Robotic ileal ureter replacement vs kidney autotransplantation for long ureteric strictures
Por:
Afferi, L, Gallioli, A, Territo, A, Cannoletta, D, Mestdagh, K, Vangeneugden, J, Van Praet, C, Desender, L, Mercier, J, Prudhomme, T, Salamone, V, Fontana, G, Albisinni, S, Osswald, R, John, H, Etcheverry, B, Vigués, F, Doumerc, N, Minervini, A, Palou, J, Decaestecker, K, Breda, A
Publicada:
1 jun 2025
Ahead of Print:
1 mar 2025
Resumen:
Objective To compare functional and surgical outcomes of robot-assisted ileal ureter replacement (RAIUR) vs robot-assisted kidney autotransplantation (RAKAT). Patients and Methods This was a retrospective analysis of patients who underwent RAIUR or RAKAT for long ureteric strictures at eight European tertiary centres (2017-2024). Primary endpoints were maintenance of estimated glomerular filtration rate (eGFR) and postoperative complications within 30 days of surgery, described using the Clavien-Dindo classification. Secondary outcomes included infections, need for lifelong drainage, stricture persistence, and re-intervention for the stricture during follow-up. Results A total of 15 and 39 patients underwent RAIUR and RAKAT, respectively. The patients who underwent RAIUR were older (61 vs 45 years, P = 0.03), with more comorbidities (Charlson Comorbidity Index >= 3: 67% vs 28%, P = 0.03) and had a lower baseline eGFR (60 vs 87 mL/min/1.73m(2), P = 0.007). The median stricture length was 9.6 cm for RAIUR vs 7 cm for RAKAT. Patients who underwent RAIUR had a shorter surgical time (290 vs 355 min, P = 0.008), whereas those who underwent RAKAT had a shorter hospitalisation (5 vs 8 days, P = 0.001). Overall complications were higher after RAIUR (73% vs 31%, P = 0.01), but Clavien-Dindo Grade >= III complications were similar (13% vs 10%). During follow-up, both groups showed slightly improved renal function, low infection rates (13% for RAIUR vs 10% for RAKAT), low stricture persistence (13% for RAIUR vs 7.7% for RAKAT), and minimal need for drainage or re-intervention. The main limitation was the modest sample size. Conclusion In the first comparative analysis of RAIUR and RAKAT, we provide evidence that both techniques provide similar improvements in renal function and similar rates of postoperative high-grade complications. Both approaches represent definitive solutions for ureteric strictures in most patients. The choice of the technique should be based on patients' factors, patients' expectations and the surgeon's experience.
Filiaciones:
Afferi, L:
Fdn Puigvert, Dept Urol, Barcelona, Spain
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Luzerner Kantonssp, Dept Urol, Luzern, Switzerland
Kantonssp Aarau, Dept Urol, Aarau, Switzerland
Gallioli, A:
Fdn Puigvert, Dept Urol, Barcelona, Spain
Territo, A:
Fdn Puigvert, Dept Urol, Barcelona, Spain
Cannoletta, D:
Fdn Puigvert, Dept Urol, Barcelona, Spain
IRCCS San Raffaele Sci Inst, Div Oncol, Unit Urol, Unit Urol,Soldera Prostate Canc Lab, Milan, Italy
Mestdagh, K:
AZMM AZ Maria Middelares, Ghent, Belgium
Vangeneugden, J:
UZ Gent, Dept Urol, Ghent, Belgium
Van Praet, C:
UZ Gent, Dept Urol, Ghent, Belgium
Desender, L:
UZ Gent, Dept Urol, Ghent, Belgium
Mercier, J:
Hosp Toulouse, Dept Urol, Toulouse, France
Prudhomme, T:
Hosp Toulouse, Dept Urol, Toulouse, France
Salamone, V:
Univ Florence, Dept Expt & Clin Med, Unit Oncol, Florence, Spain
Fontana, G:
Fdn Puigvert, Dept Urol, Barcelona, Spain
Humanitas Univ, Sch Med, Milan, Italy
Albisinni, S:
Univ Tor Vergata, Dept Urol, Rome, Italy
Osswald, R:
Kantonssp Winterthur, Dept Urol, Winterthur, Switzerland
John, H:
Kantonssp Winterthur, Dept Urol, Winterthur, Switzerland
Etcheverry, B:
Hosp Bellvitge Princeps Espanya, Dept Urol, Bellvitge, Spain
Vigués, F:
Hosp Bellvitge Princeps Espanya, Dept Urol, Bellvitge, Spain
Doumerc, N:
Hosp Toulouse, Dept Urol, Toulouse, France
Minervini, A:
Univ Florence, Dept Expt & Clin Med, Unit Oncol, Florence, Spain
Palou, J:
Fdn Puigvert, Dept Urol, Barcelona, Spain
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Decaestecker, K:
AZMM AZ Maria Middelares, Ghent, Belgium
UZ Gent, Dept Urol, Ghent, Belgium
Breda, A:
Fdn Puigvert, Dept Urol, Barcelona, Spain
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
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