Outcomes and treatment failure after open or robotic ureteral reconstruction for iatrogenic injuries

Abstract Objectives The aim of this study is to assess the aetiology, perioperative outcomes and treatment failure of contemporary patients undergoing open or robot‐assisted ureteral reconstruction for iatrogenic injuries. Patients and methods We retrospectively analysed consecutive patients who underwent ureteral reconstruction for iatrogenic injuries at two academic centres 07/2013 and 06/2022. A variety of open or robot‐assisted procedures were performed, including uretero‐cystoneostomy, Boari bladder flap, uretero‐ureterostomy, ileal replacement and pyelo‐ureteroplasty. All procedures were performed by a single surgeon with extensive experience in open and robot‐assisted surgery and preference‐based management. Outcome measures were aetiology, estimated blood loss, length of stay, postoperative complications and treatment failure, defined as upper tract obstruction requiring permanent urinary drainage. We also planned a subgroup analysis comparing the outcomes between open and robot‐assisted procedures. Results Fifty‐nine patients were included. Most injuries were consequent to endourological procedures (44%). The most frequently performed procedures were uretero‐cystoneostomy (49.2%) and Boari bladder flap (32.2%). Forty (67.8%) were open, and 19 (32.2%) were robot‐assisted procedures. Major postoperative complications were recorded in seven (11.9%) patients. After a median follow‐up of 42 months (interquartile range 12–24), treatment failure was observed in seven (11.9%) cases. Robot‐assisted versus open procedures were associated with decreased estimated blood loss (p = 0.01), length of stay (p