Robot-assisted ileal ureter replacement for complex ureteral strictures: a systematic review and single-arm meta-analysis of surgical and functional outcomes.

In 30 seconds

This systematic review and single-arm meta-analysis assessed surgical and functional outcomes after robot-assisted ileal ureter replacement (RIUR) in adults with complex ureteral strictures. Five retrospective cohort studies included 110 patients; radiation-induced injury was the predominant cause. The pooled surgical success rate was 93.9% (95% confidence interval [CI]: 87.0-97.2%). Major complications (Clavien-Dindo grades III-V) occurred at a pooled rate of 10.0% (95% CI: 4.0-24.0%), while renal function was stable or improved across all evaluated cohorts. The authors describe RIUR as a feasible, promising minimally invasive option, while noting the evidence is based on retrospective studies.

Key findings

• Pooled surgical success was 93.9% (95% CI: 87.0-97.2%) across five studies and 110 patients.
• The pooled major complication rate was 10.0% (95% CI: 4.0-24.0%); urinary anastomotic leaks were the main driver.
• Pooled metabolic acidosis requiring supplementation and stricture recurrence rates were 7.4% and 2.6%, respectively.
• Renal function remained stable or improved across all evaluated cohorts.

Why it matters

Long-segment ureteral strictures can require complex reconstruction, and open ileal ureter replacement is associated with substantial perioperative morbidity. These pooled findings suggest robot-assisted reconstruction can achieve high observed success with a measurable risk of major complications. The results help characterize potential outcomes, but the evidence base is limited and does not establish comparative benefit over open surgery.

What to keep in mind

Evidence came from five retrospective cohort studies in a single-arm meta-analysis, with no direct comparison against open surgery. Hospital stay varied widely across institutional pathways.