Presented by: Chung Un Lee MD
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Introduction

 We present our experience of robotic salvage treatment with/without using buccal mucosa graft for the management of strictures of ureteropelvic junction and upper ureter.

Materials

 Between April 2018, and January 2023, 19 patients who underwent robotic salvage ureteroplasty with excision and primary anastomosis (RSU-EPA) and 15 patients who underwent robotic salvage ureteroplasty with buccal mucosa graft (RSU-BMG) for ureteropelvic junction and upper ureter were enrolled in this study. Patient demographics, peri-operative, and follow-up data including change in renal function and success rate were collected and compared. Clinical success was defined as the disappearance of preoperative symptoms including pain and preservation of renal function. Radiological success was defined as non-obstructive excretion in diuretic renal scan.

Results

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 Primary outcome of this study is success rate including clinical and radiological success. Prior failed reconstruction is more frequent in RSU-BMG compare with RSU-EPA (2(1-3) vs, 1(1-2), p = 0.021). Prior second treatment is more frequent in RSU-BMG compare with RSU-EPA (3(15.8%) vs, 9(60%), p = 0.007), and there were two patients (13.3%) in RSU-BMG and no patients in RSU-EPA with prior 3rd treatment. Console time is longer in RSU-BMG (208.6±72.7 vs, 262.5±64.2, p = 0.031). However other perioperative data including estimated blood loss, postoperative hospital stay and double J stent remove day were not significantly different between two groups. Complications occurred in two patient (10.5%) in RSU-EPA and three patients (20%) in RSU-BMG, but there was no statistical difference. Clinical success and radiological success rate is 89.5% and 94.7% in RSU-EPA, and 100% in RSU-BMG. There was no significant difference in estimated glomerular filtration rate and relative renal uptake between preoperative and postoperative 1-, 6-, and 12-month value in two groups.

Conclusion

 Both RSU-EPA and RSU-BMG are good treatment option for the management of strictures of ureteropelvic junction and upper ureter. Though there were not statistical difference in success rate, RSU-BMG showed promising results.

Funding

None

Lead Authors

Deok Hyun Han, MD,PHD
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Co-Authors

Junseop Kim, MD
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Jae Hoon Chung, MD,PHD
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea