Category: Reconstruction: Malignant

MP14-12 - Transnephrostomic Indocyanine Green Guided Robotic Ureteral Reimplantation for Ureteroileal Strictures after Robotic Cystectomy and Neobladder.

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

Introduction & Objective :

We describe our initial experience with robotic ureteral reimplantation for ureteroenteric anastomotic strictures in patients previously treated with robotic radical cystectomy (RARC) and intracorporeal neobladders with the use of near infrared fluorescence (NIRF) imaging after transnephrostomic injection of indocyanine green (ICG).


Methods :

From April 2015 to October 2017, nine consecutive patients underwent robotic ureteral reimplantation in one tertiary referral center. All patients previously underwent RARC-N with the same standardized technique [1]. All patients previously underwent percutaneous nephrostomy and at least one antegrade stenting and stricture dilatation attempt. Surgical steps were described: Steep trendelenburg position, transnephrostomic injection of ICG to identify the lombar ureter with NIRF (Figure 1A), careful ureteral dissection on the surface of the ureter/s to avoid injurying the iliac vessels with alternate use of conventional imaging and NIRF (Figure 1B), spatulation of the ureters, JJ stent insertion and finally uretero-ileal anastomosis. Baseline, perioperative and functional outcomes data are reported.


Results :

Median time from RARC to uretero-anastomotic stricture diagnosis was 5mo (IQR 2-6). Median stricture length was 1,5 cm (IQR 1-2). Median operative time was 140 minutes (IQR 81-155) and median length of stay was 5 days (IQR 3-9). All cases were completed robotically. Neobladder Boari flap was created in all cases. Intraoperative blood loss was negligible. One patient experienced a Clavien grade 2 complication (urinary tract infection requiring antibiotics). One patient required blood transfusion (Clavien grade 2). One patient underwent ileum resection and anastomosis due to perforation (Clavien IIIb). At a median follow-up of 7 mo (IQR 4-25) no patients developed recurrence (CT scan) or worsening of renal function (new onset CKD stage 3b-4).


Conclusions :

Robotic ureteral reimplantation for uretero-enteric strictures is a safe and highly effective procedure. NIRF imaging provides an easy guide to identify and progressively dissect the ureter. Thanks to the high success rate and to the excellent functional outcomes, robotic reimplantation has become a first treatment option in our center.

Leonardo Misuraca

Fellow
"Regina Elena" National Cancer Institute, Dept. of Urology
Rome, Lazio, Italy

Giuseppe Simone

Consultant
“Regina Elena” National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Francesco Minisola

"Regina Elena" National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Giulio Vallati

"Regina Elena" National Cancer Institute, Dept. of Radiology
Roma, Lazio, Italy

Gabriele Tuderti

Fellow
"Regina Elena" National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Mariaconsiglia Ferriero

MD, PhD
"Regina Elena" National Cancer Institute, Dept. of Urology
Rome, Lazio, Italy

Salvatore Guaglianone

"Regina Elena" National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Michele Gallucci

Roma, Lazio, Italy