Ureteral stricture disease is a frequent and complex problem in urological practice, most commonly arising from iatrogenic injury. Although its exact incidence is difficult to determine, reported rates range from 0.3–2.5% following gynaecological surgery, approximately 3% after ureteroscopy, and up to 1.2% after pelvic radiotherapy. Management is influenced by stricture location, aetiology and patient-specific factors, with ureteral reimplantation remaining the standard treatment for distal ureteral strictures. Traditionally, ureteral reimplantation has been performed using an open surgical approach. Advances in minimally invasive surgery led to the introduction of laparoscopic techniques in the 1990s and robot-assisted surgery in the early 2000s. Despite increasing utilisation of robotic platforms, open reimplantation continues to be regarded as the gold standard, and current guidelines do not explicitly recommend a robotic approach. While comparative studies between laparoscopic and robotic techniques, particularly in paediatric vesicoureteral reflux, are abundant, direct comparisons between open and robotic reimplantation in adults with ureteral strictures remain limited and heterogeneous. Available evidence suggests that robotic ureteral reimplantation offers perioperative advantages, including reduced blood loss and shorter hospital stay. These benefits are likely attributable to improved visualisation, enhanced instrument dexterity and adjunctive technologies such as indocyanine green fluorescence and intraoperative ureteroscopy. However, differences in operative time and complication rates are inconsistent across studies. Importantly, stricture recurrence rates appear comparable between open and robotic approaches, supporting the non-inferiority of robotic surgery rather than demonstrating clear superiority. Long-term morbidity, including flank pain, recurrent urinary tract infections, lower urinary tract symptoms and symptomatic reflux, remains underreported and is substantial regardless of surgical technique. Patients with prior pelvic radiotherapy demonstrate higher failure rates and require careful counselling. Overall, robotic ureteral reimplantation represents a safe and effective alternative to open surgery, though robust long-term comparative data are needed to define its precise role.
Robotic vs. open ureteral reimplantation
Reviewed by Asif H Ansari
Robotic vs. open ureteral reimplantation: A retrospective comparative single-centre series.
