Laparoscopic onlay-flap ureteroplasty using cecal appendix
Miquel Amer-Mestre1, Valenti Tubau1, Ricardo Guldris-García1
1Department of Urology, Son Espases University Hospital, Palma, Balearic Islands, Spain.
Summary
Laparoscopic onlay-flap ureteroplasty using cecal appendix offers a feasible solution for challenging right mid-ureter strictures. This minimally invasive approach provides a durable, stent-free outcome for patients with chronic kidney disease.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Reconstructive Urology
Background:
- Ureteral strictures exceeding 1-2 cm typically require major surgery.
- Mid-ureteral strictures present a significant challenge, often necessitating ureteral substitution.
- Traditional treatments for mid-ureteral strictures include intestinal or buccal mucosa grafts.
Observation:
- A 63-year-old male with chronic kidney disease (CKD) and a single functioning kidney presented with a 3 cm right mid-ureter stricture.
- The patient experienced recurrent JJ-stent occlusions and required a nephrostomy tube due to obstruction.
- A laparoscopic onlay-flap ureteroplasty utilizing the cecal appendix was performed for definitive management.
Findings:
- The procedure involved ureterotomy, preparation of the cecal appendix, and ureteroplasty, with operative time of 190 minutes.
- No intraoperative complications occurred, and the JJ-stent was removed after 7 weeks.
- At 36-month follow-up, the patient remained stent-free, with stable CKD and no worsening of residual hydronephrosis.
Implications:
- Laparoscopic onlay-flap ureteroplasty with cecal appendix is a viable and well-tolerated option for mid-ureter strictures.
- This technique offers a durable, minimally invasive solution for complex ureteral reconstruction.
- Complex ureteral stricture management should be centralized in expert centers due to the technical demands.
