Presented by: Jennifer L Nguyen BS
Department of Urology, Hackensack University Medical Center

Introduction

To describe our experience using adjunctive omental wrap in robotic ureteral reconstruction (RUR) in the management of ureteral strictures.

Materials

Using the multi-center Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database, we identified patients who underwent RUR with adjunctive omental wrap from September 2013 to March 2021. We completed comparative analysis in patients undergoing buccal mucosal graft (BMG) ureteroplasty, ureteroureterostomy (UU), and refluxing reimplant with and without omental wrap. 

Results

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143 patients underwent RUR with adjunctive omental wrap for neovascularization. Prior ureteral interventions were performed in 62 patients (43.4%). The median intraoperative stricture length was 3.0 cm (IQR: 2.0-4.0), median operative time (OT) was 214.5 minutes (IQR: 174.8-277.5), and the median postoperative length of stay was one night. We observed 5 (3.6%) intraoperative complications and 4 (2.8%) major postoperative complications (≥Clavien Grade 3). We report a success rate of 86.0% (123/143) with a median follow-up of 15.5 months (4.8-34.5) with documented instances of failure occurring at a median of 5.3 months following surgery . In comparative analysis, out of 7 buccal ureteroplasty cases where no omental wrap was utilized, 4 (57.1%) had perinephric flap, 2 (28.6%) had gerota, and 1 (14.3%) had a mesenteric wrap. In the UU cases where no omental wrap was utilized, no other adjacent vascular procedure was documented, and this cohort did not demonstrate significant differences in OT, intraoperative complication rates, 30-day postoperative complication rates, or failure rates when compared to the omental wrap cohort. 

Conclusion

The omental wrap is a versatile, safe, and effective technique for adjunctive use in RUR. It has gathered popularity for graft inosculation in the BMG procedure for its excellent outcomes. Though it has no statistical benefit in the UU group, it doesn’t adversely affect perioperative outcomes whenever used. 

Funding

No funding was received for the writing of this article.

Lead Authors

Teona Iarajuli, MD
Department of Urology, Hackensack University Medical Center

Co-Authors

Tanner Corse, MD
Department of Urology, Hackensack University Medical Center

Aamirah McCutchen,
Hackensack Meridian School of Medicine

Allison Brown,
Hackensack Meridian School of Medicine

Melody Ong, MD
Department of Urology, Hackensack University Medical Center

Fahad Sheckley, MD
Department of Urology, Hackensack University Medical Center

David Strauss, MD
Temple University Hospital Department of Urology

Naveen Krishnan, MD
Temple University Hospital Department of Urology

Kirthishri Mishra, MD
Department of Urology, New York University, Langone Medical Center, New York, NY, USA

Ruth Sanchez De La Rosa, MHA
Department of Urology, Hackensack University Medical Center

Mutahar Ahmed, MD
Department of Urology, Hackensack University Medical Center

Ravi Munver, MD
Department of Urology, Hackensack University Medical Center

Daniel Eun, MD
Department of Urology, Temple University School of Medicine

Lee Zhao, MD
Department of Urology, New York University, Langone Medical Center

Michael Stifelman, MD
Department of Urology, Hackensack University Medical Center