Robot-assisted laparoscopic ipsilateral ureteroureterostomy for injury of an ectopic duplicated ureter following robotic prostatectomy.

Abstract

We report the feasibility and the safety of a robot-assisted laparoscopic ipsilateral ureteroureterostomy in a patient who had previously undergone a robot-assisted laparoscopic radical prostatectomy and was found postoperatively to have complete right sided ureteral duplication with apparent injury to the distal ectopic ureter. Robot-assisted laparoscopic ipsilateral ureteroureterostomy was performed transperitoneally using the same six port sites that had previously been used for the robotic prostatectomy. Rigid cystoscopy was performed at the time of the procedure to identify the normal ureter, perform a retrograde pyelogram, and place a double pigtail ureteral stent. The ureteroureterostomy anastamosis was performed using interrupted 4-0 polyglactin sutures. The operation was performed successfully and without complications. Total operating room time was 117 min. Robot time was 73 min. Estimated blood loss was 50ml. Other than a brief episode of renal colic on postoperative day 2, the patient recovered uneventfully and was discharged home on postoperative day 4. Preoperative serum creatinine was 1.05mg/dl and on the day of discharge was 0.85mg/dl. Prostate pathology showed adenocarcinoma of the prostate, Gleason 3+4=7 with negative margins pathologic stage T2c.Robot-assisted laparoscopic ipsilateral ureteroureterostomy is safe and effective for the treatment of ureteral injury in a duplicated system.