Presentation Authors: Christine White*, James Nolan, Ryan Dorin, Joseph Wagner, Hartford, CT
Introduction: Ureteroenteric anastomotic stricture is a known but uncommon complication after cystectomy with urinary diversion. Management options for these ureteral strictures include chronic ureteral stents or nephrostomy tubes, endoscopic ureteral dilation, or ureteral reimplantation. Ureteral reimplant is the definitive treatment associated with the highest success rate.
Methods: Using a high definition recording system and iMovie software with narrative and annotative editing, we have created a video that demonstrates our approach to robotic assisted laparoscopic ureteral reimplant for patients with a urinary diversion and ureteral stricture. Our series examines all cases from two institutions performed by two surgeons in a retrospective fashion.
Results: In the last five years, five patients have undergone robotic ureteral reimplant. Patient age ranged from 60 to 76 years old. Mean duration of time that the reimplant was performed after diversion surgery was approximately 7 months. Mean operative time was 173 minutes. Most patients underwent reimplant with no complication. One patient who underwent ureteral reimplant to neobladder with concomitant anterior abdominal wall hernia repair developed a fistula from the ileal-ileal anastomosis to the neobladder. This patient subsequently underwent a successful repair two weeks later with 8 day hospital stay. Mean estimated blood loss was 25 cc, and mean hospital length of stay was 2.2 days. Of note, two of these five patients had undergone prior radiation therapy for prostate cancer and had no associated complications.
Conclusions: Robotic ureteral reimplant in a patient with urinary diversion is a safe and effective treatment for ureteral stricture when performed by an experienced robotic surgeon. Larger studies will be needed to demonstrate the long term safety and efficacy of this repair.