V10-14: Ureteral Complications During Intracorporeal Urinary Diversion--Lessons From Our Early Experience
VideoIntroductions and Objectives
The robotic assisted laparoscopic (RAL) approach to radical cystectomy (RALRC) and pelvic lymph node dissection (PLND) has been widely adapted. Applying the RAL approach to urinary diversion, however, still has not gained popularity. In our early experience with RALRC and intra-corporeal urinary diversion (ICUD), we have identified several pitfalls pertaining to ureteral stenting and detail them in our video.
All RALRC between 2008 and 2013 were identified. Those with ICUD were evaluated for numerous parameters including complications. Videos and radiographic images detailing ureteral injuries or complications intra- and postoperatively were reviewed and detailed.
Sixteen patients underwent ICUD. Five patients were identified to have inappropriate placement of single-J stent and subsequent urinary extravasation (4 renal units) or obstruction (6 renal units). All patients were managed with perctuaneous nephrostomy tube decompression. All issues were related to use of Single-J stent.
In our early experience 31% of patients experienced ureteral injury associated with Single-J ureteral stents. The single-J ureteral stent, and its associated length, may pose difficultly in ICUD given limited space associated with this approach. We have since abandoned the use of a single-J ureteral stent in favor of a double-J ureteral stent.