Presented by: Kazumi Taguchi MD,PhD
Nagoya City University

Introduction

Ureteral stricture is a challenging condition commonly observed after ureteral stone impaction and endoscopic procedures. Although endoscopic ureterotomy is performed, there are still some cases that are difficult to treat. At our institution, we initiated robot-assisted ureteral reconstruction as an advanced medical procedure starting in the fiscal year 2022. However, the accurate identification of the stricture site has been challenging. Therefore, this study aimed to investigate the utility of a ureteral illuminating catheter (IRIS U-kit^@) for robot-assisted ureteral reconstruction.

Materials

This single-center prospective study was conducted between April 2022 and May 2023 at Nagoya City University Hospital in Japan. After obtaining informed consent from the patients with ureteral strictures following ureteral stone treatment, robot-assisted ureteral reconstruction was performed. Following general anesthesia, an IRIS catheter was inserted transurethrally and placed just below the site of the stricture under fluoroscopic guidance in the lithotomy position. The catheter was illuminated with near-infrared light during robot-assisted identification and securing of the stricture (Figure 1). The procedure was completed by replacing the catheter with a double-J stent during the ureteral anastomosis.

Results

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The average age of the patients was 56 years, with a mean BMI of 24.8 kg/m^2. The median length of the ureteral stricture was 25 mm. When compared to a control group of 8 cases using conventional ureteral catheters, the robot-assisted group demonstrated significant reductions in console time (114 min vs. 176 min, p=0.045) and time to securing the ureter (48 min vs. 83 min, p=0.22), as well as a shorter anastomosis time (20 min vs. 31 min, p=0.221). The ureters were anastomosed end-to-end, and closure was achieved with six sutures using 4-0 and 5-0 PDS. In all cases, the ureteral catheter was removed one month postoperatively, and no urinary obstruction was observed.

Conclusion

Use of a ureteral illuminating catheter is beneficial for robot-assisted ureteral reconstruction

Funding

none

Lead Authors

Shuzo Hamamoto,
Nagoya City University

Kengo Kawase,
Nagoya City University

Rei Unno,
Nagoya City University

Kentaro Mizuno,
Nagoya City University

Takahiro Yasui,
Nagoya City University