V03-12: Robotic Distal Ureteroureterostomy for Focal Distal Ureteral Strictures
Primary excision of a ureteral stricture followed by ureteroureterostomy (U-U) has been well reported for focal mid- and proximal ureteral strictures. For a distal ureteral stricture, U-U was historically less favored due to limited visualization in the deep pelvis and concerns about periureteral blood supply. We believe that the enhanced optics and fine dexterity of the robotic platform allow distal U-Us to be technically viable. We present our series of distal U-Us for focal distal ureteral strictures in conjunction with a representative case.
In a prospectively maintained ureteral reconstruction database, we followed patients who underwent a robotic-assisted laparoscopic distal U-U for a focal distal ureteral stricture. The latter was defined as any stricture at or distal to the iliac bifurcation intraoperatively or distal to the pelvic brim radiologically. In addition to patient demographics, we recorded the etiology of stricture, stricture length and recurrence rates. Recurrence was defined as findings of high-grade obstruction by a diuretic renal scan and subsequent transabdominal reoperation.
From 2012 to 2018, we identified 20 patients who underwent a robotic U-U for a distal ureteral stricture. Mean follow-up time was 11.7 months. Mean age was 45.7 while 19 of 20 patients (95%) were female. Median stricture length was 1.5 cm (range 1 to 3 cm). Most of the cases (12, 60%) presented with short segment strictures due to iatrogenic surgical injuries. Technical steps of the U-U operation were as highlighted in the representative video. There were 2 stricture recurrences (10%) necessitating a ureteral reimplantation operation.
In our experience, robotic distal ureteroureterostomy for distal ureteral stricture disease is technically viable and shows promising efficacy in properly selected patients. This technique may serve a niche for preserving the natural anatomy of the bladder and gynecological structures in addition to obviating the sequela of vesicoureteral reflux as seen in ureteral reimplantation.