Introduction

Robot-assisted surgery represents a feasible and less challenging minimally-invasive option for complex urological reconstructive procedures, including ureteral reimplantation with psoas hitch. Published experience in this field is still limited. We report our 10-year experience of this technique from a tertiary care center.

Methods

All patients that underwent ureteral reimplantation with psoas hitch technique between 2006 and 2016 at our institution were included in this study. The robotic system was used in 4-arm configuration with the addition of 2 assistant ports. The transperitoneal approach and tunneled nonrefluxing ureteral anastomosis was performed in all patients. The psoas hitch was performed using a 1-0 suture. The perioperative complications were described according to Clavien-Dindo classification.

Results

21 patients (11 men and 10 women) underwent robot-assisted ureteral reimplantation with psoas hitch technique. The median age was 66 years (IQR 41,73), body mass index 24 kg/m² (IQR 23,28) and Charlson Comorbidity Index 1 (IQR 0,2). In 2 (9,5%) patients the procedure was performed for bilateral pathology. 11 (52,4%) patients were symptomatic; of these 7 (33,3%) had pain, 2 (9,5%) hematuria and 2 (9,5%) pyelonephritis. 17 (81,0%) patients had hydronephrosis at the diagnosis. Indication for surgery was distal ureteral tumor in 7 (33,3%) patients, iatrogenic ureteral injury in 7 (33,3%), external ureteral compression in 4 (19,1%), vesicoureteral reflux in 2 (9,5%) and 1 (4,8%) patient had distal ureteral fibrosis of unknown origin. 13 (61,9%) patients had previous surgery near the distal ureter. Median operative time was 150 minutes (IQR 120,180). Mean blood loss was 30 mL (IQR 30,50). The all grade complication rate was 28,6%; five grade 1 (two prolonged pain, two transient paresthesia of the thigh and one urinary tract infection) and one grade 3 complication (bleeding required surgical revision) occurred. Median hospital stay was 5 days (IQR 4,7) and catheter time 7 days (IQR 6,10). Ureteral stent was placed in 13 patients and left in place for a median time of 30 days (IQR 20,42). After a median follow-up of 15 months (IQR 15,23) all patients were asymptomatic with no signs of hydronephrosis. Most of the patients improved renal function and none of them had a significant postoperative worsening of it.

Conclusions

This series represents the largest single-institution experience with robot-assisted ureteral reimplantation with psoas hitch technique and long follow-up. It represents a safe and effective technique with excellent outcomes and limited morbidity.

Funding

none