V10-02: Robotic buccal mucosal ureteroplasty for ureteral stricture after robotic ureterolysis
Long strictures involving the proximal ureter pose a reconstructive challenge. Recently, robot-assisted ureteroplasty with buccal mucosa graft (BMG) has been described. We present a patient who received both robotic ureterolysis followed by a robotic ureteroplasty the following year, in order to describe both robotic techniques on video.
A 58 year-old male on medication for a pituitary tumor presented with left ureteral obstruction and underwent a robotic ureterolysis/omental wrap procedure for presumed retroperitoneal fibrosis after failed medical management. Fibrosis was isolated to the region of a tortuous left iliac artery, which was likely due to trauma from a prior femoral artery catheterization during a cardiac procedure. The ureter was freed of fibrotic attachments and covered with an omental wrap. The patient did well for 1 year, but eventually developed recurrent ureteral obstruction with a 6cm mid/upper ureteral stricture requiring nephrostomy drainage and stent. He elected to undergo BMG ureteroplasty._x000D_ _x000D_ For both robotic procedures, the patient was positioned in modified lateral decubitus lithotomy position with ports similar to a pyeloplasty. For the ureteroplasty, the mouth was prepped separately for BMG harvest. Ureteroscopy and near-infrared fluorescence were used to define the proximal and distal extent of the stricture. The stricture was measured and the BMG was harvested accordingly. A ureterotomy was made along the length of the stricture over the ureteroscopy. The BMG was sewn to the ureteral edges as an onlay patch. Ureteroscopy was used to confirm patency and a stent was placed. An omental wrap was sutured over the ureter and BMG for blood supply._x000D_ _x000D_
The patient underwent an uncomplicated ureterolysis procedure with an EBL of 75cc, OR time of 280 minutes, and a hospital stay of 3 days. He is doing well with followup
We describe a case of robotic ureterolysis followed by robotic BMG ureteroplasty in the same patient. Robotic BMG ureteroplasty is an option for patients with long ureteral strictures with proximal extent, and is an alternative to autotransplantation or ileal ureter.