Category: Robotic Surgery: Upper Tract - Benign

VS16-2 - Robotic Pyeloplasty: Revisiting the Vertical Flap

Sun, Sep 23
2:00 PM - 4:00 PM

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.

Luke F. Reynolds

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

R John D'A.. Honey

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

Michael Ordon

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