PD35-07 INTERMEDIATE OUTCOMES FOLLOWING ROBOTIC NONTRANSECTING URETERAL REIMPLANTATION

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (PD35)1 Sep 2021PD35-07 INTERMEDIATE OUTCOMES FOLLOWING ROBOTIC NONTRANSECTING URETERAL REIMPLANTATION Brian W Chao, Jeremy R Slawin, Nabeel A Shakir, Srikar A Kuppa, Chinonyerem U Okoro, Robert Harrison, Nathan W Cheng, Michael D Stifelman, Daniel D Eun, and Lee C Zhao Brian W ChaoBrian W Chao More articles by this author , Jeremy R SlawinJeremy R Slawin More articles by this author , Nabeel A ShakirNabeel A Shakir More articles by this author , Srikar A KuppaSrikar A Kuppa More articles by this author , Chinonyerem U OkoroChinonyerem U Okoro More articles by this author , Robert HarrisonRobert Harrison More articles by this author , Nathan W ChengNathan W Cheng More articles by this author , Michael D StifelmanMichael D Stifelman More articles by this author , Daniel D EunDaniel D Eun More articles by this author , and Lee C ZhaoLee C Zhao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002039.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic ureteroneocystostomy can be performed via nontransecting side-to-side anastomosis, which eschews ureteral transection to preserve distal vascularity. We have previously described our early experience with this technique and herein present updated outcomes. METHODS: A multi-institutional ureteral reconstruction database (CORRUS) was retrospectively reviewed for patients undergoing robotic nontransecting ureteral reimplantation. The primary outcome of interest was freedom from recurrent ureteral stenosis, determined via a combination of reported symptoms, imaging findings, and/or endoscopy. We also report the incidence of de novo vesicoureteral reflux (VUR), defined as flank pain with voiding, recurrent urinary tract infections (UTI), and/or pyelonephritis in the absence of ureteral obstruction. RESULTS: We identified 26 patients who underwent robotic nontransecting ureteroneocystostomy between 2015 and 2020. Demographic data, peri-, and postoperative outcomes are shown in Table 1. Distribution of stricture etiology was similar to that reported in the literature, with iatrogenic injury in 15/26 patients (57.7%) being most common. 9/26 patients (34.6%) had prior operative intervention, most commonly endoscopic (88.9%). Adjunctive Psoas hitch or Boari flap was performed in 9/26 (34.6%) patients. There were no intraoperative or immediate postoperative complications. Over a median follow-up of 21 months (IQR 12–30), two patients (7.7%%) developed recurrent stenosis. One patient (3.8%) now receives chronic stent exchanges; the other (3.8%) had obstructive imaging findings and awaits further operative planning. 10/26 patients (38.5%) reported symptoms suggestive of de novo VUR. Of these, five (19.2%) reported mild flank pain with voiding, not requiring analgesics. One patient (3.8%) reported no pain but had recurrent UTIs, managed with non-antibiotic prophylaxis. One patient (3.8%) had recurrent flank pain and pyelonephritis and later underwent revision non-refluxing reimplantation. CONCLUSIONS: Robotic nontransecting ureteral reimplantation is an efficacious reconstructive option for distal ureteral strictures, even in cases of iatrogenic injury and prior abdominopelvic radiation. Symptomatic de novo VUR may develop and can often be managed conservatively. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e591-e591 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian W Chao More articles by this author Jeremy R Slawin More articles by this author Nabeel A Shakir More articles by this author Srikar A Kuppa More articles by this author Chinonyerem U Okoro More articles by this author Robert Harrison More articles by this author Nathan W Cheng More articles by this author Michael D Stifelman More articles by this author Daniel D Eun More articles by this author Lee C Zhao More articles by this author Expand All Advertisement Loading ...