V03-06 TRANSECTION-FREE SIDE-TO-SIDE DISTAL URETERAL REIMPLANTATION

Abstract

INTRODUCTION AND OBJECTIVES:Distal ureteral strictures pose a potential risk for renal impairment. The surgical gold standard involves ureteroneocystotomy with transection of the ureter. We present the technique of side-to-side anastomosis as a useful treatment option that avoids aggressive distal ureteral dissection and further compromise of blood supply. Additionally, the presence of the native ureteral orifice allows for ureteroscopic access if required.METHODS:In this video, we show our robotic surgical technique for side-to-side anastomosis for distal ureteral stricture performed by three genitourinary reconstructive surgeons from three different institutions. Our technique involves the performance of adequate ureterolysis of the healthy, proximal and non-strictured segment. Extensive dissection of the posterior ureter towards the ureterovesical junction is avoided, preventing vascular compromise. Indocyanine dye can be used to demonstrate vascularity prior to anastomosis. A psoas hitch or bladder mo...