Ann Surg Oncol. 2026 Feb 16. doi: 10.1245/s10434-026-19224-w. Online ahead of print.
ABSTRACT
BACKGROUND: Ureteroileal anastomotic strictures (UASs) occurring after radical cystectomy (RC) with ileal conduit (IC) diversion that are not amenable to endoscopic management often necessitate surgical repair. This study aimed to describe the authors’ stepwise approach to robotic surgical repair of UAS and to assess the feasibility, safety, and long-term efficacy of robotic reimplantation for UAS after RC.
METHODS: A retrospective cohort study analyzed 103 patients who underwent radical cystectomy and subsequently experienced UAS between January 2015 and September 2022, all of whom received a robot-assisted laparoscopic ureteroileal bypass repair technique. The primary endpoints were the collection of perioperative variables and the evaluation of postoperative outcomes such as complications, functional outcomes, and the need for further interventions. Data were analyzed using descriptive statistics to summarize patient characteristics and outcomes.
RESULTS: The study identified 103 patients and 112 renal units, of which 31 had right-sided, 61 had left-sided, and 9 had bilateral strictures. The mean time from cystectomy to stricture diagnosis was 11.5 ± 3.5 months, and the average time from diagnosis to robotic revision was 10.4 ± 2.4 months. Malignancy was excluded in all strictures. The mean stricture length was 2.2 ± 1.2 cm. The mean operative time was 130.4 ± 28.6 min, with a mean estimated blood loss of 67.5 ± 15.3 ml and a mean hospital stay of 5.0 ± 1.5 days. The 30-day complication rates was 15.6 %, and the 30- to 90-day complication rate was 0, with all complications classified as Clavien grade 1 or 2. During a median follow-up period of 24.3 months, the stricture recurrence rate was 5.8 % and the median time to stricture recurrence was 245 days (interquartile range [IQR], 136-584 days).
CONCLUSIONS: Robotic reimplantation with a bypass technique after radical cystectomy is a safe and feasible approach for treating ureteroileal stricture. This method demonstrated promising outcomes and warrants further validation through larger prospective studies.
PMID:41697474 | DOI:10.1245/s10434-026-19224-w
