Robot-assisted uretero-ureterostomy for iatrogenic lumbar and iliac ureteral stricture: Technical details and preliminary clinical results

Nicolmaria Buffi, Andrea Cestari, Giovanni Lughezzani, Piera Bellinzoni, Mattia Sangalli, Emanuele Scapaticci, Matteo Zanoni, Filippo Annino, Alessandro Larcher, Massimo Lazzeri, Patrizio Rigatti, Giorgio Guazzoni

Research output: Contribution to journalArticlepeer-review


Background: Although the incidence of iatrogenic ureteral strictures is low, the treatment remains challenging. Objective: To report our technique of robot-assisted uretero-ureterostomy (RAUU) for adults with iatrogenic lumbar and iliac stricture. Design, setting, and participants: A descriptive study was performed by our department. Since April 2009, five patients underwent RAUU: Two patients had developed a lumbar or iliac ureteral stricture following a ureterorenoscopy, one had ureteral catheter positioning, one had colon surgery, and one had resection of retroperitoneal cystic lymphangioma. Preoperative evaluation includes history, computed tomography (CT) scan, and mercaptoacetyltriglycine-3 (MAG3) diuretic renal scan. Surgical procedure: A flank position was used for all patients with lumbar stenosis. A supine position with the bed turned 30° was required for iliac stricture. The optical port, two 8-mm robotic ports, and one 5-mm assistant port were used. A precise definition of the site and extension of the stricture was done using the flexible ureterorenoscope. After the stricture resection, the anastomosis was performed with two running sutures on a ureteral double-J stent. Measurements: Success was defined as no postoperative symptoms and evidence of no obstruction at the CT/urography and at the MAG3 scan at 6-mo follow-up. Results and limitations: RAUU was technically feasible in all five patients. Average operating time was 135 min, and median hospital stay was 3 d. No significant complications occurred. Absence of stricture recurrence and no reduction of kidney function were confirmed by CT/urography and MAG3 scans. At a mean follow-up of 8 mo, all patients were asymptomatic. The main limitations were the short follow-up and the small sample size. Conclusions: RAUU is feasible and safe for repairing iatrogenic lumbar and iliac ureteral strictures. The flexible ureterorenoscopy is useful to localise the obstruction and to correctly define its site and extension to spare as much ureter as possible.

Original languageEnglish
Pages (from-to)1221-1225
Number of pages5
JournalEuropean Urology
Issue number6
Publication statusPublished - Dec 2011


  • Robotic surgery
  • Ureteral reconstruction
  • Ureteral stenosis

ASJC Scopus subject areas

  • Urology


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