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Lee Z , Waldorf BT , Cho EY , Liu JC , Metro MJ , Eun DD
Robotic Ureteroplasty with Buccal Mucosa Graft for the Management of Complex Ureteral Strictures
J Urol. 2017 Dec;198(6) :1430-1435
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PURPOSE: Surgical management of proximal and mid ureteral strictures not amenable to primary excision and anastomosis is challenging. Although buccal mucosa graft is commonly utilized during substitution urethroplasty, its use in substitution ureteroplasty is limited. We describe our technique for robotic ureteroplasty with buccal mucosa graft for the management of complex ureteral strictures and report our outcomes. MATERIALS AND METHODS: We retrospectively reviewed 12 patients who underwent robotic ureteroplasty with buccal mucosa graft between September 2014 and June 2016. The indication for the procedure was a proximal or mid ureteral stricture not amenable to primary excision and anastomosis. The primary outcomes were: clinical success, the absence of symptoms from ureteral pathology; and radiological success, the absence of ureteral obstruction on retrograde pyelography, renal scan, and/or computerized tomography. RESULTS: Four of 12 (33.3%) patients had ureteropelvic junction, 4/12 (33.3%) patients had proximal, and 4/12 (33.3%) patients had mid ureteral strictures. Eight of 12 (66.7%) patients had previously undergone a failed ureteral reconstruction. The median length of stricture was 3 (range 2-5) centimeters. The median operative time was 217 (range 136-344) minutes and estimated blood loss was 100 (range 50-200) milliliters. The median length of stay was 1 (range 1-6) day. At a median follow-up of 13 (range 4-30) months, 10/12 (83.3%) patients were clinically and radiologically successful. CONCLUSIONS: Robotic ureteroplasty with buccal mucosa graft is associated with low inherent morbidity and is an effective way to manage complex proximal and mid ureteral strictures.
1527-3792 Lee, Ziho Waldorf, Benjamin T Cho, Eric Y Liu, Jeffrey C Metro, Michael J Eun, Daniel D Journal Article United States J Urol. 2017 Jul 20. pii: S0022-5347(17)77184-4. doi: 10.1016/j.juro.2017.06.097.