方仁愷、黃志平

中國醫藥大學附設醫院泌尿部

Jen Kai Fang, Chi Ping Huang

Department of Urology, China Medical University Hospital, Taichung, Taiwan

 

Ureteroneocystostomy is indicated for patients with distal ureteral stricture, tumor or injury. Many patients suffered from recurrent symptomatic UTI and frequent ureteral stent replacement. Dissolving the hydronephrosis and making patients free of ureter stent are our goals of reconstruction. Robotic reconstruction of the urinary tract is evolving nowadays. The purpose of this study is to evaluate our experience of robotic ureteroneocystostomy.  

We retrospectively reviewed patients with distal ureter pathologies with hydronephrosis between August 2014 and September 2018 in China medical university hospital. 9 patients underwent robotic ureteroneocystostomy by a single surgeon and 5 patients underwent additional psoas hitch. Of these, one of the patients was diagnosed with distal ureteral urothelial carcinoma. One was the victim of ureterovaginal fistula after hysterectomy. The remaining patients had the distal ureteral stricture. Most of them were caused by endometriosis. The mean duration from diagnosis of ureteral stricture to reconstruction was 18.1 months.

In the case series, the median age of the patients was 48.5 years. The mean operative time was 200 minutes. The mean console time was 157 minutes. The average blood loss was 38.3ml. The mean hospital stay was 5.8 days. The mean postoperation Foley duration was 3.5 days. Ureteral double J stent was indwelled during operation in 6 patients but not in last 4 patients. The mean duration of ureteral double J stent indwelling time was 32 days. Renal ultrasound was used to follow hydronephrosis after the surgery. Eight patients had no more hydronephrosis after the surgery. One person had residual hydronephrosis but much better than pre-operation. The median follow-up time was 9.6 months. All patients were free of the long-term ureteral stent. There was no urine leakage, urinary tract infection, renal function deterioration nor recurrence of ureteral obstruction in this case series.

Robotic ureteroneocystostomy provides excellent success rate and minimal complications for patients with distal ureteral stricture. The magnified 3D field and the jointed-wrist instruments make the dissection and suturing easier. Most of our cases were ureteral endometriosis stenosis and good perioperative outcomes were noted in this current study. Besides, in our experience, healing and patent of anastomosis site was also well even no ureteral stent indwelled during the operation.