PD35-02 MULTI-INSTITUTIONAL EXPERIENCE WITH ROBOTIC URETERAL RECONSTRUCTION FOR RECURRENT STRICTURES AFTER PRIOR FAILED MANAGEMENT

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (PD35)1 Sep 2021PD35-02 MULTI-INSTITUTIONAL EXPERIENCE WITH ROBOTIC URETERAL RECONSTRUCTION FOR RECURRENT STRICTURES AFTER PRIOR FAILED MANAGEMENT Matthew Lee, Ziho Lee, Chinonyerem Okoro, Aeen Asghar, Randall Lee, David Strauss, Rohit Reddy, Michael Metro, Michael Stifelman, Lee C Zhao, and Daniel Eun Matthew LeeMatthew Lee More articles by this author , Ziho LeeZiho Lee More articles by this author , Chinonyerem OkoroChinonyerem Okoro More articles by this author , Aeen AsgharAeen Asghar More articles by this author , Randall LeeRandall Lee More articles by this author , David StraussDavid Strauss More articles by this author , Rohit ReddyRohit Reddy More articles by this author , Michael MetroMichael Metro More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Lee C ZhaoLee C Zhao More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002039.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical repair of recurrent ureteral strictures after prior failed intervention is technically challenging. We described our multi-institutional experience with robotic ureteral reconstruction (RUR) in patients who failed prior endoscopic and/or surgical management. METHODS: We retrospectively reviewed our Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database for all consecutive patients who underwent RUR between 05/2012—01/2020 for a recurrent ureteral stricture after having undergone a prior failed endoscopic and/or surgical repair. The method for repair was determined by the primary surgeon based on clinical history and intraoperative findings. Postoperatively, patients were assessed for surgical success defined as the absence of flank pain and obstruction on imaging. RESULTS: Overall, 105 patients met inclusion criteria (Table 1). Median stricture length was 2 (IQR 1-3) centimeters. Strictures were located at the ureteropelvic junction (UPJ) (41.0%), proximal (14.3%), middle (9.5%) or distal (35.2%) ureter. There were 9 (8.6%) radiation-induced strictures. Prior failed management included endoscopic intervention (49.5%), surgical repair (25.7%) or both (24.8%). Overall median operative time was 187.5 (IQR 143.8-279.3) minutes and estimated blood loss was 50 (IQR 40-100) milliliters. RUR techniques included ureteroureterostomy (3.4%), ureterocalycostomy (5.2%), pyeloplasty (69.0%) or buccal mucosa graft ureteroplasty (22.4%) for UPJ and proximal strictures; ureteroureterostomy (20.0%) or buccal mucosa graft ureteroplasty (80.0%) for middle strictures; ureteroureterostomy (8.1%), side-to-side reimplant (18.9%), end-to-end reimplant (70.3%) or appendiceal bypass (2.7%) for distal strictures. Adjunctive techniques such as a downward nephropexy, psoas hitch or Boari flap were utilized in 7 (6.7%), 10 (9.5%) and 8 (7.6%) cases, respectively. Major (Clavien>2) postoperative complications occurred in 2 (1.9%) patients. At a median follow-up of 15.1 (IQR 5.0-30.4) months, 95 (90.5%) cases were surgically successful. CONCLUSIONS: RUR may be performed with excellent intermediate-term outcomes for patients with recurrent strictures after prior failed endoscopic and/or surgical management. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e588-e588 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Lee More articles by this author Ziho Lee More articles by this author Chinonyerem Okoro More articles by this author Aeen Asghar More articles by this author Randall Lee More articles by this author David Strauss More articles by this author Rohit Reddy More articles by this author Michael Metro More articles by this author Michael Stifelman More articles by this author Lee C Zhao More articles by this author Daniel Eun More articles by this author Expand All Advertisement Loading ...