Robotic ureteric reimplantation has small patient numbers reported in the worldwide literature. The underlying aetiology is heterogenous and there is limited evidence on outcomes and optimum follow-up. We report our experience of benign robotic ureteric reimplantation in the largest reported series.

67 consecutive patients underwent benign ureteric reimplantation between 2016 and 2023. Six patients had a Boari flap reconstruction and five patients had a psoas hitch and ureteric reimplantation.

Primary outcome measures were any evidence of radiological obstruction post ureteric reimplantation and whether the patient remained free of stents or nephrostomies following surgery. Secondary outcome measures included post-operative complications, change in postoperative renal function and length of stay. We also wished to ascertain at what time point patients with problems presented in our long follow-up period to inform future practice, including in patients with a history of radiation.

40 females and 27 males underwent robotic reimplants, 64/67 (96%) were distal. 36 ureteric reimplants had a pathological aetiology that was Urological. 30 had a Gynaecological aetiology, of which 27 were operative injuries. Full indications are shown in Table 1.  There was one robotic conversion to open at the start of the learning curve in 2016. The median length of stay was two days.

Mean follow-up was 709 days.  2 (3%) patients showed some dilatation on follow-up imaging. One had a re-do reimplant; the other has not required intervention. All patients in this series are currently free of stents or nephrostomies.

There was no significant deterioration in renal function, with an average change in creatine of -2mmol/L (±12.5 mmol/l, p=0.07). There was one Clavien 3b complication, requiring a GA cystoscopy and dilation for a bladder neck and ureteric stricture and 11 Clavien 2 complications. One patient who had radiotherapy prior to the ureteric reimplant had a cystectomy in the follow-up period for the subsequent development of a high pressure bladder.

Robotic ureteric reimplantation is a safe procedure with high success rate and low complication rates. 3 monthly imaging followed by 12 monthly MAG-3 renograms would have captured all problems in the non-radiotherapy population.

Our current usual practice is a CT Urogram at 3 months and then a MAG-3 renogram at 12 months and to discharge the patient if these show good drainage following the ureteric reimplant. As has been noted in the general radiotherapy population who have not required reconstruction, more careful monitoring beyond 12 months may be required in those undergoing reconstruction for the development of sequelae of radiotherapy.