Robotic ureteral reconstruction for endometriosis-induced strictures: insights from a multi-institutional experience.

Purpose: To investigate outcomes of robotic ureteral reconstruction (RUR) in female patients with ureteral strictures caused by peri-ureteral endometriosis lesions.

Methods: We retrospectively reviewed our multi-institutional Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database to identify all consecutive patients undergoing RUR for surgical management of endometriosis-induced ureteral strictures between 2017 and 2022. Indications for surgery included female patients with radiographic evidence of ureteral strictures and/or decreasing renal function on renal scan. We performed a descriptives analysis of perioperative outcomes in patients who met inclusion criteria. Surgical success was defined as freedom from additional interventions for recurrent ureteral stenosis.

Results: Overall, 19 patients met the inclusion criteria. Median age was 39 (IQR 30-43) years. Ureteral strictures were located in the middle ureter in 4 (21.1%) patients and in the distal ureter in 15 (78.9%) patients. Fourteen (73.6%) patients had a known preoperative diagnosis of endometriosis. RUR techniques included refluxing reimplantation (47.4%), side-to-side reimplantation (21.1%), ureteroureterostomy (21.1%), and buccal mucosa graft ureteroplasty (10.5%). There was one (5.3%) major postoperative complication (Clavien > 2) in which a patient developed an intrabdominal abscess requiring drainage by interventional radiology. Five (26.3%) patients were ultimately diagnosed postoperatively with endometriosis based on surgical pathology. At a median follow-up of 22.5 (IQR 11.7-41.5) months, 18 (94.7%) patients were surgically successful.

Conclusion: Clinicians should maintain a high index of suspicion for endometriosis in premenopausal women with ureteral stricture disease. RUR techniques may be effective for the management of patients with ureteral strictures secondary to endometriosis.