Robotic-Assisted Lingual Mucosa Graft Ureteroplasty for Long Proximal Ureteral Stricture Following Hematopoietic Stem Cell Transplantation: A Case Report and Literature Review

INTRODUCTION: Ureteral stricture is a rare complication following hematopoietic stem cell transplantation (HSCT). However, its management poses challenges due to the patient's long-term immunosuppression and the limited clinical experience of doctors. This represents the first report of a patient who underwent lingual mucosa graft ureteroplasty (LMGU) for the management of long-segment ureteral stricture following HSCT. Surgical techniques and perioperative management strategies are described. CASE PRESENTATION: A 25-year-old female with a 10 cm long proximal and middle ureteral stricture following HSCT was successfully treated with robotic-assisted LMGU. The procedure lasted 270 minutes without conversion and intraoperative complications. Intraoperative blood loss was estimated at 50 mL. Postoperative complications included lymphatic fistula (Clavien-Dindo grade Ⅰ) and left upper extremity venous thrombosis (Clavien-Dindo grade Ⅱ). The Double-J stent was removed eight weeks postoperatively. Antegrade urography performed at ten weeks showed an unobstructed urinary tract. During follow-up assessments, the patient reported no symptoms after surgery. The glomerular filtration rate of the left kidney increased from 27.45 mL/min preoperatively to 38.79 mL/min postoperatively. Renal ultrasound performed at 3, 6, 9, and 12 months demonstrated improved hydronephrosis compared to preoperative imaging. CONCLUSION: Based on the satisfactory outcomes in this case, robotic-assisted LMGU appears to be a safe, minimally invasive, and effective reconstructive technique, providing a promising treatment for select patients with post-HSCT long proximal ureteral strictures.