V13-03 Transrectal Sp Robotic Rectal Mucosa Graft Harvest for Panurethral Stricture

You have accessJournal of UrologyLower Tract Reconstruction (including Transgender) II (V13)1 May 2024V13-03 TRANSRECTAL SP ROBOTIC RECTAL MUCOSA GRAFT HARVEST FOR PANURETHRAL STRICTURE Shree Agrawal-Patel, Javier Santiago, Hadley Wood, and Mohamed Eltemamy Shree Agrawal-PatelShree Agrawal-Patel , Javier SantiagoJavier Santiago , Hadley WoodHadley Wood , and Mohamed EltemamyMohamed Eltemamy View All Author Informationhttps://doi.org/10.1097/01.JU.0001009532.52598.9a.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rectal mucosa graft has been described as a suitable graft for extensive urethral stricture disease, especially among patients with prior buccal mucosal graft harvest. We aimed to describe the techniques required to perform a minimally invasive single port robotic assisted rectal mucosa graft harvest to add to the reconstructive urologist armamentarium. METHODS: In this case report, we report the perioperative management and surgical techniques for a 64 year old male patient, who presented with ongoing lower urinary tract symptoms and urinary retention requiring a suprapubic catheter. Further evaluation with voiding cystourethrogram and retrograde urethrogram demonstrated an 11 cm panurethral stricture extending from distal pendulous to proximal bulbar urethra. After discussion regarding approaches to his urethral stricture management, he consented to undergoing rectal mucosa graft urethroplasty with single port robotic assisted harvest, as described. RESULTS: Preoperatively, a bowel preparation was administered with a clear liquid diet, polyethylene glycol, and bisacodyl suppository. The single port robot is air docked via the single port trocar into a large cannula placed and secured into the rectum. Once the dentate line was identified, absorbable polymer injection with methylene blue dye is injected proximal to this landmark for distension of the mucosal tissue. An incision is carried along this plane laterally to create 2 cm width and dissected proximally to achieve 20 cm in graft length. Dissection was performed bluntly and sharply to allow for thin rectal mucosa graft. Accurate length was measured with markings on the remotely operated suction irrigation system in 5 cm increments prior to excision of the mucosa. The graft was prepared and a one sided dorsal graft onlay urethroplasty Kulkarni approach with a ventral partial thickness augmented anastomotic urethroplasty. Both the urethral foley and the suprapubic catheter were maintained. A voiding cystourethrogram at 3 weeks demonstrated no extravasation and a successful void trial was performed. Follow up from time of surgery is 1 month and there were no postoperative complications or readmissions. CONCLUSIONS: Rectal mucosa graft is an effective option for panurethral stricture disease. The single port robot offers a novel platform to perform this harvest in a minimally invasive manner. The ability to harvest a long segment of mucosa avoids the need for additional buccal mucosal graft harvest. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1156 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Shree Agrawal-Patel More articles by this author Javier Santiago More articles by this author Hadley Wood More articles by this author Mohamed Eltemamy More articles by this author Expand All Advertisement PDF downloadLoading ...