Shin Dongho, Kang San, Rhew Seung Ah, Yoon Chang Eil, Moon Hyong Woo, Park Yong Hyun, Cho Hyuk Jin
Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Investig Clin Urol. 2025 Jan;66(1):18-26. doi: 10.4111/icu.20240308.
To evaluate the feasibility of robot-assisted ureteral reconstruction as a minimally invasive alternative to open surgery for managing ureteric complications in transplanted kidneys.
From January 2020 to December 2023, robot-assisted ureteral reconstruction was performed on fifteen kidney transplant patients with vesicoureteral reflux (VUR) or ureteral stricture who had previously failed endoscopic treatments.
Twelve females and three males, with a mean age of 48.6±6.6 years, were included in the study. Nine patients (60.0%) underwent surgery due to VUR (grade III or higher) of the transplanted kidney, and six patients (40.0%) had transplanted ureteral strictures. Postoperative voiding cystourethrogram (VCUG) was performed at 3.2±1.6 months. Seven patients (77.8%) became VUR-free, while two patients (22.2%) had VUR regression from grade IV to I. All six patients who underwent reconstruction due to anastomosis site stricture became stenosis-free without the need for an indwelling ureteral catheter. In cases where the ureter was too short for reimplantation, a Boari flap or end-to-end anastomosis with the native ureter was performed. The mean hospital stay was 5.9±4.5 days. The urethral catheter was removed after 15.1±5.4 days, and the ureteral catheter was removed after 4.9±1.5 weeks. The mean follow-up period was 23.9±6.8 months, with no additional interventions required after surgery. No complications above Clavien-Dindo grade I were recorded.
Robotic ureteral reconstruction is technically feasible and offers an effective, minimally invasive treatment for ureteric complications in kidney transplant patients, serving as an alternative to open surgery.
评估机器人辅助输尿管重建术作为开放手术的微创替代方案，用于处理移植肾输尿管并发症的可行性。
2020年1月至2023年12月，对15例既往内镜治疗失败的肾移植患者进行了机器人辅助输尿管重建术，这些患者存在膀胱输尿管反流（VUR）或输尿管狭窄。
研究纳入12例女性和3例男性，平均年龄48.6±6.6岁。9例患者（60.0%）因移植肾VUR（III级或更高）接受手术，6例患者（40.0%）存在移植输尿管狭窄。术后3.2±1.6个月进行排尿性膀胱尿道造影（VCUG）。7例患者（77.8%）无VUR，2例患者（22.2%）的VUR从IV级降至I级。所有6例因吻合口狭窄接受重建的患者均无狭窄，无需留置输尿管导管。在输尿管过短无法再植的情况下，进行了Boari瓣或与自体输尿管端端吻合。平均住院时间为5.9±4.5天。术后15.1±5.4天拔除尿道导管，4.9±1.5周拔除输尿管导管。平均随访期为23.9±6.8个月，术后无需额外干预。未记录到Clavien-Dindo I级以上的并发症。
机器人输尿管重建术在技术上是可行的，为肾移植患者的输尿管并发症提供了一种有效、微创的治疗方法，可作为开放手术的替代方案。
