{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:23:09Z","timestamp":1785442989581,"version":"3.56.0"},"reference-count":38,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2023,12,16]],"date-time":"2023-12-16T00:00:00Z","timestamp":1702684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Ureteral stricture (US) postureteroscopic lithotripsy (URSL) has emerged as a severe complication with the widespread use of laser technology. Furthermore, managing a complex US is challenging. Therefore, this study evaluated the efficacy of robot-assisted ureteroureterostomy (RAUU) in addressing US post-URSL and analyzed the pathology of transected ureteral tissues to identify the risk factors for US. Methods: we conducted a prospective cohort study on patients who underwent RAUU for URSL-induced US from April 2021 to May 2023. Results: A total of 14 patients with a mean age of 49.8 years were included in this study. The mean stricture length on radiography was 22.66 \u00b1 7.38 mm. Nine (64.2%) patients had experienced failure with previous interventions. The overall success rate was 92.9%, both clinically and radiographically, without major complications, at a mean follow-up of 12.8 months. The pathological findings revealed microcalcifications and a loss of ureteral mucosa in 57.1% and 28.6% of patients, respectively. Conclusions: The RAUU technique shows promise as a viable option for US post-URSL in appropriately selected patients despite severe pathological changes in the ureter. Therefore, the migration of microcalcifications to the site of ureteral perforation may be a significant factor contributing to US development.<\/jats:p>","DOI":"10.3390\/jcm12247726","type":"journal-article","created":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T10:04:47Z","timestamp":1702893887000},"page":"7726","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Efficacy of Robot-Assisted Ureteroureterostomy in Patients with Complex Ureteral Stricture after Ureteroscopic Lithotripsy"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9968-7468","authenticated-orcid":false,"given":"Shuzo","family":"Hamamoto","sequence":"first","affiliation":[{"name":"Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3092-5114","authenticated-orcid":false,"given":"Kazumi","family":"Taguchi","sequence":"additional","affiliation":[{"name":"Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4176-9089","authenticated-orcid":false,"given":"Kengo","family":"Kawase","sequence":"additional","affiliation":[{"name":"Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0584-3712","authenticated-orcid":false,"given":"Rei","family":"Unno","sequence":"additional","affiliation":[{"name":"Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiko","family":"Isogai","sequence":"additional","affiliation":[{"name":"Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koei","family":"Torii","sequence":"additional","affiliation":[{"name":"Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoichiro","family":"Iwatsuki","sequence":"additional","affiliation":[{"name":"Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiki","family":"Etani","sequence":"additional","affiliation":[{"name":"Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7638-6048","authenticated-orcid":false,"given":"Taku","family":"Naiki","sequence":"additional","affiliation":[{"name":"Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2080-3794","authenticated-orcid":false,"given":"Atsushi","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2197-2477","authenticated-orcid":false,"given":"Takahiro","family":"Yasui","sequence":"additional","affiliation":[{"name":"Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1089\/end.2018.0667","article-title":"Changing trends in the treatment of nephrolithiasis in the real world","volume":"33","author":"Chung","year":"2019","journal-title":"J. Endourol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/iju.13817","article-title":"Chronological changes in epidemiological characteristics of lower urinary tract urolithiasis in Japan","volume":"26","author":"Sakamoto","year":"2019","journal-title":"Int. J. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1097\/JU.0000000000002929","article-title":"Ureteral strictures following ureteroscopy for kidney stone disease: A population-based assessment","volume":"208","author":"Sunaryo","year":"2022","journal-title":"J. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1089\/end.2020.0421","article-title":"Ureteral strictures following ureteroscopic stone treatment","volume":"35","author":"Ulvik","year":"2021","journal-title":"J. Endourol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/j.1464-410X.2005.05207.x","article-title":"Ureteroscopic endoureterotomy","volume":"95","author":"Razdan","year":"2005","journal-title":"BJU Int."},{"key":"ref_6","first-page":"95","article-title":"Risk factors for failure of endoscopic management of stone-related ureteral strictures","volume":"19","author":"Sugino","year":"2021","journal-title":"Urol. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1097\/00005373-196906000-00001","article-title":"Surgical correction of ureteral injury","volume":"9","author":"Carlton","year":"1969","journal-title":"J. Trauma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.urology.2006.09.067","article-title":"Laparoscopic ureteral reconstruction for benign stricture disease","volume":"69","author":"Simmons","year":"2007","journal-title":"Urology"},{"key":"ref_9","first-page":"221","article-title":"Robot-assisted laparoscopic ureteral reconstruction: A systematic review of literature","volume":"71","author":"Kolontarev","year":"2018","journal-title":"Cent. Eur. J. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1089\/end.2014.0243","article-title":"Open, laparoscopic, and robotic ureteroneocystotomy for benign and malignant ureteral lesions: A comparison of over 100 minimally invasive cases","volume":"28","author":"Elsamra","year":"2014","journal-title":"J. Endourol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.eururo.2014.08.057","article-title":"Use of indocyanine green during robot-assisted ureteral reconstructions","volume":"67","author":"Lee","year":"2015","journal-title":"Eur. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s11934-021-01056-8","article-title":"Robotic repair of ureteral strictures: Techniques and review","volume":"22","author":"Elbers","year":"2021","journal-title":"Curr. Urol. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"731","DOI":"10.2214\/ajr.130.4.731","article-title":"Sensitivity of gray scale ultrasound in detecting urinary tract obstruction","volume":"130","author":"Ellenbogen","year":"1978","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S0302-2838(03)00006-X","article-title":"Stone burden in an average Swedish population of stone formers requiring active stone removal: How can the stone size be estimated in the clinical routine?","volume":"43","author":"Tiselius","year":"2003","journal-title":"Eur. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: Five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1177\/12.5.333","article-title":"Histochemical recognition of calcium oxalate","volume":"12","author":"Pizzolato","year":"1964","journal-title":"J. Histochem. Cytochem."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy-to-use software \u2018EZR\u2019 for medical statistics","volume":"48","author":"Kanda","year":"2013","journal-title":"Bone Marrow Transplant."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1016\/S0022-5347(01)63711-X","article-title":"Ureteral stricture formation after removal of impacted calculi","volume":"159","author":"Roberts","year":"1998","journal-title":"J. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/S0022-5347(17)39541-1","article-title":"Endourological management of ureteral strictures","volume":"144","author":"Ferreira","year":"1990","journal-title":"J. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1111\/bju.12454","article-title":"The management of secondary pelvi-ureteric junction obstruction\u2014A comparison of pyeloplasty and endopyelotomy","volume":"113","author":"Vannahme","year":"2014","journal-title":"BJU Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1016\/j.juro.2016.10.062","article-title":"Reoperative laparoscopic ureteropelvic junction obstruction repair in children: Safety and efficacy of the technique","volume":"197","author":"Moscardi","year":"2017","journal-title":"J. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1002\/bco2.224","article-title":"Robotic ureteral reconstruction for recurrent strictures after prior failed management","volume":"4","author":"Lee","year":"2023","journal-title":"BJUI Compass"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1016\/j.eururo.2011.03.015","article-title":"Robot-assisted uretero-ureterostomy for iatrogenic lumbar and iliac ureteral stricture: Technical details and preliminary clinical results","volume":"60","author":"Buffi","year":"2011","journal-title":"Eur. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1089\/end.2018.0750","article-title":"Ureteral reimplantation, psoas hitch, and Boari flap","volume":"34","author":"White","year":"2020","journal-title":"J. Endourol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.eururo.2016.07.022","article-title":"Robot-assisted surgery for benign ureteral strictures: Experience and outcomes from four tertiary care institutions","volume":"71","author":"Buffi","year":"2017","journal-title":"Eur. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/iju.14426","article-title":"Buccal mucosal ureteroplasty for the management of ureteric strictures: A systematic review of the literature","volume":"28","author":"Heijkoop","year":"2021","journal-title":"Int. J. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.eururo.2023.04.022","article-title":"Totally intracorporeal robot-assisted unilateral or bilateral ileal ureter replacement for the treatment of ureteral strictures: Technique and outcomes from a Single Center","volume":"84","author":"Yang","year":"2023","journal-title":"Eur. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e8166","DOI":"10.7717\/peerj.8166","article-title":"Management of recurrent ureteral stricture: A retrospectively comparative study with robot-assisted laparoscopic surgery versus open approach","volume":"7","author":"Wang","year":"2019","journal-title":"PeerJ"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/j.urology.2010.01.044","article-title":"Experience with robot assisted laparoscopic surgery for upper and lower benign and malignant ureteral pathologies","volume":"76","author":"Hemal","year":"2010","journal-title":"Urology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1089\/end.2021.0315","article-title":"Robot-assisted laparoscopic distal ureteroureterostomy for distal benign ureteral strictures with long-term follow-up","volume":"36","author":"Yang","year":"2022","journal-title":"J. Endourol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1089\/end.2013.0075","article-title":"Single surgeon experience with robot-assisted ureteroureterostomy for pathologies at the proximal, middle, and distal ureter in adults","volume":"27","author":"Lee","year":"2013","journal-title":"J. Endourol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.eururo.2021.07.023","article-title":"Intracorporeal versus extracorporeal robot-assisted kidney autotransplantation: Experience of the ERUS RAKT Working Group","volume":"81","author":"Breda","year":"2022","journal-title":"Eur. Urol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1016\/j.juro.2017.06.097","article-title":"Robotic ureteroplasty with buccal mucosa graft for the management of complex ureteral strictures","volume":"198","author":"Lee","year":"2017","journal-title":"J. Urol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"F52","DOI":"10.1152\/ajprenal.00260.2018","article-title":"Macrophage-secreted TGF-\u03b21 contributes to fibroblast activation and ureteral stricture after ablation injury","volume":"317","author":"Ueshima","year":"2019","journal-title":"Am. J. Physiol. Ren. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1016\/S0022-5347(17)35899-8","article-title":"Stone granuloma: A cause of ureteral stricture","volume":"150","author":"Dretler","year":"1993","journal-title":"J. Urol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.juro.2012.08.197","article-title":"Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery","volume":"189","author":"Traxer","year":"2013","journal-title":"J. Urol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1089\/end.2017.0658","article-title":"Effect of laser settings and irrigation rates on ureteral temperature during holmium laser lithotripsy, an in vitro model","volume":"32","author":"Wollin","year":"2018","journal-title":"J. Endourol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1007\/s00345-023-04438-4","article-title":"Ureteroscopy and lasertripsy with pop dusting using high power holmium laser for large urinary stones >\u2009 15 mm: 6.5-year prospective outcomes from a high-volume stone center","volume":"41","author":"Pietropaolo","year":"2023","journal-title":"World J. Urol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/24\/7726\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:40:03Z","timestamp":1760132403000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/24\/7726"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,16]]},"references-count":38,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["jcm12247726"],"URL":"https:\/\/doi.org\/10.3390\/jcm12247726","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,16]]}}}