ORIGINAL ARTICLE   

Minerva Urology and Nephrology 2025 February;77(1):69-78

DOI: 10.23736/S2724-6051.24.06009-9

Copyright © 2024 EDIZIONI MINERVA MEDICA

language: English

Robot-assisted redo ureteral reimplantation in adults after failed primary surgery: technique and outcomes from two centers

Liqing XU ¹, Xinfei LI ¹, Fangzhou ZHAO ¹, Zhihua LI ¹, Guanpeng HAN ¹, Wencong HAN ¹, Yaming GU ², Bing WANG ², Peng ZHANG ³, Wenzhi GAO ², Liang CUI ⁴, Liqun ZHOU ¹, Kunlin YANG ¹, Xuesong LI ¹ ✉

¹ Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China; ² Department of Urology, Beijing Miyun County Hospital, Beijing, China; ³ Department of Urology, Emergency General Hospital, Beijing, China; ⁴ Department of Urology, Civil Aviation General Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China

BACKGROUND: The aim of this study was to report our technical experience and mid-term outcomes of robot-assisted redo ureteral reimplantation in adults following failed primary ureteral reimplantation.
METHODS: Twelve patients underwent robot-assisted redo ureteral reimplantation from December 2020 to May 2022 at double centers. Surgical procedures included anti-reflux dismembered submucosal tunnel reimplantation, anti-reflux dismembered nipple reimplantation, and anti-reflux non-dismembered submucosal tunnel reimplantation. The perioperative variables were prospectively collected, and the outcomes were assessed.
RESULTS: Twelve patients underwent 13 robot-assisted redo ureteral reimplantations. Anastomotic stenosis was the primary cause of redo surgery, accounting for 83.3% of cases. Additionally, 83.3% of patients had received balloon dilation, stent placement, and other urological treatments after primary surgery. All patients successfully underwent robot-assisted redo ureteral reimplantation without conversion to open or laparoscopic surgery. All patients underwent anti-reflux technique, with 9 patients undergoing submucosal tunnel reimplantation (75%) and 3 nipple reimplantation (25%). Psoas hitch was required in eight patients (66.7%). The mean operative time was 129.3±29.0 minutes. The median postoperative hospitalization time was 3.0 (IQR, 3.0, 3.0) days. At a mean follow-up of 15.7±5.9 months, all patients achieved complete success with no severe complication. Two patients (16.7%) still experienced vesicoureteral reflux related symptoms postoperatively, which improved compared to preoperatively.
CONCLUSIONS: Robotic redo ureteral reimplantation is safe and effective. The success of redo surgery is attributed to preoperative nephrostomy, clearing the fibrous scar surrounding the ureter, appropriate selection of anti-reflux technique, and psoas hitch when needed.

KEY WORDS: Robotic surgical procedures; Ureter; Replantation; Adult