A decade's experience of robotic buccal ureteroplasty for post-ureteroscopic laser lithotripsy-induced strictures-Should this be the new standard?

Objective: To present the surgical technique of robotic buccal ureteroplasty for strictures after laser lithotripsy and its outcomes. Methods: This was a retrospective study conducted at the Department of Urology, Apollo Hospitals, Chennai, India from October 2012 to October 2022. Indications for surgery included worsening hydronephrosis, declining renal function, and recurrent urinary tract infections with obstruction. Apart from liberal exposure of the stricture, we stress upon use of indocyanine green to assess vascularity and quilting of the graft to bare area of the psoas muscle to increase graft vascularity. Results: Among the 15 patients, ureteropelvic junction strictures were observed in eight (53%), while five (33%) had proximal ureteric strictures, and two (13%) had mid-ureteral strictures. Notably, eight of the 15 patients (53%) had previous unsuccessful double-J stenting. The median stricture length was 3.5 (range: 2.0-5.0) cm, with a mean operative time of 167 (range: 126-214) min and estimated blood loss of 60 (range: 40-100) mL. After a median follow-up of 12 (range: 4-32) months, 13 out of the 15 patients (87%) showed significant improvement in their follow-up functional scans. Conclusion: Robotic buccal ureteroplasty is a very effective technique for the management of laser-induced ureteral strictures with good long-term results and minimal morbidity. The results are comparable irrespective of previous failed stenting.