V05-08 MANAGEMENT OF MULTIPLE URETERAL STRICTURES IN A PARTIALLY DUPLICATED COLLECTING SYSTEM

Abstract

You have accessJournal of UrologyUpper-Tract Reconstruction (V05)1 Apr 2020V05-08 MANAGEMENT OF MULTIPLE URETERAL STRICTURES IN A PARTIALLY DUPLICATED COLLECTING SYSTEM Aeen Asghar*, Ziho Lee, Michael Metro, and Daniel Eun Aeen Asghar*Aeen Asghar* More articles by this author , Ziho LeeZiho Lee More articles by this author , Michael MetroMichael Metro More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000874.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Duplication of the collecting system can be found in nearly 1% of the general population. It can present as partial or complete duplication with or without obstruction and reflux. Herein, we present a patient with idiopathic high-grade ureteral strictures in both ureters of her partially duplicated system. METHODS: We present a 36-year-old female who was initially diagnosed with sepsis secondary to a distal left ureteral stone requiring percutaneous nephrostomy tube placement. After resolution of infection and spontaneous passage of stone, she was found to have a partially duplicated collecting system with dense strictures in both lower and upper proximal ureters on antegrade and retrograde pyelograms. A MAG-3 renal scan revealed functioning moieties with no drainage from the lower moiety and delayed drainage from the upper pole. Given her young age and desire for definitive surgery, we proceeded with Robot-Assisted Laparoscopic (RAL) ureteral reconstruction. Intraoperatively, we encountered severe peri-ureteral inflammation with an obliterated long segment lower pole proximal ureter and a dense 2.8 cm upper pole ureteral stricture, we decided to perform a ureteropyelostomy and an augmented anastomotic buccal mucosal graft ureteroplasty. This was done by creating an ureteropyelostomy anastomosis between the lower moiety pelvis to the upper moiety proximal ureter, followed by reconstruction of the 2.8 cm stricture in the upper ureter to create a new common ureteral drainage pathway. A ureteral stent was placed with the proximal curl in the lower moiety pelvis. We also placed a Foley catheter in the bladder and a Jackson-Pratt (JP) drain. RESULTS: Our console time was 303 minutes with 100 mL of blood loss. The foley catheter was removed on post-operative day (POD) 1, along with the JP drain, given its low output. Patient was discharged on POD 1 and had no 30-day post-operative complications. Her stent was removed 6 weeks post-operatively and her MAG-3 renal scan results are pending. CONCLUSIONS: Duplicated collecting systems are a rare congenital anomaly, often asymptomatic in those with bifid ureters. Patients in this population suffering from ureteral strictures may benefit from minimal invasive ureteral reconstruction. Complex ureteral reconstruction even in multi-level dense ureteral strictures in both limbs of a bifid ureter can be feasible by experienced teams if advanced surgical options such as RAL ureteropyelostomy and buccal mucosal graft ureteroplasty are utilized. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e472-e472 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aeen Asghar* More articles by this author Ziho Lee More articles by this author Michael Metro More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...