V01-03 Single Port Intravesical Distal Ureterectomy and Ureteral Reimplantation for a Right Intramural Distal Ureteral Stricture

You have accessJournal of UrologyUpper Tract Reconstruction (V01)1 May 2024V01-03 SINGLE PORT INTRAVESICAL DISTAL URETERECTOMY AND URETERAL REIMPLANTATION FOR A RIGHT INTRAMURAL DISTAL URETERAL STRICTURE Sai Krishnaraya Doppalapudi, Jennifer L. Sykes, Mira Patel, and Sammy E. Elsamra Sai Krishnaraya DoppalapudiSai Krishnaraya Doppalapudi , Jennifer L. SykesJennifer L. Sykes , Mira PatelMira Patel , and Sammy E. ElsamraSammy E. Elsamra View All Author Informationhttps://doi.org/10.1097/01.JU.0001008884.22400.05.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with multiple previous abdominal surgeries, bowel adhesions often make transperitoneal robotic access unsafe or simply not feasible. Patients with distal intramural ureteral strictures can uniquely be treated via intravesical approaches given the anatomy of their disease process. Here we demonstrate a unique surgical approach for treating an intramural right distal ureteral stricture by docking the single port robotic system directly into the bladder. METHODS: A 71-year-old female with a history of multiple abdominal surgeries and cystoscopic bladder tumor resections at the right ureteral orifice developed an intramural right distal ureteral stricture. Endoscopic management could not attain durable results and she was thus offered a right SP intravesical distal ureterectomy and ureteral reimplantation. The patient was positioned in the dorsal lithotomy position with 15 degrees of Trendelenburg tilt. A 20 Fr Foley catheter was inserted and the bladder was filled with 300 ml of normal saline. A 7 cm infraumbilical incision (over patient's previous incision) was used to eventually enter the patient's bladder. The SP Access Port was then placed directly into the bladder. The scarred right ureteral orifice was identified and the intramural ureter was circumferentially dissected down to the muscle using the diseased ureteral segment as a handle. The muscular layers of the bladder hiatus were then closed with a running barbed absorbable suture. The healthy ureter was spatulated, the diseased ureteral segment was amputated, and a gush of urinary efflux was noted. The healthy ureter was then reimplanted to the bladder mucosa using two running absorbable braided sutures. The remaining bladder mucosal defect was then closed. A 7 Fr x 24 cm JJ ureteral stent was then placed. The robot was undocked and the bladder was closed in two layers with absorbable braided sutures. The closure was tested with 200 ml of normal saline to ensure that it was watertight. Fascia and skin were then closed. RESULTS: Operative time was 100 minutes with 55 minutes of robotic time. Estimated blood loss was minimal and the patient was discharged with a Foley catheter post-op day 1. The Foley catheter was removed 1 week later and the ureteral stent was removed 4 weeks later. Ultrasound and renal scan performed 6 weeks postoperatively showed improved right hydronephrosis and no documented obstruction respectively. CONCLUSIONS: To our knowledge, this video demonstrates a unique surgical approach for the treatment of distal intramural strictures in patients with hostile abdomens. The single port robotic approach in these cases is both safe and provides excellent postoperative outcomes. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e96 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sai Krishnaraya Doppalapudi More articles by this author Jennifer L. Sykes More articles by this author Mira Patel More articles by this author Sammy E. Elsamra More articles by this author Expand All Advertisement PDF downloadLoading ...