The publisher regrets that the abstract below is erroneously not published in the above mentioned issue. The abstract in the form in which it should have been published in the supplement is available as a supplementary file.
Introduction & Objectives
Ureterocalicostomy has been regarded as a well-established treatment choice for patients suffering from recurrent ureteropelvic junction (UPJ) obstruction refractory to previous surgical management, or in the presence of an anatomically intra-renal pelvis. We detail a case of robotic-assisted laparoscopic ureterocalicostomy after failed renal pyeloplasty, with the incorporation of the Da Vinci robotic system.
Materials & Methods
A 28-year-old female patient had a significant history of right proximal ureteric stricture, of which previous right pyeloplasty was performed to relieve the obstruction. Despite so, she subsequently presented with non-specific, intermittent right loin pain of 6 months’ duration. Prior imaging performed revealed gross hydronephrosis and ureteropelvic junction narrowing in the right kidney, with cortical thinning and a minimal extra-renal pelvis. Mercaptoacetyltriglycine-3 (MAG3) renogram determined relative differential right renal function to be 30.4%. Bearing the findings, ureterocalicostomy was preferentially indicated due to the presence of cortical thinning and relatively poorer preservation of the lower pole calyx. A transperitoneal approach was adopted in a left lateral position with five trocars. After the right ureter and renal lower pole calyx were dissected and exposed, the hydronephrotic lower pole was mobilized and incised at the lowest dependent area for creation of a wide opening for anastomosis. Retrograde intra-renal surgery (RIRS) with flexible nephroscopy was then done to rule out a narrow infundibulum to the upper and middle calyces. The ureter was then spatulated and uretero-calyceal anastomosis was completed with continuous 4-0 absorbable vicryl sutures, at the most dependent point. Lastly, a double-J stent was inserted before the anastomosis was reperitonized with omentum and pneumoperitoneum was reduced.
Results
Total operative duration was 185 minutes. The immediate post-operative course was uneventful. At 6 weeks follow-up, radiological evidence with MAG3 renogram demonstrated slight UPJ obstruction with diminished differential renal function. However, this was seen in the presence of normal creatinine levels and an asymptomatic clinical picture. Elective cystoscopy, ureteroscopy and retrograde pyelogram was then performed and visualized no strictures. A patent anastomosis was also seen. She was stable post-procedure and discharged for stent removal in 4 weeks’ time.
Conclusions
Robotic-assisted laparoscopic ureterocalicostomy is a safe and feasible option for patients with recurrent UPJ obstruction, rendering superior intra-operative field visualisation and freedom of wrist movement compared to the conventional laparoscopic method.
Footnotes
Addendum to European Urology Open Science 2021;33(Suppl. 1): 18th Meeting of the EAU Robotic Urology Section in conjunction with the 13th meeting of the German Society of Robotic Urology.
Supplementary data to this article can be found online at https://doi.org/10.1016/j.euros.2021.12.001.
Appendix A. Supplementary data
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