Novel Use of Buccal Mucosal Graft for Robotic Ureteral Reconstruction After Appendiceal Interposition

Abstract

Clinical History:

A 22-year-old woman presented after initially receiving treatment for multiple injuries from a motor vehicle collision while 11 weeks pregnant.

Physical Examination:

Bilateral complete ureteropelvic junction (UPJ) disruption on antegrade and retrograde pyelogram. Ureteroscopy showed blind-ending ureters.

Diagnosis:

Bilateral UPJ avulsion.

Intervention:

In this video vignette, we detail the novel use of robotic buccal mucosal graft (BMG) for ureteral reconstruction after initial appendiceal interposition and contralateral robotic ureterocalycostomy. In the postpartum period, her reconstruction was performed in a staged manner requiring an initial robotic ureteral appendiceal interposition for management on the right and a robotic ureterocalycostomy for management of the left. She developed an anastomotic leak on the right from dehiscence of the anterior anastomosis between the distal ureter and the appendix. She subsequently underwent robotic revision with an onlay buccal mucosal graft to cover the defect, which resolved her leak on subsequent antegrade nephrostogram and retrograde pyelogram. Mercaptuacetyltriglycine (MAG3) scans postrevision showed unobstructed drainage.

Follow-Up/Outcomes:

The immediate postoperative course was uneventful, and she was discharged to home on postoperative day 3. Diagnostic retrograde and antegrade studies 3 months later showed no obstruction without extravasation. The patient continued to recover well without any flank pain or recurrent infections. Nuclear medicine MAG3 lasix flow scan ∼1 year after the BMG repair showed unobstructed drainage with a diuretic half-life of 8.5 minutes on the right side. This case highlights a potential technique for the armamentarium of urologists managing complex ureteral reconstruction such as urinary diversions for ureteral anastomotic strictures. Further efforts to refine this technique and gather further data on its efficacy in this complex patient population is needed.

Patient Consent Statement:

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Funding:

This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.

Runtime of video: 5 mins 01 secs