title: Robot-assisted uretero-ureterostomy for iatrogenic lumbar and iliac ureteral stricture: technical details and preliminary clinical results.
abstract: BACKGROUND
  Although the incidence of iatrogenic ureteral strictures is low, the treatment remains challenging.
  
  
  OBJECTIVE
  To report our technique of robot-assisted uretero-ureterostomy (RAUU) for adults with iatrogenic lumbar and iliac stricture.
  
  
  METHODS
  A descriptive study was performed by our department. Since April 2009, five patients underwent RAUU: Two patients had developed a lumbar or iliac ureteral stricture following a ureterorenoscopy, one had ureteral catheter positioning, one had colon surgery, and one had resection of retroperitoneal cystic lymphangioma. Preoperative evaluation includes history, computed tomography (CT) scan, and mercaptoacetyltriglycine-3 (MAG3) diuretic renal scan.
  
  
  METHODS
  A flank position was used for all patients with lumbar stenosis. A supine position with the bed turned 30° was required for iliac stricture. The optical port, two 8-mm robotic ports, and one 5-mm assistant port were used. A precise definition of the site and extension of the stricture was done using the flexible ureterorenoscope. After the stricture resection, the anastomosis was performed with two running sutures on a ureteral double-J stent.
  
  
  METHODS
  Success was defined as no postoperative symptoms and evidence of no obstruction at the CT/urography and at the MAG3 scan at 6-mo follow-up.
  
  
  CONCLUSIONS
  RAUU was technically feasible in all five patients. Average operating time was 135min, and median hospital stay was 3 d. No significant complications occurred. Absence of stricture recurrence and no reduction of kidney function were confirmed by CT/urography and MAG3 scans. At a mean follow-up of 8 mo, all patients were asymptomatic. The main limitations were the short follow-up and the small sample size.
  
  
  CONCLUSIONS
  RAUU is feasible and safe for repairing iatrogenic lumbar and iliac ureteral strictures. The flexible ureterorenoscopy is useful to localise the obstruction and to correctly define its site and extension to spare as much ureter as possible.
authors: Department of Urology, San Raffaele Turro, Milan, Italy. buffi.nicolomaria@hsr.it
authors: Nicolòmaria
authors: N
authors: Buffi
authors: Andrea
authors: A
authors: Cestari
authors: Giovanni
authors: G
authors: Lughezzani
authors: Piera
authors: P
authors: Bellinzoni
authors: Mattia
authors: M
authors: Sangalli
authors: Emanuele
authors: E
authors: Scapaticci
authors: Matteo
authors: M
authors: Zanoni
authors: Filippo
authors: F
authors: Annino
authors: Alessandro
authors: A
authors: Larcher
authors: Massimo
authors: M
authors: Lazzeri
authors: Patrizio
authors: P
authors: Rigatti
authors: Giorgio
authors: G
authors: Guazzoni
mesh_terms: D000328:Adult; D003251:Constriction, Pathologic; D019723:Endoscopes; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007558:Italy; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012371:Robotics / Q000295:instrumentation; D015607:Stents; D016683:Supine Position; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000295:instrumentation; D017263:Technetium Tc 99m Mertiatide; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects / Q000295:instrumentation; D014519:Ureterostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014567:Urography / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D017263:Technetium Tc 99m Mertiatide