title: Single-surgeon experience with robot-assisted ureteroneocystostomy for distal ureteral pathologies in adults.
abstract: OBJECTIVE
  To demonstrate our technical approach for robot-assisted ureteroneocystostomy (R-UNC) for benign and malignant distal ureteral pathologies.
  
  
  METHODS
  Between January 2009 and January 2013, a total of 10 patients underwent R-UNC in the distal ureter by a single surgeon. Indications for R-UNC were as follows: idiopathic (3), fistula (2), iatrogenic (2), malignancy (2), and chronic vesicoureteral reflux (1).
  
  
  RESULTS
  Tension-free anastomosis was attained in all 10 R-UNC procedures. A psoas hitch was performed in 6/10 cases (60%). Intravesical and extravesical reimplantations were completed in 5/10 (50%) and 5/10 cases (50%), respectively. A nonrefluxing ureter was constructed in 2/10 cases (20%). The patients' mean age was 52.9±16.6 years, their mean body mass index was 30.8±6.3 kg/m(2), the mean operative time was 211.7±69.3 minutes, mean estimated blood loss was 102.5±110.8 mL, and mean length of stay was 2.8±2.3 days. There were no intraoperative complications. There was one Clavien-Dindo grade I and one Clavien-Dindo grade II postoperative complication. The mean postoperative follow-up duration was 28.5±15.5 months. Two patients had recurrence of ureteral strictures at 3 months postoperatively and were managed successfully with balloon dilation.
  
  
  CONCLUSIONS
  Our technique for R-UNC demonstrates good perioperative outcomes. However, underlying periureteral inflammation and pelvic adhesions may predispose patients for stricture recurrence after R-UNC.
authors: Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors: Ziho
authors: Z
authors: Lee
authors: Shailen
authors: S
authors: Sehgal
authors: Elton
authors: E
authors: Llukani
authors: Christopher
authors: C
authors: Reilly
authors: Leo
authors: L
authors: Doumanian
authors: Jack
authors: J
authors: Mydlo
authors: David Inkoo
authors: DI
authors: Lee
authors: Daniel Dong-In
authors: DD
authors: Eun
keywords: Minimally invasive surgical procedures; Reconstructive surgical procedures; Ureter
references: Urology. 1994 Feb;43(2):255-61
references: 8116127
references: Curr Urol Rep. 2012 Jun;13(3):190-4
references: 22528117
references: J Urol. 1994 Dec;152(6 Pt 1):2057-9
references: 7966672
references: J Endourol. 2000 Sep;14(7):589-93; discussion 593-4
references: 11030542
references: Curr Opin Urol. 2010 Nov;20(6):471-82
references: 20871405
references: J Endourol. 2012 Feb;26(2):147-51
references: 22050486
references: Ann Surg. 2004 Jan;239(1):14-21
references: 14685095
references: J Laparoendosc Adv Surg Tech A. 2008 Oct;18(5):731-4
references: 18699746
references: JSLS. 2009 Jan-Mar;13(1):44-9
references: 19366540
references: BJU Int. 2011 Dec;108(11):1918-32
references: 22077547
references: J Urol. 2005 Dec;174(6):2291-6, discussion 2296
references: 16280816
references: J Endourol. 2009 Mar;23(3):457-61
references: 19250027
references: J Endourol. 2008 Dec;22(12):2691-4
references: 19040387
references: J Urol. 1990 Jan;143(1):20-3
references: 2294254
references: Urology. 2008 Jul;72(1):47-50; discussion 50
references: 18384858
references: Eur Urol. 2007 Feb;51(2):512-22; discussion 522-3
references: 16949730
references: J Endourol. 2007 Apr;21(4):368-73; discussion 372-3
references: 17451324
references: BJU Int. 2003 Jan;91(2):138-42
references: 12519115
references: Nat Clin Pract Urol. 2004 Dec;1(2):58-9
references: 16474498
references: J Urol. 1959 Nov;82:573-83
references: 14430329
references: Urology. 2010 Dec;76(6):1387-93
references: 20350753
references: J Urol. 2005 Mar;173(3):862-5
references: 15711294