Ureteroureterostomy for the management of non-neoplastic distal ureteral lesions: a new challenger of care in the era of robotic surgery?

Background: Iatrogenic lesions of the distal ureter represent a frequent and feared complication of abdominal surgery that is traditionally managed by ureteral reimplantation. The aim of this systematic review (SR) is to summarize the published literature on the role of minimally invasive ureteroureterostomy (UU) in the surgical treatment of non-neoplastic distal ureteral lesions. Methods: We performed a comprehensive literature search on PubMed, Embase, and Cochrane CENTRAL including published peer-reviewed studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The intra-, peri-, and postoperative outcomes as well as the safety profile and the success rates of minimally invasive UU are presented. Results: Seven retrospective studies with 116 patients were included in this SR. If the basic principles of the ureteral reconstructive procedure are followed, both laparoscopic and robotic UU are feasible, safe, and with a success rate ranging between 81.8% and 100%, depending on the definition of success. A single comparative study documented a significant difference in operative time and length of hospitalization in favor of robotic UU. The success of both laparoscopic and robotic UU has been mainly evaluated in the short and intermediate follow-up. Conclusion: Minimally invasive UU may represent a viable treatment option for the treatment of non-neoplastic distal ureter pathology such as iatrogenic injuries or radiotherapy-induced stenosis. Larger, prospective studies adopting a standard definition of the postoperative success are required to affirm UU as a first-line option in the management of benign distal ureteral lesions.