Robotic ileal ureter replacement vs kidney autotransplantation for long ureteric strictures

IF 3.7 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International Pub Date : 2025-03-11 DOI:10.1111/bju.16704

Luca Afferi, Andrea Gallioli, Angelo Territo, Donato Cannoletta, Kenzo Mestdagh, Joris Vangeneugden, Charles Van Praet, Liesbeth Desender, Jeremy Mercier, Thomas Prudhomme, Vincenzo Salamone, Giovanni Fontana, Simone Albisinni, Ricardo Osswald, Hubert John, Begoña Etcheverry, Francesc Vigués, Nicolas Doumerc, Andrea Minervini, Joan Palou, Karel Decaestecker, Alberto Breda

{"title":"Robotic ileal ureter replacement vs kidney autotransplantation for long ureteric strictures","authors":"Luca Afferi, Andrea Gallioli, Angelo Territo, Donato Cannoletta, Kenzo Mestdagh, Joris Vangeneugden, Charles Van Praet, Liesbeth Desender, Jeremy Mercier, Thomas Prudhomme, Vincenzo Salamone, Giovanni Fontana, Simone Albisinni, Ricardo Osswald, Hubert John, Begoña Etcheverry, Francesc Vigués, Nicolas Doumerc, Andrea Minervini, Joan Palou, Karel Decaestecker, Alberto Breda","doi":"10.1111/bju.16704","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>To compare functional and surgical outcomes of robot-assisted ileal ureter replacement (RAIUR) vs robot-assisted kidney autotransplantation (RAKAT).</p>\n </section>\n \n <section>\n \n <h3> Patients and Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 15 and 39 patients underwent RAIUR and RAKAT, respectively. The patients who underwent RAIUR were older (61 vs 45 years, <i>P =</i> 0.03), with more comorbidities (Charlson Comorbidity Index ≥3: 67% vs 28%, <i>P</i> = 0.03) and had a lower baseline eGFR (60 vs 87 mL/min/1.73m<sup>2</sup>, <i>P</i> = 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, <i>P</i> = 0.008), whereas those who underwent RAKAT had a shorter hospitalisation (5 vs 8 days, <i>P</i> = 0.001). Overall complications were higher after RAIUR (73% vs 31%, <i>P</i> = 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.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"135 6","pages":"1031-1038"},"PeriodicalIF":3.7000,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJU International","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/bju.16704","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

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/1.73m², 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.

查看原文本刊更多论文

机器人回肠输尿管置换术与自体肾移植治疗长输尿管狭窄

比较机器人辅助回肠输尿管置换术（RAIUR）与机器人辅助肾自体移植（RAKAT）的功能和手术效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

BJU International 医学-泌尿学与肾脏学

CiteScore

9.10

自引率

4.40%

发文量

262

审稿时长

1 months

期刊介绍： BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.