V01-08 ROBOTIC APPENDICEAL ONLAY FOR THE TREATMENT OF URETEROENTERIC STRICTURE

Abstract

You have accessJournal of UrologyCME1 Apr 2023V01-08 ROBOTIC APPENDICEAL ONLAY FOR THE TREATMENT OF URETEROENTERIC STRICTURE Joseph J. Boyle, Ellen Cahill, Sai Krishnaraya Doppalapudi, and Sammy E. Elsamra Joseph J. BoyleJoseph J. Boyle More articles by this author , Ellen CahillEllen Cahill More articles by this author , Sai Krishnaraya DoppalapudiSai Krishnaraya Doppalapudi More articles by this author , and Sammy E. ElsamraSammy E. Elsamra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroenteric anastomotic strictures (UES) are the most common complication requiring repeat surgery following radical cystectomy, occuring in up to 10% of patients. Untreated, they may result in loss of renal function and predispose patients to infection. Open revision of the stricture has been the gold standard, but is technically challenging. Minimally invasive surgical approaches (MIS) in stricture disease can afford greater visibility and maneuverability, while minimizing blood loss. Options for extended strictures or those located in the proximal or midureter have been historically limited to ileal ureter replacement or autologous kidney transplant, both having considerable morbidity. Onlay techniques utilizing buccal mucosa or appendix are options to repair rather than replace longer ureteral strictures. Appendiceal onlay flaps are an encouraging yet relatively under-described alternative for select patients in this group. In this video, we present a case of a 6 cm proximal right UES treated with robotic appendiceal onlay flap repair. METHODS: Procedure performed with Da Vinci Xi system. Patient placed in left lateral decubitus position. Veress needle technique used to insufflate the abdomen. Ports placed in standard position for robotic laparoscopic renal surgery, ensuring placement outside conduit margins. Right ureterolysis performed. 5-French ureteral catheter placed over a wire positioned through previously placed ureteral stent. Ureteroenteric anastomosis identified, with ureteral detubularization from anastomosis to just above stricture with a length of 6 cm. Increased ureteral caliber and vigorous saline efflux marked proximal stricture end. Appendix stapled at cecum and detubularized with preserving mesentery. Appendiceal flap sewn to detubularized segment of ureter. Intraoperative ureteroscopy demonstrated patent repair. JJ stent placed. RESULTS: No intraoperative complications. Case duration was 200 minutes. EBL was 25 mL. He was discharged POD 2 after an uncomplicated post-operative stay. Stent removed at 6 weeks. 3-month ultrasound and renal scan showed no obstruction. He was seen every 6 months with no signs or symptoms of UTI, flank pain, or hydronephrosis on ultrasound. Latest follow-up at 16 months. He reported resolution of chronic malodorous urine. CONCLUSIONS: UES remain a challenge following radical cystectomy. Robotic repair with appendiceal onlay is a safe, durable, and often overlooked treatment option. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e81 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph J. Boyle More articles by this author Ellen Cahill More articles by this author Sai Krishnaraya Doppalapudi More articles by this author Sammy E. Elsamra More articles by this author Expand All Advertisement PDF downloadLoading ...