Category: Robotic Surgery: Upper Tract - Benign

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.

Author(s)

• 

  Eric Cho

  – Resident, Department of Urology, Temple University Hospital, Philadelphia, Pennsylvania
• 

  Ziho Lee

  – Resident, Temple University Hospital, Philadelphia, Pennsylvania
• JK

  Joshua Kaplan

  – Fellow, Department of Urology, Temple University Hospital, Philadelphia, Pennsylvania
• BW

  Benjamin Waldorf

  – Fellow, Department of Urology, Temple University Hospital, Philadelphia, Pennsylvania
• MM

  Michael Metro

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

  Daniel Eun

  – Professor, Temple University, Philadelphia, Pennsylvania

Presenting Author(s)

• KY

  Kevin Yang

  – Professor, Temple University, Philadelphia, Pennsylvania