pyeloplasty reaches up to 80–100% (Abdel-Karim et al, 2016; Piaggio, Noh & González, 2007; Vannahme et al, 2014). We aim to report our experience in treating recurrent ureteral stricture and demonstrate whether robot-assisted procedure for redo ureteral surgery is as effective as open procedure while remaining less invasive. Perioperative outcomes, including demographics, operative time, estimated blood loss, complications, pain scores, success rate and cost, were compared between two groups. Conclusions: Robot-assisted surgery for recurrent stricture after previous ureteral reconstruction is as effective as open procedure and is associated with shorter operative time and less estimated blood loss
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