Presented by: Alexander Hwang MD
University of Tennessee College of Medicine, Chattanooga - Erlanger Department of Urology

Introduction

Here we report our early outcomes from ten consecutive patients who underwent robotic buccal mucosal graft (BMG) ureteroplasty for ureteral stricture disease at our regional tertiary care center.

Materials

We retrospectively reviewed our database to identify all patients who underwent robotic BMG ureteroplasty at our institution. Ten patients underwent robotic BMG ureteroplasty for benign ureteral stricture disease between January 2019 and March 2023.  The decision to proceed with robotic BMG ureteroplasty was made by the primary surgeon at the time of the operation based on imaging analysis, patient history, and intraoperative findings. Patient demographics, perioperative data, and short-term results were analyzed.  All patients underwent anterior BMG onlay. Nine/10 (90%) grafts were backed with an omental flap and 1/10 (10%) with backed with colonic mesentery. Our primary outcome was successful repair of the ureteral stricture, defined as resolution of flank pain in the affected kidney and lack of obstruction on postoperative functional imaging.

Results

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All 10 patients underwent technically successful robotic BMG ureteroplasty by a single surgeon. There were no intraoperative complications.  Median OR time was 301 min (range 210 - 378 min), median EBL was 25 mL (range 20- 50) ml.  Median length of stay was 1 day (range 0-2 days).  Median stricture length was 3 cm (range 2.5-4). Seven/10 (70%) strictures were in the proximal ureter, 2/10 (20%) strictures were located in the middle ureter, and 1/10(10%) strictures was located in the distal ureter.  One/10 (10%) stricture was secondary to iatrogenic injury.  One patient had a history of retroperitoneal radiation for previously managed testicular seminoma. One patient underwent BMG ureteroplasty following a failed robotic pyeloplasty. Nine/10 patients underwent successful repair. One patient underwent BMG ureteroplasty for attempted salvage of a marginally functional kidney. Follow up retrograde pyelography showed a patent repair, but obstruction could not be adequately assessed with functional imaging.

Conclusion

Robotic BMG ureteroplasty is a useful and feasible option for management of ureteral stricture disease.  With adequate surgeon experience, robotic BMG ureteroplasty can be performed successfully with minimal patient morbidity.

Funding

None

Co-Authors

Benjamin Waldorf, MD
University of Tennessee College of Medicine, Chattanooga - Erlanger Department of Urology

Jessica Lange, MD
University of Tennessee College of Medicine, Chattanooga - Erlanger Department of Urology

Ziho Lee, MD
Northwestern Feinberg School of Medicine