Bilateral Robot-Assisted Reconstruction of the Ureter with Buccal Graft and Omental Wrapping

Introduction and Objective: The patient is a 52-year-old man presenting to urology with renal failure secondary to bilateral ureteral strictures managed with nephrostomy tubes. He was taken to the operating room for robotic bilateral repair of ureteral strictures. Methods: Simultaneous bilateral nephrostograms and pyelograms demarcate the stricture burden at the start of case. The extent of stricture on the left was demarcated using indocyanine green injected antegrade through the pre-existing nephrostomy. The strictured portion of the left ureter was excised and a uretero-ureterostomy was performed. Next the right-sided repair was performed. Using intraoperative ureteroscopy, the extent of the right proximal stricture was appreciated and a ureterotomy was made along it, ~2 cm in total. Given the length of the stricture, decision was made to perform a buccal graft ureteroplasty. An omental wrap was also used over the repair. Finally, a ureteral reimplantation was performed for management of the right distal ureteral stricture. Once the ureter was transected proximal to the strictured urethra, it was reimplanted into the bladder. Bilateral ureteral stents were left along with bilateral Jackson-Pratt drains. Results: At 2-month follow-up, the patient was noted to have complete patency of the left ureter without hydronephrosis. However, he was noted to have a new stricture on the right requiring replacement of stent on this side. Conclusions: We demonstrated here that robot-assisted upper tract reconstruction is a valuable tool for management of ureteral strictures and that buccal mucosa grafting can also help address long strictures that may otherwise be difficult to repair. There are no commercial associations between the authors listed here and content of this surgical video. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. No competing financial interests exist. Runtime of video: 5 mins