V05-09 ROBOTIC ILEAL NEOURETER AND PSOAS HITCH FOR IATROGENIC COMPLETE URETERAL AVULSION: OUR 2 CASES EXPERIENCE

Abstract

You have accessJournal of UrologyUpper-Tract Reconstruction (V05)1 Apr 2020V05-09 ROBOTIC ILEAL NEOURETER AND PSOAS HITCH FOR IATROGENIC COMPLETE URETERAL AVULSION: OUR 2 CASES EXPERIENCE Federica Balzarini*, Andrea Pacchetti, Alberto Caviglia, Emanuele Barabino, Alberto Olivero, Federico Dotta, Matteo Valcalda, Giovanni Camerini, and Carlo Terrone Federica Balzarini*Federica Balzarini* More articles by this author , Andrea PacchettiAndrea Pacchetti More articles by this author , Alberto CavigliaAlberto Caviglia More articles by this author , Emanuele BarabinoEmanuele Barabino More articles by this author , Alberto OliveroAlberto Olivero More articles by this author , Federico DottaFederico Dotta More articles by this author , Matteo ValcaldaMatteo Valcalda More articles by this author , Giovanni CameriniGiovanni Camerini More articles by this author , and Carlo TerroneCarlo Terrone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000874.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Complete ureteral avulsion during ureteroscopy (URS) is a rare but catastrophic complication. The paucity of literature on this complication and its management may lead urologists to trouble when they plan a repair procedure. A possible therapeutic option can be represented by ileal interposition. Less than 20 cases of totally intracorporeal robotic ileal neoureter are reported in literature. The aim of the video is to show how two cases of complete ureteral avulsion were managed at our centre with an intracorporeal robotic approach. METHODS: Case A. 47 years old male patient underwent a right semirigid URS and laser treatment for a 8mm stone below ureteropelvic junction (UPJ). Complete right ureteral avulsion occurred during the attempt of retrieving a stone fragment with a basket. A nephrostomy tube was immediately placed to control the urinary leakage. After discussion with the patient about the possible solutions, a robot-assisted ileal ureter was chosen. Patient and trocar positioning: 60° modified flank position; four 8-mm robotic trocars on the pararectal line, periumbilical and two assistant robotic trocars (5 and 12mm), along the xiphopubic line. Da Vinci Xi robot docking. Case B. 68 years old male patient with 5mm stone at the level of the UPJ underwent flexible URS. Complete avulsion of the left ureter occurred during the procedure. A nephrostomy tube was immediately placed. After careful counseling, the indication of replacement of the ureter with the ileum was given. Patient and trocar positioning were the same as described above. RESULTS: Outcomes: nephrostomy removal after 7 days, catheter removal after 8 days, discharge after 10 days and stent removal after 30 days in both cases. One-month cystogram: reflux in the neoureter for case A (only at high bladder filling). Follow-up blood tests: normal renal function and pH. Urine colture: negative. 6-months CT scan: no hydronephrosis, minimal delayed right renal contrast media elimination for case A. Technical aspects: 3 robot dockings for case B compared to 1 docking for case A; mesenterial rotation for case A to achieve an isoperistaltic neoureter; presence of the sigmoid colon for case B. CONCLUSIONS: In our experience, complete intracorporeal robotic ileal interposition is a feasible option for bridging full length ureteral defects, with low complication rates. These cases are so rare that it is very difficult to standardize the procedure. Patient’s age, comorbidities, ipsilateral and contralateral kidney function, patient's expectations and surgeon experience can affect the treatment choice. 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 Federica Balzarini* More articles by this author Andrea Pacchetti More articles by this author Alberto Caviglia More articles by this author Emanuele Barabino More articles by this author Alberto Olivero More articles by this author Federico Dotta More articles by this author Matteo Valcalda More articles by this author Giovanni Camerini More articles by this author Carlo Terrone More articles by this author Expand All Advertisement PDF downloadLoading ...