Category: Reconstruction: Benign

MP14-5 - Robotic Assisted Ureteroureterostomy for Management of Distal Ureteral Defects.

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

Introduction & Objective :

 Management for short distal ureteral defects has classically been addressed with ureteral re-implant.. Although uretero-ureterostomy (UU) is a more straightforward option, it is not usually performed secondary to concerns of blood supply and subsequent rates of stricture. Use of the robotic platform, however, has facilitated enhanced vision and the ability to identify the distal ureteral blood supply making distal UU and attractive option for short ureteral strictures and injuries. Herein, we report on our experience with robotic assisted UU for distal ureteral defects.   


Methods :

From 2012 to 2018 twenty-two patients underwent robotic assisted UU for distal ureteral injury by a single surgeon. The decision to proceed with UU was based on surgical feasibility and direct visualization of ureteral blood supply. Success was defined as clinical resolution with supporting radiographic findings.


Results :

Perioperative parameters are tabulated in table 1. Of the 22 patients, 2 required subsequent balloon dilation of the UU site. One of these patients was treated successfully while the other progressed to nephrectomy. A separate patient required a buccal mucosal graft 1 year after her initial UU.


Conclusions :

Robotic assisted UU for distal ureteral defects is feasible in carefully selected patients. Additionally, UU carries several advantages over ureteral re-implant including preservation of bladder anatomy, maintenance of the anti-refluxing ureteral orifice, and minimizing ureteral dissection. Long tern studies are needed to validate our shortterm findings. 

Ziho Lee

Resident
Temple University Hospital
Philadelphia, Pennsylvania

Aryeh Keehn


Philadelphia, Pennsylvania

Linda Hsu


Philadelphia, Pennsylvania

Mahesh Botejue


Philadelphia, Pennsylvania

Daniel D. Eun

Professor
Temple University
Philadelphia, Pennsylvania