V12-03: robotic uteretal reimplantation for uretero-enteric anastomotic strictures
Uretero-enteric anastomotic strictures occur in about 2-10% of patients treated with radical cystectomy and urinary diversion (UD). In this study we report the outcomes of robotic ureteral reimplantation for ureteroenteric anastomotic strictures in patients previously treated with robot assisted radical cystectomy (RARC) and UDs.
From April 2013 to July 2016 12 patients underwent robotic ureteral reimplantation in three tertiary referral centers. Out of 12 patients, 7 had orthotopic neobladder, 4 ileal conduit and 1 Indiana pouch. All patients had prior RARC and all but one had intracorporeal UD. _x000D_ Surgical steps include a careful ureteral dissection on the surface of the ureter/s to avoid injuring the iliac vessels, spatulation of the ureters, JJ stent insertion and finally uretero-ileal anastomosis._x000D_ Baseline, perioperative and early functional outcomes data are reported._x000D_
Mean time from RARC to uretero-anastomotic stricture diagnosis was 174 days (33-674). Mean stricture length was 2 cm (range 0.5-3), median operative time was 201 minutes (83-310) and median length of stay was 2 days (2-12)._x000D_ All cases were completed robotically. Intraoperative blood loss was negligible. Four patients experienced a Clavien grade II complication (urinary tract infection requiring antibiotics). At a median follow-up of 320 days (55-907) no recurrences occurred._x000D_
Robotic ureteral reimplantation for uretero-enteric strictures is a safe and highly effective procedure. Given the suboptimal success rate of endoscopic treatment, robotic repair has become a first treatment option in our centers.