Robotic Ureteral Reconstruction Using Buccal Mucosa Grafts: A Multi-institutional Experience

Zhao, Lee C.; Weinberg, Aaron; Lee, Ziho; Ferretti, Mark; Koo, Harry P.; Metro, Michael J.; Eun, Daniel; Stifelman, Michael

doi:10.1016/j.eururo.2017.11.015

Cited by 107 publications

(102 citation statements)

References 32 publications

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“…Hence, only few series, mainly single case reports or small cohorts (5-19 patients) on BMG in ureteric reconstruction have been published to date (Table 4) [15][16][17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…Success rates of these studies are excellent and range between 83% and 100% and no major complications occurred [15][16][17][18][19][20][21]. Some of the recent studies have described a robotic assisted laparoscopic approach [19,21]. However, many patients who need a proximal ureteral reconstruction have had major surgery before and may not be eligible for laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…All of the published series have some limitations which are typical for rare diseases: inhomogeneity of the treated patients with different localizations (Table 4) and origins of strictures (e.g., previous radiation), various techniques of BMG graft placement (Table 4), and the lack of structured information of the postoperative renal function [15][16][17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

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Open ureteroplasty with buccal mucosa graft for long proximal strictures: A good option for a rare problem

Hefermehl

Tritschler²,

Kretschmer

et al. 2020

Investig Clin Urol

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Purpose: To report a single surgeon experience with one year follow-up after open ureteroplasty with buccal mucosa graft (OU-BMG) in the rare situation of long segment proximal ureteral strictures. Materials and Methods: Four patients with long segment proximal ureteral stricture underwent OU-BMG between February and July 2017. Functional outcome was assessed by pre-and postoperative serum creatinine, ultrasound and renal scintigraphy as well as patient reported outcomes. Results: Four patients with an average stricture length of 4 cm underwent OU-BMG between February and July 2017. No major postoperative complications occurred. Retrograde uretero-pyelography 6 weeks postoperatively revealed a watertight anastomosis followed by immediate emptying of the renal pelvis and ureter in all four patients. Ureteroscopy at this time showed a wide lumen with well-vascularized pink mucosa. After a mean follow-up time of 12.5 (12-14) months, postoperative serum creatinine was unimpaired. Renal scintigraphy revealed no signs of renal obstruction. With regard to intraoral surgery, no difficulties with mouth opening or intraoral dryness or numbness were reported. Conclusions: For patients with long segment ureteral strictures OU-BMG is a safe technique with excellent surgical and functional outcomes. Hence, the application of this technique should be encouraged and regarded as one of the standard options in case of this rare problem.

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“…Hence, only few series, mainly single case reports or small cohorts (5-19 patients) on BMG in ureteric reconstruction have been published to date (Table 4) [15][16][17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Open ureteroplasty with buccal mucosa graft for long proximal strictures: A good option for a rare problem

Hefermehl

Tritschler²,

Kretschmer

et al. 2020

Investig Clin Urol

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“…Redo pyeloplasty can be challenging due to scar tissue and fibrosis that lead to larger resections to fin healthy and well-vascularized tissue for reanastomosis. Buccal mucosal grafts (BMG), already in use for ureteral reconstruction, have been proposed in UPJO refractory to surgery and endoscopic treatment [47]. The procedure consists in identifying the UPJO and dissecting longitudinally the anterior aspect of the stenosis.…”

Section: Buccal Mucosal Graft In Pyeloplastymentioning

confidence: 99%

Ureteropelvic Junction Obstruction: Robot-Assisted Pyeloplasty

Diana¹,

Casale²,

Saita³

et al. 2020

Medical Robotics - New Achievements

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The standard treatment of ureteropelvic junction obstruction (UPJO) is represented by the Anderson-Hynes dismembered pyeloplasty, even if different approaches, both surgical and endoscopic, have been described. Robot-assisted pyeloplasty (RP) is a feasible and safe approach. The indications for the robotic approach remain the same as those for the laparoscopic or open pyeloplasty. Every patient with symptomatic UPJO, or with decreasing renal function in the presence of UPJO, should undergo RP. The transperitoneal, retroperitoneal, and transmesocolic approaches are described focusing on advantages and disadvantages of each approach. Robot-assisted pyeloplasty has excellent success rates for relief of obstruction and very low peri-and post-operative morbidity. The robotic surgical technique maintains the advantages of laparoscopic surgery providing a more precise manipulation and visualization, and a faster learning curve. Comparative studies are reported to confront the different techniques. Secondary minimally invasive pyeloplasty is obviously a more challenging procedure due to the fibrosis and the adhesions formed after the previous surgery. Newer techniques and indications such as the employment of buccal mucosal graft, the single port approach, and indocyanine green injection are described. Tips and tricks to keep in mind during this kind of procedure are listed in order to report our experience in this setting.

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“…Sindsdien zijn enkele caseseries beschreven waarin de BMG is toegepast bij lange proximale ureterstricturen. De laatste publicaties beschrijven het gebruik van de robotgeassisteerde techniek [10,11]. Wij hebben in onze casus bewust voor de open benadering gekozen, vanwege de complexiteit van de eerdere robotgeassisteerde procedure en de complicaties die daarna optraden (urinoom met abcedering, behandeld met percutane drainage).…”

Section: Discussieunclassified

Case report. Buccal mucosa graft voor UPJ-reconstructie na een niet-geslaagde robotgeassisteerde pyelumplastiek

et al. 2019

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Samenvatting Proximale ureterstricturen zijn een uitdaging voor de reconstructieve chirurgie. Transuretero-ureterostomie, ileuminterpositie en autotransplantatie zijn vaak genoemde mogelijkheden. Een wat minder bekend type reconstructie, de doorgaans succesvolle buccal mucosa graft (BMG) ureteroplastiek, is in kleine series in de literatuur beschreven. Wij beschrijven een casus waarin een BMG werd gebruikt voor herstel van een strictuur ter plaatse van de proximale ureter/uretero-pelviene junctie (UPJ) na iatrogeen ureterletsel en een niet-geslaagde robotgeassisteerde pyelumplastiek. Aan de hand van deze casus willen wij deze weinig bekende reconstructieve optie bij urologen onder de aandacht brengen. Trefwoorden graft van wangslijmvlies • reconstructieve urologie • ureterstricturen • UPJ Case report. Use of buccal mucosa for UPJ reconstruction after failed robot-assisted pyeloplasty Abstract Reconstructive surgery for proximal ureteral strictures is challenging. Transureteroureterostomy, ureteroileal interposition and autotransplantation are the methods most described. In literature, a somewhat less known type of reconstruction, the usually successful buccal mucosa graft (BMG) ureteroplasty is described in small case-series. We describe a case in which a BMG was used for the repair of a proximal ureteral/uteropelvine junction (UPJ) stricture following iatrogenic ureteral laceration and failed robot-assisted pyeloplasty. With this case-report we want to bring this less well known option of reconstruction to the attention of all urologists.

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Robotic Ureteral Reconstruction Using Buccal Mucosa Grafts: A Multi-institutional Experience

Cited by 107 publications

References 32 publications

Open ureteroplasty with buccal mucosa graft for long proximal strictures: A good option for a rare problem

Open ureteroplasty with buccal mucosa graft for long proximal strictures: A good option for a rare problem

Ureteropelvic Junction Obstruction: Robot-Assisted Pyeloplasty

Case report. Buccal mucosa graft voor UPJ-reconstructie na een niet-geslaagde robotgeassisteerde pyelumplastiek

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