V12-08: Ureteroileal bypass: a new robotic technic to treat ureteroentereric strictures in urinary diversion
Bladder cancer is the ninth most frequently cancer diagnosed worldwide. The standard definitive treatment for MIBC is radical cystectomy (RC) and urinary reconstruction._x000D_ Complications of RC and diversion can appear after months or years of surgical treatment. Ureteroentereric strictures are a late complication after cystectomy and diversion that occur in 2% to 15% of patients.4-6 Multiple treatment alternatives have been proposed to those strictures with variable success rates, ureteral reimplantation is still considered the gold standard surgical treatment7. However, the surgical approach to the ureteroenteric anastomosis can be challenging due to fibrosis and adhesions. We propose herein a technical modification aiming to minimize ureteral dissection; the technique involves a latero-lateral anastomosis of the dilated ureter with the ileal conduit without detaching de ureter from the intestinal segment. Our experience with this technical modification is described._x000D_
We reported a patient submitted to uretero-ieal bypass to treat uretero-enteric stricture in Bricker implant._x000D_ The technique was made robot-assisted, and it is shown in the figure.
The case reported is a 70 years-old man, without any comorbities, diagnosed with muscle invasive bladder cancer after transuretral ressection. _x000D_ He was subbmited to Robot-Assisted RC with intracorporeal Bricker diversion, without any major complications._x000D_ The pathologic report of cistectomy was high grade urothelial carcinoma pT2 N0._x000D_ With 3 months of follow-up, patient refered left flank pain, without any report of urinary infecction._x000D_ Serum Creatinine before cistetomy was 0.8 mg/dL, and 3 months after surgery it increased to 1.33 mg/dL._x000D_ The CT scan showed the right kidney without any change, there was no limphnode or visceral metastasis, the left kidney had adequate contrast enhancement, and there was ureteral hydronephrosis till the implant in the Bricker, without patency for contrast. There was no sign of metastasis in the implant._x000D_ With a follow-up of one year after the uretero-ileal bypass, patient is assimptomatic, serum creatinine decreased to 0,92 mg/dL, and image control shows total resolution of hydronephrosis._x000D_
Latero-lateral ureteroenteric anastomosis is a feasible treatment option for benign anastomotic strictures. It can be performed either by open or minimally invasive approaches with good perioperative outcomes