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Robotic Buccal Ureteroplasty: a Review of the Current Literature

  • Endourology (P Mucksavage, Section Editor)
  • Published:
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Abstract

Purpose of Review

This study aimed to provide an overview of the literature on buccal mucosal ureteroplasty for ureteral stricture disease, with a specific focus on the application of the robotic platform to buccal ureteroplasty.

Recent Findings

In our review, we highlight the results of Zhao et al. from the New York University School of Medicine Department of Urology, as well as our own results from Temple University Hospital. Zhao et al. published the first series of four patients who underwent robotic buccal ureteroplasty. Mean stricture length was 3.0 cm, and at a mean follow-up of 15 months, all repairs remained patent. We also describe our results in 10 patients who underwent robotic buccal ureteroplasty at Temple University Hospital. Median stricture length was 3.0 cm, and at a median follow-up of 5 months, all repairs remain patent.

Summary

Robotic buccal ureteroplasty offers a promising option for repair of complex ureteral strictures.

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Abbreviations

UPJ:

Ureteropelvic junction

UU:

Ureteroureterostomy

UP:

Ureteropyelostomy

UC:

Ureterocalicostomy

BF:

Boari flap

DN:

Downward nephropexy

IU:

Ileal ureter

RA:

Renal autotransplantation

BMG:

Buccal mucosal graft

IVU:

Intravenous urogram

ICG:

Indocyanine green

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Nakada SY, Hsu THS. Management of upper urinary tract obstruction. In: Walsh PC, Retik AB, Vaughn ED, et al., editors. Campbell’s urology. 10th ed. Philadelphia: Saunders-Elsevier Health Sciences; 2012. p.

    Google Scholar 

  2. Tyritzis SI, Wiklund NP. Ureteral strictures revisited…trying to see the light at the end of the tunnel: a comprehensive review. J Endourol. 2015;29:124–36.

    Article  PubMed  Google Scholar 

  3. Hafez KS, Wolf JS. Update on minimally invasive management of ureteral strictures. J Endourol. 2003;17:453–64.

    Article  PubMed  Google Scholar 

  4. Wise GJ, Shteynshlyuger A. An update on lower urinary tract tuberculosis. Curr Urol Rep. 2008;9:305–13.

    Article  PubMed  Google Scholar 

  5. Khalaf I, Shokeir A, Shalaby M. Urologic complications of genitourinary schistosomiasis. World J Urol. 2012;30:31–8.

    Article  PubMed  Google Scholar 

  6. Knight RB, Hudak SJ, Morey AF. Strategies for open reconstruction of upper ureteral strictures. Urol Clin N Am. 2013;40:351–61.

    Article  Google Scholar 

  7. Lee Z, Eun DD, et al. Single surgeon experience with robot-assisted ureteroureterostomy for pathologies at the proximal, middle and distal ureter in adults. J Endourol. 2013a;27:994–9.

    Article  PubMed  Google Scholar 

  8. Bowsher WG, Costello AJ, et al. A critical appraisal of the Boari flap. BJU Int. 1982;54:682.

    Article  CAS  Google Scholar 

  9. Chang SS, Kock MO. The use of an extended spiral bladder flap for treatment of upper ureteral loss. J Urol. 1996;156:1981–3.

    Article  CAS  PubMed  Google Scholar 

  10. Stein R, Thuroff JW, et al. Psoas hitch and Boari flap ureteroneocystostomy. BJU Int. 2013;112:137–55.

    Article  PubMed  Google Scholar 

  11. Stoltzenburg J, Kallidonis P, et al. Robot-assisted technique for Boari flap ureteric reimplantation: replacing the techniques of open surgery in robotics. BJU Int. 2016;118:482–4.

    Article  Google Scholar 

  12. Mauck RJ, Morey AF, et al. Central role of Boari bladder flap and downward nephropexy in upper ureteral reconstruction. J Urol. 2011;186:1345–9.

    Article  PubMed  Google Scholar 

  13. Shoemaker, cited by, Hansen MH, Murray P, et al. The use of bowel in urologic reconstructive surgery. Surg Clin N Am. 2016;96:567–82.

    Article  Google Scholar 

  14. Matlaga BR, Assimos DG, et al. Ileal ureter substitution: a contemporary series. Urology. 2003;62:998–1001.

    Article  PubMed  Google Scholar 

  15. Bonfig R, Riedmiller H, et al. Ileal ureteric replacement in complex reconstruction of the urinary tract. BJU Int. 2004;93:575–80.

    Article  CAS  PubMed  Google Scholar 

  16. Chung BI, Libertino JA, et al. The use of bowel for ureteral replacement for complex ureteral reconstruction: long term results. J Urol. 2006;175:179–84.

    Article  PubMed  Google Scholar 

  17. Armatys SA, Bihrle R, et al. Use of ileum as ureteral replacement in urological reconstruction. J Urol. 2009;181:177–81.

  18. Wolff B, Roupret M, et al. Long-term functional outcomes after ileal ureter substitution: a single-center experience. Urology. 2011;78:692–5.

    Article  PubMed  Google Scholar 

  19. Brando LF, Stein RJ, et al. Robotic ileal ureter: a completely intracorporeal technique. Urology. 2014;83:951–4.

    Article  Google Scholar 

  20. Chopra S, Berger A, et al. Initial series of four-arm robotic completely intracorporeal ileal ureter. J Endourol. 2016;30:395–9.

    Article  PubMed  Google Scholar 

  21. Dahl DM, McDougal WS. Use of intestinal segments in urinary diversion. In: Walsh PC, Retik AB, Vaughn ED, et al., editors. Campbell’s urology. 10th ed. Philadelphia: Saunders-Elsevier Health Sciences; 2012. p.

    Google Scholar 

  22. Hansen MH, Murray P, et al. The use of bowel in urologic reconstructive surgery. Surg Clin N Am. 2016;96:567–82.

    Article  PubMed  Google Scholar 

  23. Hardy JD, Eraslan S. Autotransplantation of the kidney for high ureteral injury. J Urol. 1963;90:563–74.

    CAS  PubMed  Google Scholar 

  24. Wotkowicz C, Libertino JA. Renal autotransplantation. BJU Int. 2004;93:253–7.

    Article  CAS  PubMed  Google Scholar 

  25. Eisenberg ML, Stoller ML, et al. Long-term outcomes and late complications of laparoscopic nephrectomy with renal autotransplantation. J Urol. 2008;179:240–3.

    Article  PubMed  Google Scholar 

  26. Cowan NG, Barry JM, et al. Renal autotransplantation: 27-year experience at 2 institutions. J Urol. 2015;194:1357–61.

    Article  PubMed  Google Scholar 

  27. Gordon ZN, Abaza R, et al. Completely intracorporeal robotic renal autotransplantation. J Urol. 2014;192:1516–22.

    Article  PubMed  Google Scholar 

  28. Filipas D, Thuroff JW, et al. The hostology and immunohistochemistry of free buccal mucosa and full-skin grafts after exposure to urine. BJU Int. 1999;84:108–11.

    Article  CAS  PubMed  Google Scholar 

  29. Chapple C, Atala A, et al. SIU/ICUD consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty. Urology. 2014;83(supplement 3a):s31–47.

    Article  PubMed  Google Scholar 

  30. Bhargava S, Chapple CR. Buccal mucosal urethroplasty: is it the new gold standard? BJU Int. 2004;93:1991–3.

    Google Scholar 

  31. Somerville JJF, Naude JH. Segmental ureteric replacement: an animal study using a free, non-pedicled graft. Urol Res. 1984;12:115–9.

    Article  CAS  PubMed  Google Scholar 

  32. • Naude JH. Buccal mucosal grafts in the treatment of ureteric lesions. BJU Int. 1999;83:751–4. The first published report of buccal mucosal grafting for ureteral strictures in human patients

    Article  CAS  PubMed  Google Scholar 

  33. Kroepfl D, Musch M, et al. Treatment of long ureteric strictures with buccal mucosal grafts. BJU Int. 2009;105:1452–5.

    Article  PubMed  Google Scholar 

  34. Badawy AA, Abuzeid AM, et al. Buccal mucosa graft for ureteral stricture substitution: initial experience. Urology. 2010;76:971–5.

    Article  PubMed  Google Scholar 

  35. Padney A, Keller H, et al. Buccal mucosal graft in reconstructive urology: uses beyond urethral stricture. Int J of Urol. 2014;21:732–4.

    Article  Google Scholar 

  36. Bjurlin MA, Stifelman MD, et al. Near-infrared fluorescence imaging: emerging applications in robotic upper urinary tract surgery. Eur Urol. 2014;65:793–801.

    Article  PubMed  Google Scholar 

  37. Lee Z, Eun DD, et al. Novel use of indocyanine green for intraoperative, real-time localization of ureteral stenosis during robot-assisted ureteroureterostomy. Urology. 2013b;82:729–33.

    Article  PubMed  Google Scholar 

  38. Lee Z, Eun DD, et al. Use of indocyanine green during robot-assisted ureteral reconstructions. Eur Urol. 2015;67:291–8.

    Article  PubMed  Google Scholar 

  39. •• Zhao LC, Stifelman MD, et al. Robot-assisted ureteral reconstruction using buccal mucosa. Urology. 2015;86:634–8. This represents the first published series of robotic buccal ureteroplasty patients from a group who remain at the forefront of developing this technique

    Article  PubMed  Google Scholar 

  40. Lee Z, Eun DD, et al. Single-surgeon experience with robot-assisted ureteroneocystostomy for distal ureteral pathologies in adults. Korean J Urol. 2013c;54:516–21.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Benjamin Waldorf.

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Conflict of Interest

Benjamin Waldorf, Ziho Lee, Laura Kidd, Joshua Kaplan, Andrew Harris, Michael Metro, and Jeffrey Liu each declare no potential conflicts of interest.

Daniel Eun reports honoraria for teaching activities and lectures for Intuitive Surgical.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Endourology

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Waldorf, B., Lee, Z., Kidd, L. et al. Robotic Buccal Ureteroplasty: a Review of the Current Literature. Curr Urol Rep 18, 40 (2017). https://doi.org/10.1007/s11934-017-0683-x

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  • DOI: https://doi.org/10.1007/s11934-017-0683-x

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