Bilateral ureteral reconstruction with U-shaped ileal interposition segment

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Retroperitoneal fibrosis can cause ureteral strictures, leading to kidney damage.
• Complex cases involving vascular encasement pose significant surgical challenges.
• Previous treatments may include nephrostomy dependence.

Purpose of the Study:

• To describe a novel robotic technique for bilateral ureteral reconstruction.
• To address ureteral strictures in the context of retroperitoneal fibrosis and vascular encasement.
• To present a case study of successful ileal interposition.

Main Methods:

• Robotic-assisted surgery was employed for bilateral ureteral reconstruction.
• A U-shaped ileal segment was used for interposition.
• The technique involved ureteral dissection, spatulation, and mucosa-to-mucosa anastomosis to the ileal segment.
• Double-J and single-J stents were utilized for urinary diversion and support.

Main Results:

• Successful reconstruction of bilateral mid-ureteral strictures was achieved.
• The patient, previously dependent on nephrostomy, had restored urinary continuity.
• The robotic approach facilitated precise dissection and anastomosis in a challenging anatomical field.

Conclusions:

• Robotic ureteral reconstruction with U-shaped ileal interposition is a viable option for complex ureteral strictures.
• This technique can effectively manage ureteral reconstruction in patients with retroperitoneal fibrosis and vascular encasement.
• The described method offers a minimally invasive solution for challenging urological reconstructions.