Presentation Authors: Randall Lee*, Ziho Lee, Aeen Asghar, David Strauss, Kevin Yang, Philadelphia, PA, Toshiyuki China, Tokyo, Japan, Michael Metro, Daniel Eun, Philadelphia, PA
Introduction: The management of multifocal ureteral stricture disease using minimally invasive techniques can be both complex and challenging. The robotic platform has been used with increasing frequency to address the difficulties encountered during repair. Buccal mucosa serves as an ideal graft for urothelial repair which has been well documented for repair of urethral stricture disease. Here, we present a case of multifocal ureteral strictures involving the proximal and distal ureter, which were both successfully repaired using buccal mucosal grafts.
Methods: 73 year male with history of nephrolithiasis status post multiple endoscopic procedures, presented for evaluation of ureteral strictures. Retrograde pyelograms revealed strictures involving both the proximal and distal ureter. Patient was taken to the operating room for multiple balloon dilations, however symptoms quickly returned. He presented for evaluation and scheduled for ureteral reconstruction. He ultimately underwent a robotic assisted double buccal mucosal ureteroplasty described in our video.
Results: Total console time was 280 minutes with an estimated blood loss of 100 mL. There were no intraoperative complications. Patient was discharged on post operative day 1.
Conclusions: We demonstrate that robotic-assisted buccal mucosal ureteroplasty with the assistance of indocyanine green (ICG) is a feasible option for the patients with multifocal strictures. ICG can facilitate ureteral dissection and assess ureteral blood supply intraoperatively. Buccal mucosal ureteroplasty may spare patients from morbidities that may be accompanied with more traditional surgical options.