# Surgical success following robotic upper urinary tract reconstruction, results from a global network of healthcare organizations

## TL;DR

This study evaluates the success of robotic upper urinary tract surgeries across multiple healthcare centers, identifying risk factors for needing postoperative drainage.

## Contribution

The study provides real-world outcomes of robotic ureteral reconstruction from diverse healthcare organizations, expanding beyond high-volume centers.

## Key findings

- 10.8% of robotic pyeloplasty patients needed drainage, with diabetes and smoking as risk factors.
- Radiation history was a significant risk factor for needing drainage after ureteral reimplantation and ureteroureterostomy.
- Age over 50 years increased the risk of drainage following ureteroureterostomy.

## Abstract

Available data on robotic ureteral reconstruction procedures is concentrated from high volume centers. To better understand generalizability of success, we used a network of healthcare organizations (HCOs) to evaluate surgical success following robotic-assisted pyeloplasty (RP), ureteral reimplantation (RR), and ureteroureterostomy/ureteroplasty (RU).

We searched the TriNetX database for adult (>18 years old) patients undergoing RP, RR and RU. Our primary outcome was need for drain placement (nephrostomy or ureteral stent) from 4 weeks to 10 years postoperatively. We evaluated risk factors (RF) for drain placement (vascular disease, kidney disease, diabetes (DM), smoking history, radiation history, age, body mass index (BMI, kg/m^2)) using hazard ratios, with significance when 95% confidence interval does not include 1.0.

Analyses were run in October 2024. There were 1,324 RP patients from 30 HCOs, 464 RR patients from 22 HCOs, and 875 RU patients from 27 HCOs. Respectively, 10.8%, 11.7%, and 7.9% of patients needed a drain. DM (HR 2.0 (1.04–3.68)), smoking (HR 2.2 (1.34–3.49)), and BMI > 25 (HR 1.6 (1.07–2.34)) were RFs for drain placement following RP. DM (HR 2.8 (1.18–6.63)) was also a RF for RR patients. Radiation was a RF for both RR (HR 2.9 (1.03–8.09)) and RU (HR 3.7 (1.006–13.9)) patients. Age > 50 years (HR 2.3 (1.16–4.49)) was a RF for RU patients.

We report outcomes of robotic ureteral reconstruction from a variety of HCOs. This data helps describe the real world experience of patients undergoing robotic upper urinary tract reconstruction.