Management of recurrent ureteral stricture: a retrospectively comparative study with robot-assisted laparoscopic surgery versus open approach

Qing Wang; Yuchao Lu; Henglong Hu; Jiaqiao Zhang; Baolong Qin; Jianning Zhu; Najib Isse Dirie; Zongbiao Zhang; Shaogang Wang

doi:10.7717/peerj.8166

Management of recurrent ureteral stricture: a retrospectively comparative study with robot-assisted laparoscopic surgery versus open approach

PeerJ. 2019 Dec 4:7:e8166. doi: 10.7717/peerj.8166. eCollection 2019.

Authors

Qing Wang¹, Yuchao Lu¹, Henglong Hu¹, Jiaqiao Zhang¹, Baolong Qin¹, Jianning Zhu¹, Najib Isse Dirie¹, Zongbiao Zhang¹, Shaogang Wang¹

Affiliation

¹ Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Abstract

Background: Management of recurrent ureteral stricture is challenging. Consensus on the best surgical choice has not been demonstrated. In this study, we aim to report our experience in treating recurrent ureteral stricture and demonstrate whether robot-assisted procedure for redo ureteral surgery is as effective as open procedure while remaining less invasive.

Methods: We retrospectively assessed 41 patients (22 robot-assisted surgeries and 19 open surgeries) who underwent consecutive robot-assisted and open procedures for redo ureteral surgery from January 2014 to 2018 in our institution. Perioperative outcomes, including demographics, operative time, estimated blood loss, complications, pain scores, success rate and cost, were compared between two groups.

Results: There was no significant intergroup difference in terms of age, body mass index, gender composition and American Society of Anesthesiologists scores. A total of 31 patients underwent redo pyeloplasty and ten underwent redo uretero-ureterostomy. Compared with open group, robot-assisted group showed shorter operative time (124.55 min vs. 185.11 min, p < 0.0001), less estimated blood loss (100.00 mL vs. 182.60 mL, p = 0.008) and higher cost (61161.77¥ vs. 39470.79¥, p < 0.0001). Complication rate and pain scores were similar between two groups. Median follow-up periods were 30 and 48 months for robot-assisted and open group respectively. Success rate in the robot-assisted (85.71%) and the open group (82.35%) was not significantly different.

Conclusions: Robot-assisted surgery for recurrent stricture after previous ureteral reconstruction is as effective as open procedure and is associated with shorter operative time and less estimated blood loss.

Keywords: Open surgery; Recurrent ureteral stricture; Robotic surgery; Ureteral reconstruction.

Grants and funding

This work was supported by the National Key Research and Development Program of China (No. 2016YFC0902601). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.