Mp48-13 a Multi-Institutional Experience With Robotic Intracorporeal Ileal Ureter Replacement

You have accessJournal of UrologyReconstruction: Ureteral Reconstruction (Including Pyeloplasty) and Bladder Reconstruction (Including Trauma-Related Fistula) I (MP48)1 May 2024MP48-13 A MULTI-INSTITUTIONAL EXPERIENCE WITH ROBOTIC INTRACORPOREAL ILEAL URETER REPLACEMENT Emily Ji, Jeffery Lin, Rohan Bhalla, Rebeca Gonzalez Jauregui, Nathalie Eid, Brian Flynn, Lee C. Zhao, and Ziho Lee Emily JiEmily Ji , Jeffery LinJeffery Lin , Rohan BhallaRohan Bhalla , Rebeca Gonzalez JaureguiRebeca Gonzalez Jauregui , Nathalie EidNathalie Eid , Brian FlynnBrian Flynn , Lee C. ZhaoLee C. Zhao , and Ziho LeeZiho Lee View All Author Informationhttps://doi.org/10.1097/01.JU.0001009512.15743.d7.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although ileal ureter replacement is a technically challenging procedure with significant morbidity, it is an effective treatment for reconstruction of long-segment ureteral defects. The literature regarding robotic ileal ureter replacement is limited to a handful of small case series. We report our multi-institutional experience with robotic intracorporeal ileal ureter replacement (RIUR). METHODS: We performed a retrospective review of all patients who underwent RIUR at three institutions from April 2016-July 2023. Patients undergoing RIUR in the setting of an ileal conduit were excluded. Indication for surgery was a long segment ureteral defect that was not amenable to other types of repair. Surgical success was defined as the absence of obstructive flank pain and ureteral obstruction on functional imaging and/or endoscopic evaluation. Only patients with follow up >3 months were assessed for surgical success. RESULTS: Of 39 patients who underwent RIUR, 26 (66.7%) had unilateral reconstruction and 13 (33.3%) had bilateral reconstruction. Sixteen (41.0%) patients had a history of pelvic radiation. The most common etiology of ureteral injury was iatrogenic (21/39, 52.8%). Median stricture length was 15 cm (IQR 10-16). In 6 patients, a concomitant abdominopelvic reconstruction was performed at time of RIUR: 4 underwent bladder augmentations, 1 had sigmoid colectomy with diverting ileostomy, and 1 underwent bladder neck reconstruction. Median operative time was 371 minutes (IQR 332-444), estimated blood loss was 100 ml (IQR 50-188), and length of stay was 5 days (IQR 4-6). There were 3 (7.8%) intraoperative complications: 1 conversion to open due to technical failure of the robot, 1 inferior vena cava injury that required repair, and 1 chylous leak from the peri-aortic lymph nodes that required lymph node dissection. There were 8 (20.5%) major (Clavien ≥III) 30 day complications: 5 patients had urinary anastomotic leaks that required drain placement, 1 patient had an intraabdominal abscess that required drain placement, 1 patient had a small bowel and urinary anastomotic leak that required exploratory laparotomy, and 1 patient developed renal bleeding after starting anticoagulation for pulmonary embolism requiring angioembolization. 6 patients did not have >3 months follow up. At a median follow up of 14 months (IQR 7-27), 30/33 (90.9%) patients were surgically successful. CONCLUSIONS: RIUR is an effective treatment for patients with long-segment ureteral injuries. However, the procedure is challenging and associated with a significant major complication rate. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e778 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Emily Ji More articles by this author Jeffery Lin More articles by this author Rohan Bhalla More articles by this author Rebeca Gonzalez Jauregui More articles by this author Nathalie Eid More articles by this author Brian Flynn More articles by this author Lee C. Zhao More articles by this author Ziho Lee More articles by this author Expand All Advertisement PDF downloadLoading ...