Robotic ileal ureteral reconstruction for radiation-induced ureteral strictures in pelvic malignancy survivors: experience from a multi-institutional database

BACKGROUND: Chronic double-J stenting or nephrostomy dependence remains the default management for radiation-induced ureteral strictures (RIUS). This study aimed to evaluate the feasibility and clinical efficacy of robotic ileal ureter replacement (IUR) in managing RIUS with prior pelvic malignancy radiotherapy. METHODS: In our prospective multi-institutional RECUTTER database, 35 patients with a diagnosis of RIUS underwent robotic IUR between March 2019 and April 2024. Unilateral and bilateral procedures were performed with or without augmentation ileocystoplasty. Baseline characteristics, perioperative, and follow-up results of the patients were collected. Postoperative complications were evaluated using the Clavien-Dindo (CD) Classification system. RESULTS: All patients were female with a mean age of 49.46±8.25 year. Cervical carcinoma was the predominant primary malignancy for radiotherapy (85.7%). The median length of the ileal graft was 28 cm (range 15-45). The mean operative time was 331.6±112.3 min, and the median estimated blood loss was 50 mL (range 20-100). The mean postoperative hospitalization was 12.43±6.00 day. During the median follow-up of 20 months (range 12-74), 34 patients (97.1%) achieved clinical success. One case of surgical failure developed right ureteral restenosis post-bilateral IUR. Complications included short-term (20%: CD grade I 11.4%, grade II 8.6%) and long-term events (22.9%, all grade II). No grade ≥III complications occurred. CONCLUSIONS: Robotic IUR represents a feasible and effective option-for managing RIUS after pelvic malignancy radiotherapy, addressing surgical challenges posed by dense adhesions, retroperitoneal fibrosis, extensive bilateral strictures, and concurrent bladder contracture.