Category: Robotic Surgery: Upper Tract - Benign

VS16-6 - Robotic Appendiceal Interposition in the Management of a Left Ureteroenteric Anastomotic Stricture

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

Introduction & Objective : Following radical cystectomy and ileal conduit formation, the management of ureteral anastomotic stricture is challenging. Surgical management of such ureteral strictures is particularly difficult given the atypical anatomy. Our video demonstrates our use of an appendiceal tissue graft to repair a distal ureteral stricture. We describe robot-assisted ureteroplasty with appendiceal interposition for the management of a distal left ureteral stricture in a patient with an ileal conduit.


Methods : A 66 year old male who had previously undergone robotic radical cystoprostatectomy and ileal conduit formation developed a long segment ureteral stricture at the ureteroileal anastomosis. The patient was taken to the operating room for stricture repair and the repair of a ventral hernia, both to be performed on the same day under the same anesthetic. Preoperative retrograde pyelogram demonstrated nonobstructive 3.5cm high-grade stricture at the distal ureteroileal anastomosis. Intraoperatively, the stricture was measured to be 5cm. Given the long length of stricture, the decision was made to utilize the appendix to assist with the ureteral repair and with achieving tension-free anastomosis. 


Results : Console time was 290 minutes and the estimated blood loss was 250mL. There were no intraoperative complications. The hospital length of stay was 8 days due to complications from the concomitantly performed ventral hernia repair. On post-operative day 8, antegrade pyelogram demonstrated a mildly dilated left collecting system and free flow of contrast in the distal left ureter without obstruction. There were no other complications. Nuclear medicine Lasix renogram performed 4 months post-operatively indicated an improvement with a T1/2 of 19.5 minutes and equivalent renal function bilaterally.


Conclusions : Robotic Assisted Laparoscopic Appendiceal interposition is a feasible option to repair long ureteral strictures in patients with an ileal conduit.

Eric Y. Cho

Resident
Department of Urology, Temple University Hospital
Philadelphia, Pennsylvania

Eric Y Cho, Urology Resident, Temple University Hospital, Philadelphia, Pennsylvania

Ziho Lee

Resident
Temple University Hospital
Philadelphia, Pennsylvania

Joshua R. Kaplan

Fellow
Department of Urology, Temple University Hospital
Philadelphia, Pennsylvania

Benjamin Waldorf

Fellow
Department of Urology, Temple University Hospital
Philadelphia, Pennsylvania

Michael J. Metro

Associate Professor and Director of Reconstructive Urology
Department of Urology, Temple University Hospital
Philadelphia, Pennsylvania

Daniel D. Eun

Professor
Temple University
Philadelphia, Pennsylvania

Kevin Yang