NARUS 2018: Robotic Ureteral Reimplantation For Uretero-Enteric Anastomotic Strictures following Radical Cystectomy
Background
Uretero-enteric anastomotic strictures occur in about 2-10% of patients treated with radical cystectomy (RC) and urinary diversion (UD). It is often due to poor vascularity of the distal ureters. Ureteroenteric (UE) strictures can be asymptomatic and result in UTIs and loss of renal function. Endoscopic management has a high failure rate, and therefore primary reimplantation, has been the definitive treatment option for eligible patients. However, it is an invasive option with longer recovery time and associated complications.
In this study, the authors examined the outcomes of patients undergoing robotic reimplantation of UE strictures following RC in 5 academic tertiary centers.
Methods
This was a retrospective multi institutional study encompassing 5 centers with 6 surgeons, occurring between January 2013 to June 2017. All patients underwent Robotic cystectomy for primary bladder cancer. All patients except one patient, underwent intracorporal urinary diversion. Following diagnosis of the stricture, all patients underwent percutaneous nephrostomy insertion before the reimplantation.
Results
- A total of 31 patients were included in this study, and 19/31 patients had orthotopic neobladder, 11 had an ileal conduit and 1had an Indiana pouch. One patient underwent extracorporeal Studer neobladder. Overall 38 ureters underwent reimplantation with 24 patients having unilateral and 7 patients having bilateral UE strictures. 12 patients required Boari flap prior to the reimplantation.
- Mean time from RC to UE stricture diagnosis was 4 months (1-28). The mean stricture length was 1.5 cm (range 0.5-10), and the median operative time was 225 minutes (45-540). The median length of stay was 2 days (1-13), and intraoperative blood loss was 100 ml (25-200).
- Three (10%) patients experienced a Clavien grade II complication (urinary tract infection requiring antibiotics). At a median follow-up of 12 months (1-30) only one patient experienced recurrence of the stricture.
Conclusions
The authors concluded that robotic ureteral reimplantation for UE strictures is a safe and highly effective procedure. Given the suboptimal success rate of endoscopic treatment, the authors believe that robotic repair should become a first treatment option in these cases.
Presented By: Nariman Ahmadi, University of Southern California, Los Angeles, California, USA
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV