Validation of robotic-assisted ureteroplasty with buccal mucosa graft for stricture at the proximal and middle ureters: the first comparative study

Yang, Che‐Hsueh; Lin, Yi‐Sheng; Weng, Wei Chun; Lu, Chin Heng; Hsu, Chao‐Yu; Tung, Min‐Che; Ou, Yen Chuan

doi:10.1007/s11701-021-01331-3

Cited by 7 publications

(6 citation statements)

References 21 publications

(18 reference statements)

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“…Finally, 23 studies with a total of 825 patients met the eligibility criteria for our meta‐analysis [11–18,22–36]. A total of 13 studies with 607 patients presented their experience with IUR, and 10 studies with 218 patients described OMGU for the treatment of ureteric stricture (Table 1) [11–18,22–36]. The median (range) sample size per study was 19 (9–108).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 4031 references were identified for the initial search. After removing duplicate references and screening the Finally, 23 studies with a total of 825 patients met the eligibility criteria for our meta-analysis [11][12][13][14][15][16][17][18][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. A total of 13 studies with 607 patients presented their experience with IUR, and 10 studies with 218 patients described OMGU for the treatment of ureteric stricture (Table 1) [11][12][13][14][15][16][17][18][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36].…”

Section: Search Resultsmentioning

confidence: 99%

“…But in the past, patients with long proximal or middle ureteric strictures had to undergo this surgery to get rid of JJ stents or nephrostomy tubes [15]. Recently, OMGU has received more attention and obtained encouraging results [12,[16][17][18], which may bring about some changes in the management of ureteric strictures. Therefore, we conducted a systematic review and meta-analysis to analyse the efficacy and safety of the above two surgical methods for the management of ureteric strictures.…”

Section: Introductionmentioning

confidence: 99%

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Oral mucosal graft ureteroplasty versus ileal ureteric replacement: a meta‐analysis

et al. 2023

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ObjectivesTo describe outcomes of oral mucosal graft ureteroplasty (OMGU) and ileal ureter replacement (IUR) and determine the relative merits of both procedures. MethodsDatabases (including PubMed, Embase and Cochrane) were interrogated for eligible trials that assessed outcomes of OMGU or IUR from 2000 to 30 July 2022. The variables analysed were reconstruction success rates, stricture length, hospital stays, perioperative complications and long-term complications. ResultsA total of 23 single-arm studies were included. The pooled reconstruction success rates for OMGU and IUR were 94.9% (95% confidence interval [CI] 91.0%-97.7%) and 85.8% (95% CI 81.0%-90.0%), respectively. Stricture length of patients in the OMGU and IUR groups were 3.73 (95% CI 3.17-4.28) and 11.55 (95% CI 9.82-13.29) cm, respectively. The maximal stricture length repaired by OMGU was 8 cm. The hospital stays were 5.85 (95% CI 3.88-7.82) and 11.55 (95% CI 6.93-16.17) days in the OMGU and IUR groups, respectively. The incidences of low-grade postoperative complications were 13.6% (95% CI 6.9%-20.3%) and 27.3% (95% CI 19.5%-35.1%), high-grade postoperative complications were 4.6% (95% CI 1.8I-8.5%) and 13.0% (95% CI 9.4%-17.1%), and long-term complications (occurred at > 3months) were 9.0% (95% CI 1.7%-20.0%) and 35.4% (95% CI 25.8%-45.6%) in the OMGU and IUR groups, respectively. ConclusionAn OMGU is an effective, minimally invasive, and safe alternative to IUR for the management of long ureteric strictures. OMGU was the preferred treatment for long ureteric strictures, especially obstructed ureter segments of ≤8 cm.

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Section: Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oral mucosal graft ureteroplasty versus ileal ureteric replacement: a meta‐analysis

et al. 2023

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“…Our study is not free of limitations. Nowadays, BMG ureteroplasty is performed by the robotic approach in experienced hands, and there is enough literature to support this [ 22 – 24 ]. As the majority of our depicted patients already had open reconstructive surgery before the BMG ureteroplasty, an open approach was attempted to establish the procedure in our department.…”

Section: Discussionmentioning

confidence: 99%

Ureteroplasty with buccal mucosa graft without omental wrap: an effective method to treat ureteral strictures

Engelmann,

Yang,

Pickl

et al. 2024

World J Urol

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Purpose Successful treatment options for ureteral strictures are limited. Surgical options such as ileal interposition and kidney autotransplantation are difficult and associated with morbidity and complications. Techniques such as Boari flap and psoas hitch are limited to distal strictures. Only limited case studies on the success of open buccal mucosa graft (BMG) ureteroplasty exist to this date. The purpose of this study was to evaluate the success of open BMG ureteroplasty without omental wrap. Methods In this single-center retrospective study between July 2020 and January 2023, we included 14 consecutive patients with ureteric strictures who were treated with open BMG ureteroplasty without omental wrap. The primary outcome was the success of open BMG ureteroplasty. Further endpoints were complications and hospital readmission. Outcome variables were assessed by clinical examination, kidney sonography, and patient anamnesis. Results Out of 14 patients, 13 were stricture and ectasia-free without a double-J stent at a median follow-up of 15 months (success rate 93%). No complications were observed at the donor site, and the complication rate overall was low with 3 out of 14 patients (21%) having mild-to-medium complications. Conclusions Open BMG ureteroplasty without omental wrap is a successful and feasible technique for ureteric stricture repair.

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“…Further studies comparing BMG ureteroplasty to ureteral stenting alone have shown superior outcomes with BMG grafting, validating its utility. In 2021, Yang conducted a two-phase study comparing BMG ureteroplasty to ureteral stenting alone [13]. Prior to definitive repair, patients underwent 6 months of ureteral stenting for their stricture.…”

Section: Discussionmentioning

confidence: 99%

Robotic Buccal Mucosa Graft Ureteroplasty for Complex Ureteral Stricture Disease: Early Outcomes at a Single Institution

2024

J Surg

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Background: Complex ureteral stricture disease is a challenging surgical problem. Traditional approaches, such as ileal ureter interposition or renal auto-transplantation, have significant associated morbidity. Robotic Buccal Mucosal Graft Ureteroplasty (RBMGU) is an alternative technique for managing complex ureteral stricture disease. This study aims to establish the safety and efficacy of RBMGU in managing Complex Ureteral Stricture Disease (CUSD). Materials & Methods:A retrospective analysis of ten patients with benign CUSD who underwent RBMGU between 2019 and 2023 was conducted. Patient selection criteria included imaging evaluation, patient characteristics, and intraoperative findings. Demographic data, perioperative variables, and follow-up outcomes were analyzed using descriptive statistics. The primary outcome measure was successful stricture repair, defined as resolution of flank pain without the need for secondary intervention. Secondary outcomes included radiographic evidence of upper tract urinary obstruction resolution.Results: All ten patients underwent technically successful RBMGU performed by a single surgeon. Ureterolithiasis was the etiology in nine cases, with one case involving prior retroperitoneal radiation. Prior interventions included ureteroscopy (n=7), ureteral balloon dilation (n=3), and failed robotic pyeloplasty (n=1). Strictures were predominantly in the proximal ureter (n=7). At a median followup of 10 months, 80% of patients reported pain resolution, while the remaining 20% showed improvement. Eight patients exhibited no evidence of obstruction on follow-up MAG3 renal scans. Median stricture length was 3.0 centimeters, with median operating room time of 301 minutes and estimated blood loss of 25 cc. No significant intraoperative complications were observed. Conclusion:These findings indicate that RBMGU is a feasible and effective approach for managing CUSD, suggesting its potential for adoption by community-based robotic urologists.

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Validation of robotic-assisted ureteroplasty with buccal mucosa graft for stricture at the proximal and middle ureters: the first comparative study

Cited by 7 publications

References 21 publications

Oral mucosal graft ureteroplasty versus ileal ureteric replacement: a meta‐analysis

Oral mucosal graft ureteroplasty versus ileal ureteric replacement: a meta‐analysis

Ureteroplasty with buccal mucosa graft without omental wrap: an effective method to treat ureteral strictures

Robotic Buccal Mucosa Graft Ureteroplasty for Complex Ureteral Stricture Disease: Early Outcomes at a Single Institution

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