<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Ureteral Rhabdomyosarcoma (RMS) in children is a rare malignancy that may involve the ureter, leading to obstruction and hydronephrosis. Management requires a combination of oncologic therapy and individualized surgical planning, particularly when tumor resection results in extensive ureteral defects. This case report describes an 8-year-old girl with pelvic embryonal RMS involving the right distal ureter, previously treated with pelvic radiotherapy and VAD (vincristine, actinomycin, and doxorubicin) chemotherapy. Imaging showed tumor compression of the distal ureter with grade III hydronephrosis. Surgical resection necessitated en bloc distal ureterectomy, creating a 10-cm ureteral defect. Due to prior pelvic radiation and concerns regarding bladder fibrosis and metabolic complications from bowel interposition, ureteral substitution using the appendix was performed. Postoperative recovery was uneventful, with stable renal function, normal electrolyte balance, and no urinary leakage. Follow-up imaging at 6 months demonstrated a well-functioning appendiceal conduit and no residual tumor. This case illustrates that appendiceal ureteral substitution can be a safe and effective reconstructive option for long distal ureteral defects in pediatric RMS, particularly when prior radiation limits alternative techniques. Careful surgical technique and close follow-up remain essential to ensure optimal outcomes</em></p><p><em> </em></p></td></tr></tbody></table></div><p><strong><em>Keywords: Ureteral Substitution, Ureteral Reconstruction, Appendix, Embryonal Rhabdomyosarcoma</em></strong></p><p> </p>

Ureteral injuries can lead to renal dysfunction, and conventional treatments such as ureteral stents and autologous tissue grafts have limitations. This study aimed to evaluate the biocompatibility of a "biotube" created using in-body tissue architecture (iBTA) technology for ureteral reconstruction in a canine model. Biotubes were implanted in dogs to replace a segment of the ureter. Ureteral stents were used to prevent obstruction. Autopsies were performed 2-3 months after implantation, and the implantation sites were examined histologically to assess tissue regeneration, vascularization, and potential inflammatory reactions. Ureteral stenting effectively prevented obstruction and ensured adequate urinary flow during the observation period. All biotubes were significantly shortened after implantation. No signs of inflammation or foreign body reactions were recorded, indicating good biocompatibility. Although epithelial cell invasion was observed, muscle tissue migration and angiogenesis were limited. Biotubes demonstrate potential as temporary ureteral substitutes; however, improvements in epithelialization and muscle tissue migration are necessary for successful long-term ureteral regeneration. Further experimental studies are required to evaluate their clinical utility as scaffold materials for ureteral reconstruction.

Purpose: We aim to determine if ureteral rest is necessary prior to distal ureteral reconstruction with reimplantation with or without psoas hitch and/or Boari flap. Methods: We retrospectively reviewed all patients who underwent ureteral reimplantation at a single institution from December 2016 to April 2023. We included all reimplantation techniques, including psoas hitch and Boari flap. Patients were stratified based on if they had ureteral rest, defined as the absence of a ureteral stent for at least 4 weeks prior to the operation. Patient demographics, stricture characteristics, and perioperative outcomes were compared between the two groups. Patients were scheduled for 3 and 12 month postoperative ultrasounds to assess for stricture recurrence. Renal scintigraphy was used if significant or worsening hydronephrosis was seen. Results: Our cohort consisted of 50 patients, among whom 29 (58%) underwent ureteral rest before reimplantation. Demographics, stricture characteristics, and use of psoas hitch and/or Boari flap were comparable between the two groups. Stricture etiology was significantly different in patients with and without ureteral rest (p = 0.002). The cohort without ureteral rest had a higher percentage of radiation-induced ureteral injury (47.6%), while the cohort with ureteral rest had a higher percentage of iatrogenic ureteral injury (75.9%). Other/idiopathic causes were split relatively evenly. Median follow-up for the cohort was 8.6 months (interquartile range: 4.6-17.4 months). Postoperatively, there were no significant differences in 30-day complication rate, postoperative hydronephrosis, or stricture recurrence rate. Conclusions: Our data suggest that ureteral rest does not confer an advantage for distal ureteral reconstruction. Thus, operation should not be delayed in order to achieve ureteral rest when reimplantation is expected.

Buccal mucosa graft (BMG) ureteroplasty has emerged as a versatile technique for managing long-segment or complex ureteral strictures. However, the optimal surgical approach-Robotic-Assisted (RAS), Laparoscopic, or Open surgery-remains debated. We aimed to systematically evaluate and compare the perioperative outcomes and safety profiles of these three modalities. A systematic literature search was conducted in PubMed, Embase, and Web of Science up to November 2025, following PRISMA 2020 guidelines. Studies reporting outcomes of BMG ureteroplasty via robotic, laparoscopic, or open approaches were included. The primary outcome was surgical success rate. Secondary outcomes included operative time, hospital stay, and complication rates (total and Clavien-Dindo ≥ 3). Statistical analysis was performed using R software with a Generalized Linear Mixed Model (GLMM). Sixteen studies involving 398 patients (Robotic: n = 256; Laparoscopic: n = 98; Open: n = 44) were included. The pooled surgical success rates were uniformly high across all groups: Robotic (90.4%), Laparoscopic (92.5%), and Open (90.9%), with no statistically significant differences (P > 0.05). However, regarding safety, the robotic approach demonstrated a superior profile. Despite managing complex cases, the robotic cohort exhibited a minimal incidence of major complications (Clavien-Dindo ≥ 3) compared to laparoscopic and open groups. Sensitivity analysis confirmed the robustness of these findings, indicating that the efficacy of RAS is generalizable and not driven by single-center data. Robotic-assisted BMG ureteroplasty achieves excellent functional outcomes comparable to the open gold standard and the laparoscopic approach. In terms of safety, RAS demonstrates a favorable profile with a marked reduction in severe perioperative complications compared to laparoscopic and historical open cohorts. Consequently, RAS represents a safe and effective minimally invasive alternative for complex ureteral reconstruction, offering durability comparable to open repair with minimized morbidity.

Endourologic treatments are first-line interventions for short ureteral strictures. With long strictures and endourologic failures, open repair has historically been; however, robotic-assisted approaches have recently been shown to be efficacious. As a quality measure, we wanted to assess the performance of robotic ureteral reconstruction compared with open surgical repair during our transition to robotic surgery at a Canadian tertiary care center. From 2011-2024, 43 complex ureteral stricture cases (19 open, 24 robotic) were performed. Primary outcome was six-month success defined by a composite of stent/pain-free status and renogram T½ . Secondary outcomes included length of stay, operative time, estimated blood loss, and complications. Success rates at six months were non-significantly different between robotic and open repair (83% vs. 79%, p=0.36). Length of stay was shorter in the robotic group (3.1±1.9 vs. 4.9±3.3 days, p=0.018). Estimated blood loss (231±84 vs. 244±170 mL, p=0.30) and operative time (220±67 vs. 214±74 minutes, p=0.40) were comparable between groups. Complication rates were similar between groups. Overall, robotic reconstruction yields equivalent six-month success to open repair with shorter length of stay. These findings support continuing robotic-assisted ureteral reconstruction as a safe and effective alternative to open surgery, offering equivalent short-term success and reduced hospital stay.

To synthesize the current literature regarding the evaluation and management of genitourinary fistula in women. Genitourinary fistula are aberrant communications between the urinary tract and genital tract that present with urinary leakage per the vagina. Initial management often involves conservative measures, such as urethral catheter or ureteral stent placement, progressing to surgical repair when needed. Key surgical principles include a tension-free, watertight closure with well-vascularized tissue including tissue interposition as appropriate, and postoperative urinary drainage. When surgical management of vesicovaginal fistula is necessary, a transvaginal repair is the most common. Other minimally invasive approaches are increasing and result in similarly high success rates with lower patient morbidity compared to open abdominal surgeries. The initial management of ureterovaginal fistula commonly includes ureteral stent placement. When not feasible or in persistent fistula, laparoscopic and robotic surgical repair with ureteral reconstruction offers high success rates with lower morbidity than an open approach. Successful management of genitourinary fistula ranges from conservative urinary tract drainage to surgical interventions based on etiology, location, and complexity. Approaches to repair are shifting toward less invasive procedures. With optimal technique and surgical planning, high success rates can be achieved, particularly in primary repairs.

To develop, validate, and compare a Traditional Multivariable Logistic Regression model with a Machine Learning-based LASSO Regression Model for predicting significant renal function recovery in adult patients undergoing surgical repair for ureteric obstruction, and to present the most practical model as a clinical nomogram. We retrospectively analyzed data from 100 adult patients who underwent surgical repair for unilateral ureteric obstruction at our institution. The primary endpoint was significant renal function recovery, defined as a ≥ 15% increase in ipsilateral glomerular filtration rate (GFR). Two predictive models were developed: a parsimonious "Multivariable Model" using backward stepwise regression, and a "LASSO Model" using least absolute shrinkage and selection operator regression. The models' performance was rigorously compared based on discrimination (Area Under the Curve - AUC), calibration (calibration curve), and clinical utility (Decision Curve Analysis - DCA). Internal validation was performed using 500 bootstrap resamples. The Multivariable Model identified four independent predictors: age (OR = 1.05, p = 0.042), preoperative ipsilateral GFR (OR = 1.20, p < 0.001), renal atrophy (OR = 6.32, p = 0.028), and SFU Grade 4 (vs. Grade 2, OR = 23.8, p = 0.003). The LASSO model selected 12 variables. The LASSO model showed a slightly higher discrimination (AUC: 0.841 vs. 0.827) and a better optimism-corrected AUC in bootstrap validation (0.779 vs. 0.776). Decision Curve Analysis also revealed a marginally higher net benefit for the LASSO model. However, the simpler 4-variable Multivariable Model demonstrated excellent calibration and its clinical utility was very close to that of the more complex model. Given its superior balance of high performance and clinical practicality, the Multivariable Model was selected and presented as a nomogram. We developed a robust 4-variable nomogram for predicting renal recovery. While a more complex LASSO model showed marginal statistical advantages, our simpler model provides a better balance of accuracy, interpretability, and clinical utility, making it a valuable tool for patient counseling and surgical decision-making.

BackgroundUreteral strictures pose significant challenges in urological surgery, requiring precise localization of stenotic segments for effective resection. Traditional rigid ureteroscopy-assisted techniques involve positioning limitations and procedural inefficiencies. This study evaluates the safety and efficacy of a novel approach combining flexible ureteroscopy and laparoscopy for ureteroureterostomy, focusing on improved intraoperative navigation and reduced procedural complexity.MethodsA retrospective analysis was conducted in 12 patients (7 males, 5 females; median age 50 years) undergoing laparoscopic ureteroureterostomy with flexible ureteroscopy between July 2023 and August 2024. All strictures were located in the upper ureter (length: 8–23 mm). Key innovations included lateral positioning, a flexible ureteroscope sheath (external/internal diameter: 12 Fr /10 Fr), and real-time ureteral light guidance. Surgical parameters (operative time, blood loss), perioperative outcomes, and follow-up data (median 10 months) were analyzed. Biochemical recovery (serum creatinine normalization) and radiological recovery (urography patency) were primary endpoints.ResultsAll procedures were completed without conversion to open surgery. Median operative time was 175 min (range: 130–225), with intraoperative bleeding of 22.5 mL (range: 20–50). Flexible ureteroscopy enabled repeated lumen verification (median 6 insertions) without ureteral trauma. Postoperatively, hydronephrosis resolved in all patients, with no anastomotic leaks or restenosis. Median hospital stay was 5.5 days (range: 3–9); one patient experienced transient fever. Biochemical and radiological recovery was achieved in all cases. Follow-up imaging (median 10 months) confirmed sustained ureteral patency and improved renal function.ConclusionsThe integrated flexible ureteroscopy-laparoscopy approach enhances surgical precision and efficiency for upper ureteral strictures, mitigating positioning limitations and reducing iatrogenic injury. While initial outcomes demonstrate safety and efficacy, long-term follow-up and prospective multicenter trials are warranted to validate durability. This technique represents a promising advancement in minimally invasive ureteral reconstruction.

Introduction: Urological injuries are rare but significant complications of obstetric and gynecologic procedures, associated with morbidity, prolonged hospital stay, and medicolegal implications. Bladder injuries are typically identified intraoperatively, while ureteric injuries are often delayed presentation. Early recognition and prompt management are critical to reduce complications. The study aimed to evaluate the incidence, type, timing of detection, management, and outcomes of urological injuries in patients undergoing obstetric and gynecologic surgeries.Materials and methods: This retrospective and prospective study included 15,697 procedures (6150 gynecologic surgeries, 9547 lower segment cesarean sections) performed from January 2020 to December 2024 at a tertiary care center. Intraoperative and postoperative urological injuries were recorded and classified as early (≤7 days) or late (>7 days). Management strategies included primary repair, endoscopic procedures, stenting, or ureteric reconstruction. Descriptive statistics summarized patient demographics, injury rates, and outcomes. Comparisons were performed using chi-square and t-tests, with p <0.05 considered significant.Results: Urological injuries occurred in 43 (0.27%) procedures; bladder injuries in 34 (0.21%), ureteric injuries in 7 (0.04%), and combined injuries in 2 (0.01%). Bladder injuries were slightly more frequent during obstetric procedures 22 (0.23%) compared to gynecologic procedures 12 (0.19%), whereas ureteric injuries occurred only in gynecologic surgeries 7 (0.11%). Most injuries 33 (76.7%) were detected intraoperatively. Intraoperative bladder injuries were repaired primarily with suprapubic cystostomy, and ureteric injuries underwent uretero-neocystostomy or ureteroureterostomy. Early recognition facilitated effective management and favorable outcomes, with mean hospital stay ranging from four to 12 days depending on injury type and timing.Conclusion: Urological injuries are uncommon but clinically important. Early intraoperative detection and tailored surgical management ensure optimal outcomes. Preventive strategies, including meticulous surgical technique and careful intraoperative assessment, are essential to minimize morbidity.

Laparoscopic ureteral reconstruction using the appendix is a novel and minimally invasive technique for treating long ureteral strictures. This study aims to report our initial experience and outcomes of laparoscopic appendiceal onlay flap ureteroplasty (LAOU) and laparoscopic appendiceal interposition ureteroplasty (LAIU) in patients with long ureteral strictures. Data of 16 patients with right long ureteral strictures underwent either LAOU or LAIU between October 2021 and January 2025 in a single center were collected retrospectively. The pre-, intra-, and postoperative variables and follow-up results were analyzed. Ten (62.5%) patients underwent LAIU, and six (37.5%) underwent LAOU. The mean stricture length was 3.2cm (range, 2.0-5.0cm), the operative time was 200.6min (range, 150-240min), the estimated blood loss was 84.4 mL (range, 50-200 mL), and the mean postoperative hospital stay was 5.9 days (range, 4-8 days). With a mean follow-up of 14.9 months (range, 3-30 months), the overall success rate was 93.8%. There was no significant difference in the parameters between LAOU and LAIU surgical procedures. Laparoscopic appendiceal ureteroplasty is a viable option for treating long-segment ureteral strictures on the right side. The choice between appendiceal onlay or interposition depends on the specific condition of the strictures.

To present our experience of surgical management of vesicovaginal fistulas (VVFs). From 1996 to 2025, 156 women with VVFs underwent surgical treatment at the Department of Urology, North-Western State Medical University named after I.I. Mechnikov. Age ranged from 21 to 79 years (mean 45.2+/-4.6 years). Recurrent fistulas were observed in 42 (26.9%) patients, who had previously undergone from one to six unsuccessful surgical attempts. The predominant cause of VVF formation was iatrogenic injury to the urinary bladder during gynecological interventions (77.5%). Fistula repair was performed in 140 patients, with a transvaginal approach used in 91.4% of cases. The transabdominal approach was employed in 12 women, including 10 cases with concurrent ureteral reconstruction and 2 performed via laparoscopic approach. Among 140 patients who underwent fistula closure, success was achieved in 139 cases (99.3%). In our clinic, transvaginal fistula closure is the preferred surgical method for managing vesicovaginal fistulas. We consider it the least traumatic open technique, even compared with its laparoscopic alternative. Transvaginal vesicovaginal fistula closure remains the method of choice for treatment of VVFs. A transabdominal approach, including laparoscopic repair, is justified only when simultaneous ureteral reconstruction is required. Heterotopic cystoplasty is regarded as the most reliable reconstructive option for patients with radiation-induced fistulas.

Purpose: Ureteral complications are among the most common types of complications following kidney transplantation (KT). In the past, these complications were often managed using endoscopic and open surgical approaches. However, the robot-assisted approach has been recently implemented. Nevertheless, the available data regarding the potential impact of robotic surgery in this field are sparse. This systematic review (SR) aims to summarize the available evidence of robot-assisted ureteral reconstruction following KT, focusing on postoperative outcomes and complications. Methods: Studies eligible for inclusion focused on evaluating the success and/or complications associated with robot-assisted ureteral reconstruction after KT. An SR was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search was performed using the Web of Science, PubMed, and Scopus databases, with no restrictions on the time period. Only articles published in English were considered. Results: After screening 5337 publications, this SR included 9 studies with a total of 127 patients. The most common indication for reconstruction was ureteral stricture (n = 108, 85%), and the most frequently performed procedure was ureteroneocystostomy (n = 59, 46.8%). Following robot-assisted ureteral reconstruction procedures, the average success rate was 91.3%. Regarding intraoperative complications, six patients (4.7%) required conversion to open surgery. As for postoperative complications, the number of patients experiencing Clavien-Dindo Grade 1, 2, 3, and 4 complications were 15/121 (12.4%), 20/121 (16.5%), 4/121 (3.3%), and 2/121 (1.6%), respectively. Conclusion: With the advancements in robotic platforms as well as KT surgeons' expertise in minimally invasive surgery, robot-assisted ureteral reconstruction after KT is increasingly recognized as a safe and effective option for recipients with ureteral complications.

This study aims to determine the clinical urology CT scan procedure for kidney stones, analyze the justification for employing ureteral tracking reconstruction, and evaluate the ideal slice thickness for achieving accurate diagnostic images. This research employed a descriptive qualitative methodology utilizing a case study technique in the Radiology Department of RSUD (Regional General Hospital) dr. Loekmono Hadi Kudus. The subjects comprised of three radiographers, one radiologist, one referring physician, and three CT scan images of the urology. Data was obtained through observation, interviews, documentation, and literature review. The data were subsequently studied through reduction, presentation, discussion, and conclusion formulation. The examination was conducted without any specific preparation, merely by consuming 500-750 ml of water and refraining from urinating. The patient was placed in a supine position, feet-first, with arms elevated above the head, exposing the area from the xiphoid process to the symphysis pubis. A 5 mm slice thickness was employed for axial imaging, while 1.5 mm was utilized for tracking reconstruction. The ureteral tracking technique offers an extensive visualization of the urinary tract, facilitating in the detection of stones and obstructions. A reduced slice thickness improves image clarity and elucidates anatomical details. The application of a thin slice thickness (≤1.5 mm) is essential for enhancing picture clarity, facilitating in the identification of small, and minimizing interpretative inaccuracies. Consequently, the use of ureteral tracking reconstruction with a thin slice thickness is highly recommended as a standard practice for urological CT scans in kidney stone cases.

BackgroundUreteral reimplantation plays a crucial role in distal ureteral reconstruction, and the integration of robotic systems has greatly enhanced minimally invasive surgical techniques. This pilot study aims to evaluate the technically feasibility and safety of the newly developed KangDuo Surgical Robot-01 (KD-SR-01) system in performing robot-assisted ureteral reimplantation.MethodsThis prospective, single-center, single-arm pilot study was conducted from February 2022 to June 2024. Thirty-one ureteral reimplantation procedures were performed using the KD-SR-01 system. We collected the patients’ characteristics, perioperative data and follow-up findings prospectively. We used the NASA-TLX (National Aeronautics and Space Administration Task Load Index) to assess ergonomics.ResultsAll 31 procedures were completed successfully without conversion. The median operative time was 153 min (IQR, 136–178.5 min). The median estimated blood loss was 20 mL (IQR, 15–35 mL). No patients needed blood transfusions during the operation. No severe complications occurred either intraoperatively or postoperatively. The median postoperative hospital stay was 4 days (IQR, 4–4 days). At a median follow-up of 22 months (IQR, 13–35 months), the subjective success rate was 96.8% (95% confidence interval: 83.3–99.9%). The surgeon indicated a high level of comfort, with a NASA-TLX global score of 9.47 ± 4.97.ConclusionsThe KD-SR-01 system is technically feasible and safe for robot-assisted ureteral reimplantation.Trial registrationThis study was registered at www.chictr.org.cn (ChiCTR2200056553) on February 7, 2022.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12893-025-03216-w.

To evaluate the clinical efficacy of minimally invasive ureteral reconstruction for benign strictures and analyze its impact on health-related quality of life (HRQoL) and psychological status. This retrospective study included 29 patients undergoing robotic/laparoscopic ureteral reconstruction at our institution. Surgical outcomes were assessed through imaging, laboratory parameters, and patient-reported outcomes assessed via the validated SF-36 quality-of-life instrument and Hospital Anxiety and Depression Scale (HADS) psychological distress screening tool. With a median follow-up of 12 months, the surgical success rate was 96.6%. The perioperative complication rate was 6.90% (2 cases of transient high fever), with no severe adverse events observed. Preoperative SF-36 scores in physical functioning (PF) and bodily pain (BP) domains were significantly lower than those of the general population (p < 0.001). Postoperatively, except for vitality(VT) and mental health (MH) domains which surpassed population norms, scores in other dimensions showed no significant differences compared to the general population (p > 0.05). Notably, all SF-36 domains demonstrated significant improvement from baseline (p < 0.05). Additionally, both anxiety and depression scores assessed by HADS decreased markedly after surgery (p < 0.05). Minimally invasive ureteral repair and reconstruction effectively relieves obstruction, improves renal function, and significantly enhances health-related quality of life and psychological well-being, representing a safe therapeutic option for benign ureteral strictures. Surgical intervention reduces the need for long-term stent or nephrostomy placement, thereby alleviating physical and psychological burdens. Further studies with expanded cohorts and extended follow-up durations are warranted to validate long-term outcomes.

ObjectivesPatients with a poorly functioning kidney, defined as less than 20% differential renal function, have historically been considered poor candidates for ipsilateral ureteral reconstruction for stricture. To determine if renal function can be safely preserved in poorly functioning kidneys with ureteral stricture, we evaluated patient outcomes following ureteral reconstruction.MethodsWe conducted a review of 114 adult patients who underwent ureteral reconstructive surgery at our institution between 2013 and 2023. Patients with poorly functioning ipsilateral kidneys were identified by a preoperative renal scan (MAG3 renogram). Variables of interest included patient characteristics, peri/postoperative outcomes, resolution of hydronephrosis, pre/postoperative renal function, and preservation of renal parenchyma.ResultsOf the 8 patients meeting inclusion criteria, 5 underwent bladder elongation psoas hitch (BEPH), 1 ileal ureter, 1 ileal ureter with BEPH, and 1 ureteroureterostomy. Median preoperative differential renal function was 16.0% with a median preoperative serum creatinine (sCr) of 1.70 mg/dL before decompression and 1.35mg/dL after percutaneous nephrostomy tube (PCN) placement. Preoperative median average renal parenchyma thickness (RPT) was 14.5mm. At 6-month follow-up, median sCr and RPT were preserved at 1.25mg/dL (p= 0.084) and 14.3 mm (p=0.41), respectively. At median follow-up of 49.2 months, all patients had a successful repair, defined as no reinsertion of stent/PCN, resolution of hydronephrosis, and no return to the operating room for revision or nephrectomy. Median sCr at last follow-up showed sustained improvement at 1.22 (p=0.0097).ConclusionsReconstruction can be successful for obstructed kidneys with less than 20% differential function and may be considered prior to nephrectomy.

BackgroundUreteral stricture is caused by iatrogenic and non-iatrogenic factors. The treatment of ureteral stricture usually involves ureteral reconstruction. This study aimed to identify and analyze the top 100 most cited (T100) papers in ureteral stricture reconstruction, a field lacking prior bibliometric analysis.MethodsUsing the Web of Science Core Collection, we retrieved the T100 articles and review articles on ureteral stricture reconstruction and applied bibliometric tools (CiteSpace, VOSviewer, Bibliometrix) to examine citation patterns, authorship, geographic distribution, journal distribution, co-citation networks, and keyword trends.ResultsThe T100 articles received 4 to 130 citations each, with an average of 25.13. Publications originated from 23 countries, with the USA leading (56 papers, 1,635 total citations) followed by China (17 papers). Temple University (USA, 12 papers) and Peking University (China, 9 papers) were among the most productive institutions. Daniel D. Eun was the top contributing author (12 papers). Urology, Journal of Endourology, and Journal of Urology were the most productive journals. Topic and keywords analysis shows the hot spots of mucosa grafts and robot-assisted surgery.ConclusionsOur study provides a comprehensive overview of influential literature in ureteral stricture reconstruction. Ureteral stricture reconstruction is an emerging research field. Mucosa grafts and robot-assisted surgery are likely to be hot topics in the future.

Comparative analysis of KangDuo surgical robot versus da Vinci surgical system in classic and complex ureteral reconstruction surgery: A double-center prospective cohort study

BackgroundOmentum has a wide application value in ureteroplasty, however, some specific situations limit its clinical application. Therefore, we modified the application method of omentum and proposed a new method named omental covering (OC) technique. This study aims to systematically evaluate the safety and efficacy of OC technique in robot-assisted lingual mucosa graft ureteroplasty (RA-LMGU).MethodsWe conducted a retrospective analysis of data from 79 patients who underwent RA-LMGU between June 2021 and October 2024 at two hospitals. Patients were divided into two groups according to the method of omental application: the omental wrapping (OW) group and the OC group. Perioperative and follow-up data were collected.ResultsA total of 79 patients were included, with 24 in the OW group and 55 in the OC group. The median ureteral stricture length was 4.3 [interquartile range (IQR), 3.7, 6.0] cm in the OW group and 3.0 (IQR, 2.1, 4.0) cm in the OC group (P<0.001). The median operative time was 181 (IQR, 139, 217) min in the OW group and 150 (IQR, 110, 198) min in the OC group (P=0.06). The median postoperative stay was 7 (IQR, 7, 8) days in the OW group and 6 (IQR, 5, 7) days in the OC group (P<0.001). The median follow-up time was 32 (IQR, 26, 39) months in the OW group and 11 (IQR, 4, 16) months in the OC group (P<0.001). It is worth noting that both groups achieved a 100% surgical success rate.ConclusionsThese short-term follow-up results demonstrated that the OC technique is also safe and effective in ureteral repair and reconstruction using lingual mucosa graft and it can reduce postoperative stay.

IntroductionComplex proximal ureteral strictures can pose significant surgical challenges, including long or obliterated strictures, inability to perform primary anastomotic repairs, fixed renal pelvis, impaired vascular supply from prior surgeries, and poor healing of the proximal ureter. We describe a novel surgical technique for addressing these issues.MethodsOur technique involves a combination of ureterolysis, renal pelvis flap creation, and buccal mucosal grafting. The procedure commences with exposure of the renal pelvis, creation of a U-shaped renal pelvis flap as the posterior plate and a buccal mucosa graft as the anterior plate. The omentum is then secured to provide a vascular bed for the graft.ResultsA total of 4 patients were included, with a mean age of 49 years. The median operating time was 4.08 h. The median post-operative length of stay was 1.5 days. At initial mean radiographic follow-up period of 3.2 months the success rate of the reconstruction was 100% with all patients demonstrating complete resolution of symptoms and radiographic improvement. Long-term follow-up was on average 22.3 months with sustained stability/improvement in radiographic hydronephrosis and symptoms, with no evidence of stricture recurrence. There were no donor site complications.ConclusionThis novel surgical technique, involving ureteroplasty with a renal pelvis flap augmentation and buccal mucosal graft (RPFA-BMG), proves effective for complex proximal ureteral reconstruction. It is particularly suitable for long proximal obliterated strictures that require a combination of tissue transfer techniques for successful ureteral reconstruction and achievement of physiologic drainage.