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MP24-04 EXPANDING ROLE OF ROBOTIC SURGERY IN RECONSTRUCTIVE UROLOGY
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Saturday, May 13, 2017
MP24-03 ROBOTIC-ASSISTED URETERAL REIMPLANTATION WITH PSOAS HITCH: EXPERIENCE IN 21 PATIENTS Vincent De Coninck*, Paolo Umari, Nicola Fossati, Ruben De Groote, Marijn Goossens, Peter Schatteman, Geert De Naeyer, Frederiek D’Hondt, Alex Mottrie, Aalst, Belgium INTRODUCTION AND OBJECTIVES: Robot-assisted surgery represents a feasible and less challenging minimally-invasive option for complex urological reconstructive procedures, including ureteral reimplantation with psoas hitch. Published experience in this field is still limited. We report our 10-year experience of this technique from a tertiary care center. METHODS: All patients that underwent ureteral reimplantation with psoas hitch technique between 2006 and 2016 at our institution were included in this study. The robotic system was used in 4-arm configuration with the addition of 2 assistant ports. The transperitoneal approach and tunneled nonrefluxing ureteral anastomosis was performed in all patients. The psoas hitch was performed using a 1-0 suture. The perioperative complications were described according to Clavien-Dindo classification. RESULTS: 21 patients (11 men and 10 women) underwent robot-assisted ureteral reimplantation with psoas hitch technique. The median age was 66 years (IQR 41,73), body mass index 24 kg/m2 (IQR 23,28) and Charlson Comorbidity Index 1 (IQR 0,2). In 2 (9,5%) patients the procedure was performed for bilateral pathology. 11 (52,4%) patients were symptomatic; of these 7 (33,3%) had pain, 2 (9,5%) hematuria and 2 (9,5%) pyelonephritis. 17 (81,0%) patients had hydronephrosis at the diagnosis. Indication for surgery was distal ureteral tumor in 7 (33,3%) patients, iatrogenic ureteral injury in 7 (33,3%), external ureteral compression in 4 (19,1%), vesicoureteral reflux in 2 (9,5%) and 1 (4,8%) patient had distal ureteral fibrosis of unknown origin. 13 (61,9%) patients had previous surgery near the distal ureter. Median operative time was 150 minutes (IQR 120,180). Mean blood loss was 30 mL (IQR 30,50). The all grade complication rate was 28,6%; five grade 1 (two prolonged pain, two transient paresthesia of the thigh and one urinary tract infection) and one grade 3 complication (bleeding required surgical revision) occurred. Median hospital stay was 5 days (IQR 4,7) and catheter time 7 days (IQR 6,10). Ureteral stent was placed in 13 patients and left in place for a median time of 30 days (IQR 20,42). After a median follow-up of 15 months (IQR 15,23) all patients were asymptomatic with no signs of hydronephrosis. Most of the patients improved renal function and none of them had a significant postoperative worsening of it. CONCLUSIONS: This series represents the largest singleinstitution experience with robot-assisted ureteral reimplantation with psoas hitch technique and long follow-up. It represents a safe and effective technique with excellent outcomes and limited morbidity. Source of Funding: none
MP24-04 EXPANDING ROLE OF ROBOTIC SURGERY IN RECONSTRUCTIVE UROLOGY Michael W. Kemper*, Alan Carnes, Shenelle Wilson, Rabii Madi, Augusta, GA INTRODUCTION AND OBJECTIVES: As robotic surgery becomes more widely used, its applications are rapidly being expanded into areas of urology beyond oncology. The objective of this study is to review the institutional experience in robotic surgery in reconstructive urology. METHODS: Charts were retrospectively reviewed and patient demographic, surgical, and follow-up data were collected based on a single surgeon experience with robotic surgery in reconstructive urology from 2012-2016. Descriptive statistics were used to analyze this patient population.
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RESULTS: A total of 39 operations on 38 patients from a single surgeon were identified - 20 robotic pyeloplasties, 9 robotic ureteral reimplantations, 3 robotic uretero-ureterostomies, 3 robotic ileal conduits, 2 robotic ileal conduit revisions and 3 robotic vesicovaginal fistula repairs. Of the robotic pyeloplasties, 16 were dismembered while 4 were Y-V plasties. A crossing vessel was identified in 50% of cases. Indication for surgery included flank pain in 90% of patients, worsening kidney function in 20%, and infection in 10%. Median LOS was 1 day. Median follow-up was 7.5 months. All patients experienced resolution of symptoms, improvement in diuretic half time and stable or improved renal function on post-operative imaging. Of the robotic ureteral reimplants, 3 required psoas hitch and 3 required Boari flap. Median LOS was 1.5 days. Median follow-up was 8 months. All patients with adequate follow-up showed resolution of hydronephrosis, improvement in diuretic half-time and stable or improved renal function on postoperative imaging. All robotic uretero-ureterostomies were performed end to end. Indications included mid-ureteral stricture, iatrogenic midureteral injury, and retrocaval ureter. Median LOS was 2 days. Median follow-up was 8 months, and all patients showed resolution of hydronephrosis, improvement in diuretic half-time and stable or improved renal function on post-operative imaging. All robotic ileal conduits and revisions were performed intracorporeally. Indications included urethrocutaneous fistula, neurogenic bladder, stricture of previous cutaneous ureterostomies after cystectomy, and anastamotic ureteral strictures. All robotic vesicovaginal fistula repairs were performed using sigmoid fat interposition, with one durable success. CONCLUSIONS: Robotic surgery in the field of reconstructive urology is feasible and can be performed with good results. This is especially true of ureteral reconstruction, where all patients in this experience had good outcomes, with generally brief length of stay. Source of Funding: None
MP24-05 UPPER URINARY TRACT DECOMPRESSION USING ILEAL URETER REPLACEMENT IN COMPARISON TO ENDOURETERAL THERMOEXPANDABLE STENT [MEMOKATH 051] Ilgar Akbarov*, Mustafa Al-Mahmid, David Pfister, Axel Heidenreich, Cologne, Germany INTRODUCTION AND OBJECTIVES: To assess the long-term outcomes and complications of Ileal Ureter Replacement (IUR) compared to the use of Memokath 051 for ureteral reconstruction. METHODS: In the last 10 years, two groups of patients with ureteral strictures (benign or malignant) have been followed up retrospectively. The first group consists of 17 patients, mean age of 59 years, presented with ureteral obstruction and treated with a thermoexpandable stent Memokath as a minimally-invasive procedure. Whereas the second group of 27 patients, mean age of 55 years received an IUR as alternative treatment method. Patients were followed for a mean period of 42 months. Assessment included examination of serum creatinine, renal ultrasound, retrograde pyelography and isotopic renography. RESULTS: In the first group (17 pat., 27 renal units): upper tract decompression was succeed in 6 renal units only (35%), in which 3 patients had initially no obstruction and the other 3 developed a temporary obstruction. 11 Patients developed a permanent obstruction (65%), 8 of those patients received another minimally-invasive treatment like percutaneous nephrostomy, DJ stent or reinsertion of Memokath stent. 3 patients underwent open surgery. 7 patients developed urinary tract infections (41%). Obstruction with deterioration of renal function secondary to dislocation of the stent developed in 5 patients (8 renal units - 29%). Early total obstruction due to insufficient dilatation effect of the stent took place in 1 patient. Other complications included: gross hematuria, irritative voiding, urinary retention as well as ureteroenteric fistula in 1 patient (3.7% of the renal units). In the second group, upper tract decompression was achieved in 24 (88.8%) patients; a secondary nephrectomy was performed in 2 patients. 1 patient
Vol. 197, No. 4S, Supplement, Saturday, May 13, 2017
MP24-03 ROBOTIC-ASSISTED URETERAL REIMPLANTATION WITH PSOAS HITCH: EXPERIENCE IN 21 PATIENTS Vincent De Coninck*, Paolo Umari, Nicola Fossati, Ruben De Groote, Marijn Goossens, Peter Schatteman, Geert De Naeyer, Frederiek D’Hondt, Alex Mottrie, Aalst, Belgium INTRODUCTION AND OBJECTIVES: Robot-assisted surgery represents a feasible and less challenging minimally-invasive option for complex urological reconstructive procedures, including ureteral reimplantation with psoas hitch. Published experience in this field is still limited. We report our 10-year experience of this technique from a tertiary care center. METHODS: All patients that underwent ureteral reimplantation with psoas hitch technique between 2006 and 2016 at our institution were included in this study. The robotic system was used in 4-arm configuration with the addition of 2 assistant ports. The transperitoneal approach and tunneled nonrefluxing ureteral anastomosis was performed in all patients. The psoas hitch was performed using a 1-0 suture. The perioperative complications were described according to Clavien-Dindo classification. RESULTS: 21 patients (11 men and 10 women) underwent robot-assisted ureteral reimplantation with psoas hitch technique. The median age was 66 years (IQR 41,73), body mass index 24 kg/m2 (IQR 23,28) and Charlson Comorbidity Index 1 (IQR 0,2). In 2 (9,5%) patients the procedure was performed for bilateral pathology. 11 (52,4%) patients were symptomatic; of these 7 (33,3%) had pain, 2 (9,5%) hematuria and 2 (9,5%) pyelonephritis. 17 (81,0%) patients had hydronephrosis at the diagnosis. Indication for surgery was distal ureteral tumor in 7 (33,3%) patients, iatrogenic ureteral injury in 7 (33,3%), external ureteral compression in 4 (19,1%), vesicoureteral reflux in 2 (9,5%) and 1 (4,8%) patient had distal ureteral fibrosis of unknown origin. 13 (61,9%) patients had previous surgery near the distal ureter. Median operative time was 150 minutes (IQR 120,180). Mean blood loss was 30 mL (IQR 30,50). The all grade complication rate was 28,6%; five grade 1 (two prolonged pain, two transient paresthesia of the thigh and one urinary tract infection) and one grade 3 complication (bleeding required surgical revision) occurred. Median hospital stay was 5 days (IQR 4,7) and catheter time 7 days (IQR 6,10). Ureteral stent was placed in 13 patients and left in place for a median time of 30 days (IQR 20,42). After a median follow-up of 15 months (IQR 15,23) all patients were asymptomatic with no signs of hydronephrosis. Most of the patients improved renal function and none of them had a significant postoperative worsening of it. CONCLUSIONS: This series represents the largest singleinstitution experience with robot-assisted ureteral reimplantation with psoas hitch technique and long follow-up. It represents a safe and effective technique with excellent outcomes and limited morbidity. Source of Funding: none
MP24-04 EXPANDING ROLE OF ROBOTIC SURGERY IN RECONSTRUCTIVE UROLOGY Michael W. Kemper*, Alan Carnes, Shenelle Wilson, Rabii Madi, Augusta, GA INTRODUCTION AND OBJECTIVES: As robotic surgery becomes more widely used, its applications are rapidly being expanded into areas of urology beyond oncology. The objective of this study is to review the institutional experience in robotic surgery in reconstructive urology. METHODS: Charts were retrospectively reviewed and patient demographic, surgical, and follow-up data were collected based on a single surgeon experience with robotic surgery in reconstructive urology from 2012-2016. Descriptive statistics were used to analyze this patient population.
e303
RESULTS: A total of 39 operations on 38 patients from a single surgeon were identified - 20 robotic pyeloplasties, 9 robotic ureteral reimplantations, 3 robotic uretero-ureterostomies, 3 robotic ileal conduits, 2 robotic ileal conduit revisions and 3 robotic vesicovaginal fistula repairs. Of the robotic pyeloplasties, 16 were dismembered while 4 were Y-V plasties. A crossing vessel was identified in 50% of cases. Indication for surgery included flank pain in 90% of patients, worsening kidney function in 20%, and infection in 10%. Median LOS was 1 day. Median follow-up was 7.5 months. All patients experienced resolution of symptoms, improvement in diuretic half time and stable or improved renal function on post-operative imaging. Of the robotic ureteral reimplants, 3 required psoas hitch and 3 required Boari flap. Median LOS was 1.5 days. Median follow-up was 8 months. All patients with adequate follow-up showed resolution of hydronephrosis, improvement in diuretic half-time and stable or improved renal function on postoperative imaging. All robotic uretero-ureterostomies were performed end to end. Indications included mid-ureteral stricture, iatrogenic midureteral injury, and retrocaval ureter. Median LOS was 2 days. Median follow-up was 8 months, and all patients showed resolution of hydronephrosis, improvement in diuretic half-time and stable or improved renal function on post-operative imaging. All robotic ileal conduits and revisions were performed intracorporeally. Indications included urethrocutaneous fistula, neurogenic bladder, stricture of previous cutaneous ureterostomies after cystectomy, and anastamotic ureteral strictures. All robotic vesicovaginal fistula repairs were performed using sigmoid fat interposition, with one durable success. CONCLUSIONS: Robotic surgery in the field of reconstructive urology is feasible and can be performed with good results. This is especially true of ureteral reconstruction, where all patients in this experience had good outcomes, with generally brief length of stay. Source of Funding: None
MP24-05 UPPER URINARY TRACT DECOMPRESSION USING ILEAL URETER REPLACEMENT IN COMPARISON TO ENDOURETERAL THERMOEXPANDABLE STENT [MEMOKATH 051] Ilgar Akbarov*, Mustafa Al-Mahmid, David Pfister, Axel Heidenreich, Cologne, Germany INTRODUCTION AND OBJECTIVES: To assess the long-term outcomes and complications of Ileal Ureter Replacement (IUR) compared to the use of Memokath 051 for ureteral reconstruction. METHODS: In the last 10 years, two groups of patients with ureteral strictures (benign or malignant) have been followed up retrospectively. The first group consists of 17 patients, mean age of 59 years, presented with ureteral obstruction and treated with a thermoexpandable stent Memokath as a minimally-invasive procedure. Whereas the second group of 27 patients, mean age of 55 years received an IUR as alternative treatment method. Patients were followed for a mean period of 42 months. Assessment included examination of serum creatinine, renal ultrasound, retrograde pyelography and isotopic renography. RESULTS: In the first group (17 pat., 27 renal units): upper tract decompression was succeed in 6 renal units only (35%), in which 3 patients had initially no obstruction and the other 3 developed a temporary obstruction. 11 Patients developed a permanent obstruction (65%), 8 of those patients received another minimally-invasive treatment like percutaneous nephrostomy, DJ stent or reinsertion of Memokath stent. 3 patients underwent open surgery. 7 patients developed urinary tract infections (41%). Obstruction with deterioration of renal function secondary to dislocation of the stent developed in 5 patients (8 renal units - 29%). Early total obstruction due to insufficient dilatation effect of the stent took place in 1 patient. Other complications included: gross hematuria, irritative voiding, urinary retention as well as ureteroenteric fistula in 1 patient (3.7% of the renal units). In the second group, upper tract decompression was achieved in 24 (88.8%) patients; a secondary nephrectomy was performed in 2 patients. 1 patient