SynthesisJournal of robotic surgery2026
Robot-assisted ileal ureter replacement for complex ureteral strictures: a systematic review and single-arm meta-analysis of surgical and functional outcomes.
Synthesis in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Complex, long-segment ureteral strictures present significant reconstructive challenges. While open ileal ureter replacement is the historical gold standard, it carries substantial perioperative morbidity. This systematic review and single-arm meta-analysis evaluate the surgical and functional outcomes of robot-assisted ileal ureter replacement (RIUR). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search of four databases was conducted through September 2026 to identify studies reporting adult RIUR outcomes for complex strictures. Outcomes were pooled using random-effects models. Five retrospective cohort studies comprising 110 patients met the inclusion criteria, with radiation-induced injury representing the predominant etiology (44.5%). The pooled surgical success rate was 93.9% (95% confidence interval [CI]: 87.0-97.2%). The pooled major complication rate (Clavien-Dindo grades III-V) was 10.0% (95% CI: 4.0-24.0%), driven primarily by urinary anastomotic leaks, typically managed with prolonged stenting. Pooled rates for metabolic acidosis requiring supplementation and stricture recurrence were 7.4% and 2.6%, respectively, while renal function remained stable or improved across all evaluated cohorts. Pooled mean operative time and estimated blood loss were 339.1 min (95% CI: 310.5-367.7) and 103.7 mL (95% CI: 54.9-152.6), respectively, while length of hospital stay varied widely by regional institutional pathway (median 3.0 days in early-discharge cohorts to 14.2 days in inpatient testing protocols). Current evidence suggests that RIUR represents a feasible and promising minimally invasive option for complex ureteral defects, with observed success rates meeting historical clinical benchmarks and an acceptable perioperative safety profile.
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