V01-09 Robotic Assisted Laparoscopic Transureteropyelostomy

You have accessJournal of UrologyUpper Tract Reconstruction (V01)1 May 2024V01-09 Robotic Assisted Laparoscopic Transureteropyelostomy Matthew Lee, Julienne Jeong, Kelley Zhao, and Daniel Eun Matthew LeeMatthew Lee , Julienne JeongJulienne Jeong , Kelley ZhaoKelley Zhao , and Daniel EunDaniel Eun View All Author Informationhttps://doi.org/10.1097/01.JU.0001008884.22400.05.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical management of long segment ureteral strictures after prior radiation therapy may be challenging due to increased fibrosis and damage to the periureteral blood supply. Traditionally, ileal ureter reconstruction has been utilized in this setting, however this approach may result in significant morbidity. We describe the case of a patient with a radiation-induced left sided pan ureteral stricture who underwent a transureteropyelostomy. METHODS: The patient is a 62-year-old female with history of a left sided pan ureteral stricture secondary to radiation for cervical cancer. She was previously managed with chronic ureteral stent exchanges. Preoperative renal scan demonstrated a split function of 60% and 40% in the right and left kidney, respectively, with a mildly delayed nephrogram on the left side. A left percutaneous nephrostomy tube was placed 4 weeks prior to definitive management. Preoperative antegrade and retrograde pyelograms demonstrated a pan ureteral left sided stricture with normal caliber in the proximal left ureter. Cystogram demonstrated a 250-milliliter bladder capacity. Patient elected to undergo a robotic transureteropyelostomy which involves transection of the left ureter at the proximal end of the stricture and an end-to-side anastomosis of the transected end to the right renal pelvis. RESULTS: Intraoperatively, estimated blood loss was 200 milliliters and operative time was 178 minutes. There were no intraoperative complications and the patient was discharged on postoperative day one. The patient's ureteral stent was removed 6 weeks postoperatively. The patient had no flank pain and did not experience any postoperative complications. The patient's 12-week postoperative renal scan demonstrated post lasix half time of 7 minutes on left and differential renal function of 54% of right kidney and 46% of left kidney. CONCLUSIONS: Robotic transureteropyelostomy is a novel technique for management of patients with long-segment radiation induced strictures with small bladder capacities. Anastomosing the ureter to the contralateral renal pelvis may offer a more robust blood supply versus a transureteroureterostomy. Transureteropyelostomy may also avoid the morbidity associated with ileal ureter reconstruction and serves as an alternative approach for these patients. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e98 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Matthew Lee More articles by this author Julienne Jeong More articles by this author Kelley Zhao More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...