V08-06 REDO ROBOTIC LEFT URETERAL REIMPLANT USING THE EXTRAVESICAL LUAA TECHNIQUE

Abstract

You have accessJournal of UrologyCME1 May 2022V08-06 REDO ROBOTIC LEFT URETERAL REIMPLANT USING THE EXTRAVESICAL LUAA TECHNIQUE Clark Judge, Anastasia Gliatis, Amrita Mohanty, and Mohan Gundeti Clark JudgeClark Judge More articles by this author , Anastasia GliatisAnastasia Gliatis More articles by this author , Amrita MohantyAmrita Mohanty More articles by this author , and Mohan GundetiMohan Gundeti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002606.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrence of vesicoureteral reflux (VUR) after reimplantation is a therapeutic challenge. Options include conservative management with surveillance, endoscopic treatment with injection of a Dextranomer-hyaluronic acid bulking agent, and re-operation, either by open or minimally invasive approach. High grade reflux (grade 3-5) recurrence is unlikely to resolve with surveillance or endoscopic treatment. We demonstrate the steps to a redo extravesical robotic-assisted laparoscopic left ureteral reimplant using the LUAA technique (Length of detrusor tunnel (L), use of a U stitch (U) in the proximal detrusorraphy, placement of permanent ureteral alignment suture (A) at the apex of the closure, and inclusion of ureteral adventitia (A) in the detrusorraphy). METHODS: A 12-year-old male presents after a urinary tract infection and a recurrence of grade 3 VUR on the left secondary to volitional urinary holding. He had previously had an extravesical robotic-assisted laparoscopic bilateral ureteral reimplant for bilateral grade 4 VUR seven years prior with resolution of the reflux and urinary tract infections. Pre-operative video urodynamics revealed a smooth, large capacity bladder (740cc) with normal sensation and without detrusor overactivity. After consideration of the options, the patient and his parents elected to undergo a redo extravesical robotic-assisted laparoscopic left ureteral reimplant. RESULTS: Successful completion of the redo extravesical robotic-assisted laparoscopic left ureteral reimplant. There was significant adhesion of the vas deferens to the distal left ureter requiring extensive dissection. CONCLUSIONS: This video demonstrates that an extravesical robotic-assisted laparoscopic left ureteral reimplant is feasible and safe to perform as a re-operation after previous robotic ureteral reimplant. The most significant adhesion encountered was at the distal ureter, with the vas deferens densely adhered. We demonstrate the steps to this advanced procedure. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e715 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clark Judge More articles by this author Anastasia Gliatis More articles by this author Amrita Mohanty More articles by this author Mohan Gundeti More articles by this author Expand All Advertisement PDF DownloadLoading ...