Robotic Ileal Interposition for Radiation-induced Ureteral Stricture Disease

• Published in: Urology (Ridgewood, N.J.) N.J.), 2017-06, Vol.104, p.9-10
• Main Authors: Baumgarten, Adam S., Shah, Bhavik B., Patel, Trushar B., Wiegand, Lucas R.
• Format: Article
• Language: English
• Subjects: Aged; Anastomosis, Surgical - methods; Combined Modality Therapy; Female; Humans; Radiation Injuries - surgery; Radiotherapy - adverse effects; Robotic Surgical Procedures - methods; Stents; Tomography, X-Ray Computed; Ureteral Obstruction - diagnostic imaging; Ureteral Obstruction - etiology; Ureteral Obstruction - surgery; Urinary Diversion - methods; Uterine Cervical Neoplasms - drug therapy; Uterine Cervical Neoplasms - radiotherapy
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2017.02.033

To present a novel surgical concept using preoperative imaging to estimate length needed for ileal segment. This enables robotic ileal interposition to be completed with only 1 position change during surgery. The index patient is a 69-year-old woman with a history of stage IIIB cervical cancer treated with chemotherapy and radiation 5 years prior to presentation. The patient subsequently developed a long segment stricture of the left ureter, which had been managed with ureteral stents. The patient decided to proceed with robotic ileal ureter for management of her ureteral stricture disease. We used preoperative computed tomography scan measurements to estimate length needed for ileal segment. This eliminated the need for multiple position changes during surgery. The patient tolerated the procedure well. Estimated blood loss was 50 cc. Kidney ultrasound at 1 month post-op revealed no hydronephrosis. Renal scan at 12 months post-op revealed stable function at 32% and no evidence of obstruction. The patient reports she is doing well and is pain free at this time. Robotic ileal interposition is a technically feasible procedure with good functional outcomes. By using preoperative imaging to estimate length needed for ileal segment, only 1 position change is needed during surgery.