Category: Robotic Surgery: Upper Tract - Benign

VS8-5 - Robotic Ureterocalicostomy for Upper Ureteric Stricture

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective : p.p1 {margin: 0.0px 0.0px 10.0px 0.0px; text-align: justify; font: 12.0px 'Times New Roman'; color: #000000; -webkit-text-stroke: #000000} span.s1 {font-kerning: none}

Ureterocalicostomy is indicated mainly in cases with failed pyeloplasty or with a completely intrarenal pelvis. While there have been several case series reported , robotic ureterocalicostomy done for a Iatrogenic pelviureteric junction  stricture secondary to celiac plexus block (alcohol) resulting in long segment PUJ stricture (corrosive) is a rarity. We here by present the video of Robotic Ureterocalicostomy done for this patient which highlights the clinical and surgical challenges in evaluating and treating the patient and the technique of the procedure as well.


Methods : p.p1 {margin: 0.0px 0.0px 10.0px 0.0px; text-align: justify; font: 12.0px 'Times New Roman'; color: #000000; -webkit-text-stroke: #000000} span.s1 {font-kerning: none}

An 18 year old male, who is a known patient  of chronic calcific pancreatitis underwent Celiac plexus block for pain management two months back. He presented with history of 3 weeks pain in the epigastric region and  the right flank. History of fever, vomiting and diarrhoea for period of one week. He was clinically stable with all laboratory investigations within normal range. On examination he had a tender right loin. A computed tomography of abdomen was performed which revealed an urinoma which is communicating with the renal pelvis. A percutaneous nephrostomy was done. Nephrostogram was done after 3 weeks which revealed the ureteric defect of approximately 4 cm at the level of PUJ with a completely intrarenal pelvis. Robotic ureterocalicostomy was performed.


Results : p.p1 {margin: 0.0px 0.0px 10.0px 0.0px; text-align: justify; font: 12.0px 'Times New Roman'; color: #000000; -webkit-text-stroke: #000000} span.s1 {font-kerning: none}

A post operative X ray KUB revealed Double ‘J’ Stent in position which was removed after a period of 4 weeks. Intravenous pyelogram was performed after 4 months which revealed a good drainage with no extravasation of contrast.


Conclusions : p.p1 {margin: 0.0px 0.0px 10.0px 0.0px; text-align: justify; font: 12.0px 'Times New Roman'; color: #000000; -webkit-text-stroke: #000000} span.s1 {font-kerning: none}

Robotic ureterocalicostomy has been performed world over with successful outcomes and is considered as a effective option in treating secondary PUJ obstruction. In rare situations like this case where the anatomy is distorted and lots of hilar fibrosis, robotic surgery plays a very crucial role in fine and accurate dissection of tissues and meticulous suturing.

Deepak Ragoori

Consultant Urologist
Asian Institute of Nephrology and Urology
Hyderabad, Telangana, India

Dr. Deepak Ragoori, MS MCh, Senior consultant Urologist at Asian Institute of Nephrology and Urology, Hyderabad, India. I am an avid sports enthusiast, loves traveling and a foodie. I am passionate about my work as a Urologist and have a special interest in the field of Endourology and Robotics. I would love to contribute to my best of capability towards training the younger generation and at the same time learn from the pioneers in the field of urology.
2004 - MBBS
2008 - Master of Surgery
2012 - MCh Urology

Mallikarjuna Chiruvella

Chief Urologist
Asian Institute of Nephrology and Urology
Hyderabad, Telangana, India

Syed Md Ghouse

Consultant Urologist
Asian Institute of Nephrology and Urology
Hyderabad, Telangana, India

Taif Bendigere

Consultant Urologist
Asian Institute of Nephrology and Urology
Hyderabad, Telangana, India

Bhavatej Enganti

Purnachandra Reddy Kondakindi