Category: Robotic Surgery: Upper Tract - Benign

Introduction & Objective :

Different approaches exist for the management of proximal ureteric strictures and obstruction of the ureteral pelvic junction. Although spiral flaps have the advantage of being able to manage a long stricture, they can be technically challenging. We revisit the use of the vertical flap for the management of a proximal ureteric stricture in a patient with a box shaped renal pelvis.

Methods :

The colon was medialized and the renal pelvis and proximal ureter were cleared of investing tissues. The vertical flap was carefully measured with a 2:1 ratio to ensure the flap was well vascularized. The posterior wall was sutured first followed by the anterior wall with absorbable 4-0 sutures. Care was taken to preserve ureteral blood supply and a handle of excess renal pelvis as well as the stent was used for counter traction during the suturing.  

Results :

The reconstruction resulted in a funnel shaped UPJ with a widely patent proximal ureter. The flap was well vascularized and the reconstruction was watertight.

Conclusions :

The vertical flap provides as excellent option for the management of proximal ureteric strictures with a moderate length defect and a box shaped renal pelvis. It is technically simpler than a spiral flap and should be considered as an option for patients undergoing reconstruction surgery.

Presenting Author(s)

• LR

  Luke Reynolds

  – Clinical Fellow, St. Michael's Hospital - University of Toronto, Toronto, Ontario, Canada

Author(s)

• RH

  R John Honey

  – Professor, St. Michael's Hospital - University of Toronto, Toronto, Ontario, Canada
• MO

  Michael Ordon

  – Associate Professor, St. Michael's Hospital - University of Toronto, Toronto, Ontario, Canada