PD41-10 A MULTI-INSTITUTIONAL EXPERIENCE WITH ROBOTIC URETEROPLASTY WITH BUCCAL MUCOSA GRAFT: AN UPDATED ANALYSIS OF INTERMEDIATE-TERM OUTCOMES (2020)

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-10 A MULTI-INSTITUTIONAL EXPERIENCE WITH ROBOTIC URETEROPLASTY WITH BUCCAL MUCOSA GRAFT: AN UPDATED ANALYSIS OF INTERMEDIATE-TERM OUTCOMES Ziho Lee*, Aeen Asghar, David Strauss, Randall Lee, Matthew Lee, Jeremy Slawin, Helaine Koster, Min Jun, Sreeya Komaravolu, Michael Metro, Michael Stifelman, Lee Zhao, and Daniel Eun Ziho Lee*Ziho Lee* More articles by this author , Aeen AsgharAeen Asghar More articles by this author , David StraussDavid Strauss More articles by this author , Randall LeeRandall Lee More articles by this author , Matthew LeeMatthew Lee More articles by this author , Jeremy SlawinJeremy Slawin More articles by this author , Helaine KosterHelaine Koster More articles by this author , Min JunMin Jun More articles by this author , Sreeya KomaravoluSreeya Komaravolu More articles by this author , Michael MetroMichael Metro More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Lee ZhaoLee Zhao More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical management of complex proximal and mid ureteral strictures not amenable to primary excision and anastomosis is challenging. Although robotic ureteroplasty with buccal mucosa graft (RU-BMG) has been associated with excellent outcomes in this setting, the literature is limited by small patient cohorts and short-term follow-up. We report our multi-institutional RU-BMG experience and intermediate-term outcomes. METHODS: We retrospectively reviewed our multi-institutional RU-BMG database to identify all patients who underwent the procedure between 10/2013-8/2018 with ≥12 months follow up. All procedures were performed by three primary surgeons from three institutions. The indication for RU-BMG was a complex proximal or mid ureteral stricture not amenable to primary excision and anastomosis secondary to length of stricture or extensive fibrosis. Two major surgical techniques were utilized. In patients with a narrowed ureteral lumen, the stricture was longitudinally incised and the graft was onlayed over the defect (onlay technique). In patients with an obliterated ureteral lumen, the stricture was excised, a plate of healthy ureter was brought together, and the graft was onlayed over the defect (augmented anastomotic technique). Our primary outcome was surgical success, which we defined as the absence of flank pain from ureteral obstruction and ureteral patency on radiographic imaging. RESULTS: Of 49 total patients, 40 (81.6%) underwent the onlay technique and 9 (18.4%) underwent the augmented anastomotic technique. The reconstructed ureter was wrapped with omentum in 48/49 (98.0%) and peri-renal fat in 1/49 (2.0%) cases. Eighteen/49 (36.7%) patients previously underwent a failed ureteral reconstruction. The median length of stricture was 3.0 centimeters (IQR 2.0-3.6, max 8.0 cm). The median operative time was 226 minutes (IQR 194-288), estimated blood loss was 100 milliliters (IQR 50-100), and length of stay was 1 day (IQR 1-3). Three/49 (6.1%) patients experienced a major postoperative complication (Clavien >2) within 30 days of surgery. At a median follow up of 25 months (IQR 17-36), 43/49 (87.8%) cases were surgically successful. Four of 6 (66.7%) stricture recurrences occurred ≥10 months postoperatively. CONCLUSIONS: RU-BMG for the management of complex proximal and mid ureteral strictures is associated with excellent intermediate-term outcomes. Given the timing of potential stricture recurrences, patients undergoing RU-BMG should be followed chronically. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e825-e825 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ziho Lee* More articles by this author Aeen Asghar More articles by this author David Strauss More articles by this author Randall Lee More articles by this author Matthew Lee More articles by this author Jeremy Slawin More articles by this author Helaine Koster More articles by this author Min Jun More articles by this author Sreeya Komaravolu More articles by this author Michael Metro More articles by this author Michael Stifelman More articles by this author Lee Zhao More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...