A flap with its own blood supply: robot-assisted appendiceal ureteroplasty for complex ureteral strictures-a systematic review and single-arm meta-analysis.

In 30 seconds

This systematic review and single-arm proportional meta-analysis assessed the success and safety of robot-assisted appendiceal ureteroplasty (RAU) for complex upper- and mid-ureteral strictures in adults. Four studies comprising 63 patients were included; most repairs used an appendiceal onlay flap, and urolithiasis or its endoscopic treatment was the leading stricture cause. Pooled surgical success at the latest available follow-up was 95.1% (95% CI 85.3-98.5%). Any-grade complications occurred in a pooled 17.5%, while the pooled rate of Clavien-Dindo grade III-V events was 3.0%.

Key findings

• Pooled surgical success at latest available follow-up was 95.1% (95% CI 85.3-98.5%).
• Any-grade complications occurred in 11 of 63 patients (pooled 17.5%, 95% CI 9.9-28.8%), mostly postoperative urinary tract infections.
• Clavien-Dindo grade III-V events occurred in 3.0% (95% CI 0.5-15.4%); pooled recurrent stricture was 3.3%.
• Global renal function remained stable in most reported patients, but function of the reconstructed kidney was rarely assessed.

Why it matters

Complex ureteral strictures can require major reconstructive procedures with distinct morbidity. These pooled results suggest RAU may offer a reconstructive option with high reported success and relatively few severe complications in selected adults treated at experienced centres. However, the evidence base is small and does not establish comparative safety or long-term durability, so the findings should be interpreted as preliminary rather than definitive.

What to keep in mind

Only four studies and 63 patients were included. The evidence concerns selected adults treated in experienced centres, follow-up was limited to the latest available reports, and reconstructed-kidney function was rarely assessed.