Vangeneugden Joris, Lavagno Federico, Berquin Camille, Desender Liesbeth, Van Laecke Steven, Oderda Marco, Allasia Marco, Breda Alberto, Van Praet Charles, Decaestecker Karel, Gontero Paolo
Department of Urology, Ghent University Hospital, ERN eUROGEN accredited center, Ghent, Belgium.
Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Eur Urol Open Sci. 2025 Jun 3;77:23-28. doi: 10.1016/j.euros.2025.05.007. eCollection 2025 Jul.
Ureteral stenosis following renal transplantation can occur in up to 10% of patients. Initial management, after kidney drainage, may include endoscopic balloon dilation ± laser incision. In case of recurrence after a primary endourological approach, strictures >1-3 cm, or complex anatomy in transplant patients, ureteral reconstruction should be performed. A robotic approach may reduce morbidity in this fragile population. We describe our case series of robot-assisted surgical treatments for ureteral stenosis in kidney transplant patients.
We included 29 renal transplant patients who suffered from ureteral stenosis in whom ureteral reconstruction was performed at three referral centers from November 2019 to March 2024. Different approaches were used: ureteroneocystostomy (with or without an antireflux tunnel or a Boari flap), ureteroureterostomy, and pyeloureterostomy using the native ureter (ipsilateral or contralateral).
All cases were performed using the Da Vinci Xi robotic system and completed successfully without intraoperative complications. The median pre- and postoperative (3 mo) glomerular filtration rates were 45 (interquartile range [IQR] 31-60) and 46 (IQR 31-58) ml/min, respectively. The median hospital stay was 4 (IQR 3-6) d. Postoperative complications were limited (21% Clavien-Dindo ≤2 and 10% Clavien-Dindo ≥3). Of 29 patients, 28 (97%) were free from nephrostomy or JJ stent at a median follow-up of 18 (IQR 13-34) mo. Our retrospective findings advocate confirmation through prospective data.
We demonstrate the safety and feasibility of robot-assisted ureteral reconstruction in kidney transplant patients with ureteral stenosis, allowing high-quality realignment of the urinary tract, quick recovery with a low complication rate, and good preservation of renal function in this fragile population.
We demonstrate several robot-assisted ureteral reconstruction options for kidney transplant patients suffering from ureteral stenosis. We found these techniques to be safe and effective, with low complication rates and good preservation of the renal function.
肾移植后输尿管狭窄在高达10%的患者中可能发生。在肾脏引流后的初始治疗可能包括内镜下球囊扩张±激光切开。如果在初次腔内治疗后复发、狭窄长度>1 - 3厘米或移植患者解剖结构复杂，则应进行输尿管重建。机器人手术方法可能会降低这类脆弱人群的发病率。我们描述了我们对肾移植患者输尿管狭窄进行机器人辅助手术治疗的病例系列。
我们纳入了29例患有输尿管狭窄的肾移植患者，他们于2019年11月至2024年3月在三个转诊中心接受了输尿管重建手术。采用了不同的方法：输尿管膀胱吻合术（有或无抗反流隧道或Boari瓣）、输尿管输尿管吻合术以及使用自体输尿管（同侧或对侧）的肾盂输尿管吻合术。
所有病例均使用达芬奇Xi机器人系统完成，手术成功，无术中并发症。术前和术后（3个月）肾小球滤过率的中位数分别为45（四分位间距[IQR]31 - 60）和46（IQR 31 - 58）ml/分钟。中位住院时间为4（IQR 3 - 6）天。术后并发症有限（21% Clavien - Dindo≤2级，10% Clavien - Dindo≥3级）。在29例患者中，28例（97%）在中位随访18（IQR 13 - 34）个月时无需肾造瘘或留置双J管。我们的回顾性研究结果有待前瞻性数据证实。
我们证明了机器人辅助输尿管重建在患有输尿管狭窄的肾移植患者中的安全性和可行性，能够实现尿路的高质量重新排列，恢复快，并发症发生率低，并能在这类脆弱人群中良好地保留肾功能。
我们展示了几种针对患有输尿管狭窄的肾移植患者的机器人辅助输尿管重建方案。我们发现这些技术安全有效，并发症发生率低，且能良好地保留肾功能。
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