V10-03: Robot Assisted Bilateral Ureteral Reimplantation on Studer Neobladder with Exposure of Iliac Artery Prosthesis
The Studer type neobladder is an orthotopic vesical substitution alternative that provides a continent reservoir that works at low pressure and is easy to void. One possible complication of this diversion is the uretero-intestinal stenosis. The presence of vascular prosthesis can cause an inflammatory reaction that might affect the ureters. The standard treatment for the stenosis is the surgical repair. This ureteral reconstruction is a demanding surgery in the open approach._x000D_ Robotic sugery enhaces vision of the surgical field while maintaining a high freedom of movement and facilitates a successful repair.
We present the case of a 72-year-old male, with a history of hypertension, diabetes and hyperuricemia, who’s urological history began in April 2015 with a Transurethral Resection of Bladder (TURB) that showed a High Grade cT1 bladder tumor and Carcinoma in situ (Cis) with an early recurrence. In November 2015, he underwent a Robotic Assisted Laparoscopic Radical Cystoprostatectomy with bilateral lymphadenectomy and Studer type Neobladder. After removing ureteral catheters (1 week after surgery) the patient present urinary leaks at the level of uretero-neovesical anastomosis. Bilateral Nephrostomy catheters where placed. After conservative treatment with ureteral catheters, an antegrade pyelography showed resolution of the urinary leaks but presence of bilateral distal ureteral stenosis _x000D_ In March 2016 the patient presented in the emergency room with severe bleeding due to a fistula between the left common iliac artery and the Studer neobladder, requiring percutaneous placement of two arterial prostheses. _x000D_ _x000D_ In April 2016, a Robotic Assisted Laparoscopic Bilateral ureteral reimplantation on Studer Neobladder was performed. _x000D_ Local Bioglue was used to cover the area of exposure of vascular prosthesis.
The surgical time was 210 minutes. The preoperative hemoglobin was 120 mg/dL and the postoperative one was 100 mg/dL. No blood transfusions were necessary. There were no postoperative complications. The patient was discharged at the 8th day after surgery. Nephrostomies were removed 15 days after surgery.
Robot assisted surgery is a good approach for the treatment of ureterointestinal stenosis, even in cases of concomitant vascular disease.