V01-10 Peri-Ureteral Tissue Sparing Robotic Intracorporeal Reverse 7 Ileal Conduit

You have accessJournal of UrologyUpper Tract Reconstruction (V01)1 May 2024V01-10 PERI-URETERAL TISSUE SPARING ROBOTIC INTRACORPOREAL REVERSE 7 ILEAL CONDUIT Matthew Epstein, Matthew Lee, Fenizia Maffucci, Jessica Clark, Michael Metro, and Daniel Eun Matthew EpsteinMatthew Epstein , Matthew LeeMatthew Lee , Fenizia MaffucciFenizia Maffucci , Jessica ClarkJessica Clark , Michael MetroMichael Metro , and Daniel EunDaniel Eun View All Author Informationhttps://doi.org/10.1097/01.JU.0001008884.22400.05.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroenteric anastomotic stricture is an unwelcome complication after urinary diversion, for which definitive repair often requires surgical revision. Stricture formation is associated with distal ureteral ischemia owing to over-dissection of the distal ureteral segment. In patients with pre-existing risk factors for the development of ureteral strictures undergoing urinary diversion, careful surgical attention is warranted to avoid ureteroenteric anastomotic stricture formation. In this video, we present a rarely performed technique in a patient with bilateral ureteral stricture disease undergoing a urinary diversion that avoids peri-ureteral tissue mobilization. METHODS: Saline is injected into bilateral nephrostomy tubes to dilate the healthy ureteral segments proximal to the stricture, aiding in initial identification of both ureters in the retroperitoneum. Ureteral perfusion is then assessed using intravenous indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging. The ureters are incised sharply on the anterior surface at a healthy ureteral segment with good tissue perfusion proximal to the stricture. A reverse 7 ileal conduit is then constructed by bringing the butt-end of the ileal segment under the mesentery to the left ureter. A left end-to-side ureteroenteric anastomosis and right side-to-side anastomosis is then completed with placement of bilateral JJ ureteral stents. RESULTS: We performed a robotic intracorporal reverse-7 ileal conduit urinary diversion for a 63 year old female with an "end-stage," contracted bladder with 90cc capacity and bilateral, long-segment ureteral strictures measuring 8 cm on the right and 10 cm on the left. The operation lasted approximately 6 hours on the console, with estimated blood loss of 350cc and no intra-operative complications. Stents were removed after 4 weeks. At her 4 month follow-up visit, she remains "tubeless." A Mag3 Renal Scan with Lasix demonstrated no evidence of obstruction with bilateral diuretic half-life time of 4.5 minutes, and her eGFR remains stable at 4 months at 67 mL/min/1.73 m2 from a pre-operative eGFR of 66 mL/min/1.73m2. CONCLUSIONS: We provide demonstration of a peri-ureteral tissue sparing robotic intracorporeal reverse 7 ileal conduit aimed to reduce the risk of ureteroenteric stricture formation by minimizing peri-ureteral tissue dissection and mobilization. Source of Funding: NA © 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 Epstein More articles by this author Matthew Lee More articles by this author Fenizia Maffucci More articles by this author Jessica Clark More articles by this author Michael Metro More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...