Effectiveness of the Ureteral Illuminating Catheter in Securing Adhesive Ureters in Robot-Assisted Ureteral Reconstruction.

Abstract

Objective: Ureteral strictures, a common complication of ureteral stone treatment, pose substantial challenges. These conditions often necessitate robot-assisted ureteral reconstruction (RUR), a procedure complicated by difficulty in identifying and mobilizing adhesive ureters. This study evaluated the effectiveness of a ureteral illuminating catheter (IRIS U-kit) in enhancing visualization and securing adhesive ureters during RUR.

Methods: This retrospective cohort study included 24 patients who underwent RUR for stone-related ureteral strictures at two academic centers in Japan between April 2022 and June 2024. The patients were divided into two groups: those with the IRIS catheter and those with conventional indocyanine green (ICG) and near-infrared fluorescence imaging. The primary endpoint was a stent-free status with preserved renal function. Secondary outcomes included surgical time and postoperative recovery metrics.

Results: Each group included 12 patients during the study period. The IRIS catheter group demonstrated a 54% reduction in ureter securing time (38.0 vs. 82.5 min, p = 0.001) and a 33-min shorter console duration (144.0 vs. 177.0 min, p = 0.005) than the ICG group. All patients in both groups achieved a stent-free status by 6-7 weeks postoperatively, with no significant differences in serum creatinine levels or estimated glomerular filtration rates between the preoperative and postoperative periods. Additionally, both groups showed significant improvement in hydronephrosis, with moderate to severe grades decreasing from 41.7% preoperatively to 8.3% postoperatively.

Conclusion: The IRIS catheter significantly enhanced the efficiency of RUR by improving the visualization of adhesive ureters without compromising the ability to observe other anatomical structures.