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10.10.2020 | Urology - Original Paper

Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy

verfasst von: Sida Cheng, Shubo Fan, Jie Wang, Shengwei Xiong, Xinfei Li, Yangyang Xu, Zhihua Li, Hua Guan, Peng Zhang, Hongjian Zhu, Chen Huang, Lei Zhang, Kunlin Yang, Xuesong Li, Liqun Zhou

Erschienen in: International Urology and Nephrology | Ausgabe 3/2021

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Abstract

Purpose

To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios.

Methods

From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2–6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures.

Results

A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2–6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time (P = 0.008), shorter postoperative hospital stay (P = 0.011) but higher hospital cost (P < 0.001). At a mean follow-up of 12.8 months, the overall success rate was 94.3%. There was no difference in postoperative complications or the success rate between the approaches.

Conclusion

Laparoscopic and robotic onlay flap/graft ureteroplasty can be safe and feasible to repair long proximal/middle ureteral strictures while robotic procedures showed higher efficiency, faster recovery but higher cost. Our algorithmic strategies may provide beneficial references for their standardization and dissemination into clinical care.

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Titel: Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy
verfasst von: Sida Cheng
Shubo Fan
Jie Wang
Shengwei Xiong
Xinfei Li
Yangyang Xu
Zhihua Li
Hua Guan
Peng Zhang
Hongjian Zhu
Chen Huang
Lei Zhang
Kunlin Yang
Xuesong Li
Liqun Zhou
Publikationsdatum: 10.10.2020
Verlag: Springer Netherlands
Erschienen in: International Urology and Nephrology / Ausgabe 3/2021
Print ISSN: 0301-1623
Elektronische ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-020-02679-5

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Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy