Bilateral ureteral reconstruction with U-shaped ileal interposition segment

We describe a robotic technique for bilateral ureteral reconstruction using a U-shaped ileal interposition in the setting of retroperitoneal fibrosis and vascular encasement. A 77-year-old man with chronic kidney disease, prior orchiectomy with retroperitoneal radiation for testicular cancer, radical prostatectomy, and spine surgery, presented with retroperitoneal fibrosis, bilateral mid-ureteral strictures, and nephrostomy dependence. After adhesiolysis, both ureters were identified at the pelvic brim, dissected off the great vessels, and proximally spatulated. A 25-cm ileal segment was isolated, configured in a U-shape, and anastomosed to the bladder dome at its apex. Each ureter was reimplanted mucosa-to-mucosa to a separate ileal limb over double-J stents, with additional single-J stents placed across the vesico-ileal anastomosis.