Robotic-Assisted Laparoscopic Transureteropyelostomy: A Novel Technique for Management of Long-Segment Radiation Induced Strictures

Clinical History: The patient is a 62-year-old female with a history of cervical cancer treated with radiation therapy. This was complicated by a left-sided pan-ureteral stricture that was subsequently managed with chronic ureteral stent exchanges. The patient ultimately desired definitive treatment of her ureteral stricture. Physical Exam and Diagnosis: Preoperative renal scan demonstrated a split function of 60% and 40% in the right and left kidneys, respectively, with a mildly delayed nephrogram on the left side. A left percutaneous nephrostomy tube was placed 4 weeks before definitive management. Preoperative antegrade and retrograde pyelograms demonstrated a pan-ureteral left-sided stricture with normal caliber in the proximal left ureter. The cystogram demonstrated a 250-milliliter bladder capacity. Intervention: The patient elected to undergo a robotic transureteropyelostomy which involved transection of the left ureter at the proximal end of the stricture and an end-to-side anastomosis of the transected end to the right renal pelvis. Intraoperatively, the estimated blood loss was 200 milliliters, and the operative time was 178 minutes. There were no intraoperative complications, and the patient was discharged on postoperative day one without issue. Follow Up and Outcomes: The patient’s ureteral stent was removed 6 weeks postoperatively. The patient had no flank pain and did not experience any major (Clavien >2) postoperative complications. The patient’s 12-week postoperative renal scan demonstrated post-lasix half-time of 7 minutes on the left and differential renal function of 54% of the right kidney and 46% of the left kidney. Author Disclosure Statement: Matthew Lee, Kelley Zhao, Jahnavi Kishore, Julienne Jeong, and Randall Lee have no competing financial interests. Daniel D. Eun is a paid speaker, consultant, and proctor for Intuitive Surgical, a shareholder of Melzi Corp, advisory board for Medtronic and has received trainee support from Hitachi Medical. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure. All patient identifiable information was removed from the video prior to publication. Runtime of video: 4 mins 58 secs.