V12-08 URETEROILEAL BYPASS: A NEW ROBOTIC TECHNIC TO TREAT URETEROENTERERIC STRICTURES IN URINARY DIVERSION

You have accessJournal of UrologyBladder Oncology and Diversion1 Apr 2017V12-08 URETEROILEAL BYPASS: A NEW ROBOTIC TECHNIC TO TREAT URETEROENTERERIC STRICTURES IN URINARY DIVERSION Guilherme Padovani, Rubens Park, Marcos Mello, Rafael Coelho, Leonardo Borges, Adriano Nessralah, Miguel Srougi, and William Nahas Guilherme PadovaniGuilherme Padovani More articles by this author , Rubens ParkRubens Park More articles by this author , Marcos MelloMarcos Mello More articles by this author , Rafael CoelhoRafael Coelho More articles by this author , Leonardo BorgesLeonardo Borges More articles by this author , Adriano NessralahAdriano Nessralah More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and William NahasWilliam Nahas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3214AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder cancer is the ninth most frequently cancer diagnosed worldwide. The standard definitive treatment for MIBC is radical cystectomy (RC) and urinary reconstruction. Complications of RC and diversion can appear after months or years of surgical treatment. Ureteroentereric strictures are a late complication after cystectomy and diversion that occur in 2% to 15% of patients. 4-6 Multiple treatment alternatives have been proposed to those strictures with variable success rates, ureteral reimplantation is still considered the gold standard surgical treatment 7. However, the surgical approach to the ureteroenteric anastomosis can be challenging due to fibrosis and adhesions. We propose herein a technical modification aiming to minimize ureteral dissection; the technique involves a latero-lateral anastomosis of the dilated ureter with the ileal conduit without detaching de ureter from the intestinal segment. Our experience with this technical modification is described. METHODS We reported a patient submitted to uretero-ieal bypass to treat uretero-enteric stricture in Bricker implant. The technique was made robot-assisted, and it is shown in the figure. RESULTS The case reported is a 70 years-old man, without any comorbities, diagnosed with muscle invasive bladder cancer after transuretral ressection. He was subbmited to Robot-Assisted RC with intracorporeal Bricker diversion, without any major complications. The pathologic report of cistectomy was high grade urothelial carcinoma pT2 N0. With 3 months of follow-up, patient refered left flank pain, without any report of urinary infecction. Serum Creatinine before cistetomy was 0.8 mg/dL, and 3 months after surgery it increased to 1.33 mg/dL. The CT scan showed the right kidney without any change, there was no limphnode or visceral metastasis, the left kidney had adequate contrast enhancement, and there was ureteral hydronephrosis till the implant in the Bricker, without patency for contrast. There was no sign of metastasis in the implant. With a follow-up of one year after the uretero-ileal bypass, patient is assimptomatic, serum creatinine decreased to 0,92 mg/dL, and image control shows total resolution of hydronephrosis. CONCLUSIONS Latero-lateral ureteroenteric anastomosis is a feasible treatment option for benign anastomotic strictures. It can be performed either by open or minimally invasive approaches with good perioperative outcomes © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1374 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Guilherme Padovani More articles by this author Rubens Park More articles by this author Marcos Mello More articles by this author Rafael Coelho More articles by this author Leonardo Borges More articles by this author Adriano Nessralah More articles by this author Miguel Srougi More articles by this author William Nahas More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...