Robot Assisted Ileal Ureter Replacement For Complete Ureteral Avulsion

Complete ureteral avulsion is a rare yet severe iatrogenic complication of ureteroscopic stone treatment, with an incidence of less than 1%. Traditional management typically involves initial percutaneous nephrostomy drainage, followed by a period of delayed open reconstruction-such as ileal interposition, renal autotransplantation, or, in unsalvageable cases, nephrectomy. This report describes a case of a female patient who experienced an iatrogenic ureteral avulsion during treatment of an 8 mm proximal ureteral stone. After an initial percutaneous nephrostomy, a robot-assisted ileal interposition was successfully carried out the next day. In addition to harvesting and isoperistaltic interposition of a 25 cm ileal segment, the procedure included bilateral inguinal hernia repair. The surgery was technically challenging due to the patient's body habitus, necessitating a change from the initial lateral decubitus position to supine and back to lateral decubitus, resulting in an operative time of approximately 300 min with minimal blood loss. The postoperative course was uneventful; the patient was discharged on postoperative day 7, and the Foley catheter was removed on day 10 following an unremarkable cystogram. The intraluminal drain was removed cystoscopically four weeks postoperatively. The six-month follow-up was uneventful (creatinine 0.8 mg/dL, glomerular filtration rate (GFR) >90 mL/min/1.73 m²). Renal scintigraphy revealed no obstruction. This case demonstrates that robot-assisted repair may be a safe and practical option in selected cases compared to delayed reconstruction, helping patients avoid extended urinary diversion when treated at experienced centers.