V09-07 ROBOTIC INTRACORPOREAL SINGLE ILEAL INTERPOSITION FOR BILATERAL URETERAL STRICTURE

Abstract

You have accessJournal of UrologyUpper Tract Reconstruction (V09)1 Sep 2021V09-07 ROBOTIC INTRACORPOREAL SINGLE ILEAL INTERPOSITION FOR BILATERAL URETERAL STRICTURE Sunchin Kim, and Matthew Gretzer Sunchin KimSunchin Kim More articles by this author , and Matthew GretzerMatthew Gretzer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002052.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bilateral ureteral obstruction is a common complication for patients who have undergone radiation treatment for cervical cancer. Given the effect of radiation to the bladder, the usual reconstructive options are limited and becomes a challenging problem for a urologist to manage. This video aims to offer a robotic, completely intracorporeal urinary diversion using a single ileal loop interposition for bilateral ureteral strictures. METHODS: A 29 year old female with cervical cancer underwent treatment with robotic radical hysterectomy, bilateral salpingectomy, para-aortic lymph node dissection, then radiation treatment. She developed a vesicovaginal fistula and underwent repair with a pudendal thigh flap, then developed bilateral obliterative ureteral strictures at the mid-distal junction managed with bilateral nephrostomy tubes. Discussion of other options included Boari flap, psoas hitch, buccal augment, appendiceal interposition, and autotransplant. Patient was placed in a steep Trendelenburg position with four 8-mm robotic trocars placed subcostally and one assistant 12 mm port. Bilateral ureters were dissected out and transected at the level of their obliteration. The left ureter was tunneled underneath the rectum and brought over to the right side for a spatulated Wallace anastomosis. The distance between the ureter and bladder was measured, and the ileal segment was harvested. RESULTS: The operative time was 5 hours and 30 minutes. Estimated blood loss was 30 ml. Length of stay was 8 days with no complications, had extended stay for pain control given significant prior narcotics use. Bowel function and flatus were present on postoperative day 3. Foley catheter was left in place for 10 days, and bilateral ureteral stents were left in for 6 weeks. Preoperative creatinine was 0.83. Post-stent removal creatinine was 0.55. A flexible cystoscopy after stent removal revealed widely patent vesico-ileal and ileo-ureteral anastomoses. CONCLUSIONS: Complete intracorporeal robotic ileal interposition for bilateral ureters is a safe and feasible option for bilateral ureteral strictures. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e689-e689 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sunchin Kim More articles by this author Matthew Gretzer More articles by this author Expand All Advertisement Loading ...