Robotic repair of iatrogenic ureteral stricture after pelvic surgery: a changing treatment paradigm

Ureteral injury represents one of the most common and redoubtable complications of pelvic surgeries. They could be recognized during the procedure with an intraoperative repair or they may be evidenced in the postoperative time with a deferred correction. In this latest event, the clinical presentation is wide-ranging in signs and symptoms. The most frequents signs or symptoms are incidentally hydronephrosis or associated with fever, chronic pain, and, ultimately, chronic impaired renal function, if untreated. However, isolated creatinine serum level elevation or asymptomatic cases are not uncommon especially in case of indolent evolution. The open approach has always been the gold standard for surgical correction of these challenging stenosis due to fibrosis, adhesions and obliterated surgical planes, although with high perioperative morbidity.4 In recent years, scattered experiences of minimally-invasive approaches were reported with the aim of replicating the favorable results of the open approach with the benefits of reduced perioperative morbidity, smaller scars and shorter length of hospital stay (LOS). Despite the surgical evolution in this challenging field, data on minimallyinvasive correction, and in particular robotic correction of iatrogenic ureteral injuries, remains limited. To address this unmet need, we analyzed our data of patients diagnosed with ureteral iatrogenic stenosis from pelvic surgery treated with robotic approach, at our institution.