Robot-Assisted Ureteroplasty with Labial Mucosal Onlay Grafting for Long Left-Sided Proximal Ureteral Stenosis in Children and Adolescents: Technical Tips and Functional Outcomes

Purpose: To evaluate functional outcomes of robot-assisted ureteroplasty with labial mucosa grafting for proximal long ureteral stenosis (LUS) in children and adolescents. Mterials and Methods: Included in this study were 15 patients who underwent robot-assisted ureteroplasty with labial mucosal grafting in our center between July 2017 and September 2021. The left affected stenotic ureter was repaired using labial mucosal grafting. Faced with the obliterated segment, it was excised and the spatulated portion re-anastomosed with a pelvic flap as the dorsal wall. The labial mucosa graft was placed as the ventral wall. The preoperative clinical data and followed-up outcomes were collected and evaluated. Results: Labial mucosa graft onlay ureteroplasty was performed successfully in all 15 patients with no occurrence of intraoperative complications or surgical conversion. Five patients underwent an onlay ureteroplasty, and 10 underwent an dorsally augmented pelvic flap anastomotic ureteroplasty. The median(range) stricture length was 7 (3-10) cm. The median operative time was 390 (216-480) mins, and the estimated blood loss was 40 ml. At the median follow-up of 35months (range 12-58), the overall success rate was 93.3%. Conclusions: Labial mucosa grafting is safe and feasible for repairing long ureteral strictures in pediatric and adolescent patients. Our experience may provide beneficial references and conveniences to solve complex problems in proximal long ureteral stenosis.