Abstract
Background/Objective:
Managing long-segment bilateral ureteral strictures in the mid/upper ureters with chronic renal insufficiency (CRI) and small bladder capacity is challenging. A Boari flap is not an option caused by low bladder capacity. Ileal replacement of the ureteral strictures risks worsening metabolic-acidosis in CRI. 1,2 In this situation, a buccal mucosal graft is a safe and effective surgical technique. 3,4 Buccal mucosal graft ureteroplasty is associated with high success rates and a low rate of complications. 5 This video presents a robot-assisted buccal mucosa graft ureteroplasty to treat long-segment bilateral ureteral strictures in a patient with CRI and small bladder capacity.
Materials:
A 54-year-old lady with a history of genitourinary-tuberculosis was found to have bilateral long-segment ureteral strictures and upstream hydroureteronephrosis. The patient was initially managed with anti-tubercular treatment (ATT) and bilateral Double-J stents. She completed 6 months of ATT and the stents were replaced with bilateral percutaneous-nephrostomies because of persistent hydronephrosis. After drainage, the serum creatinine (SCr) was 2.2 mg/dL with a glomerular filtration rate of 24.7 mL/(min·1.73 m2) and a urinary bladder capacity of 200 mL. A simultaneous antegrade and retrograde contrast study showed a stricture length of 4–5 cm on each side located in the mid/upper ureter. Bilateral buccal mucosal grafts ureteroplasty were then offered as a solution to this problem using the Da Vinci Si system.
Results:
The operative time was 230 minutes with blood loss of 50 mL. Postoperative recovery was uneventful. At 6 months, SCr was 1.8 mg/dL with unobstructed drainage through both ureters on a renal dynamic scan.
Conclusions:
Buccal mucosa graft ureteroplasty is a well-suited procedure for reconstruction of long-segment ureteral strictures that are not amenable for routine procedures.
No competing financial interests exist.
Runtime of video: 6 mins 50 secs
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