Linder Brian J, Frank Igor, Occhino John A
Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
Int Urogynecol J. 2018 Apr;29(4):595-597. doi: 10.1007/s00192-017-3459-4. Epub 2017 Sep 7.
We present a video describing the technical considerations for performing an extravesical robotic ureteral reimplantation.
A 55-year old woman presented with urinary incontinence secondary to a ureterovaginal fistula after robotic-assisted hysterectomy. After failure of more conservative measures, she proceeded to a robotic ureteral reimplantation. Following port placement, the ureter is identified at the level of the iliac vessels and dissected circumferentially. The ureter is dissected free to the level of the ureterovaginal fistula, transected, and the distal remnant ligated. The ureter is spatulated, a cystotomy created, and a running anastomosis with mucosa-to-mucosa apposition performed over a stent. Care is taken to ensure it is tension free. The integrity of the anastomosis is tested with retrograde filling of the bladder. Postoperatively, a drainage catheter is left to allow for adequate healing. Follow-up imaging is performed to ensure a patent anastomosis.
The patient had an uncomplicated postoperative course. A cystogram showed adequate healing at 10 days, and the stent was removed at 6 weeks. A follow-up renal ultrasound 6 weeks later showed no hydronephrosis.
Extravesical robotic ureteral reimplantation is a useful technique for managing ureterovaginal fistula; here we highlight pertinent technical considerations.
我们展示了一段视频，描述了进行膀胱外机器人输尿管再植术的技术要点。
一名55岁女性在机器人辅助子宫切除术后因输尿管阴道瘘出现尿失禁。在更保守的措施失败后，她接受了机器人输尿管再植术。放置端口后，在髂血管水平识别输尿管并进行环形解剖。将输尿管游离至输尿管阴道瘘水平，横断，结扎远端残端。将输尿管做成斜面，切开膀胱，在支架上进行黏膜对黏膜的连续吻合。注意确保无张力。通过膀胱逆行充盈测试吻合口的完整性。术后留置引流导管以促进充分愈合。进行随访成像以确保吻合口通畅。
患者术后过程顺利。膀胱造影显示10天时愈合良好，6周时取出支架。6周后的随访肾脏超声显示无肾积水。
膀胱外机器人输尿管再植术是治疗输尿管阴道瘘的一种有用技术；在此我们强调相关的技术要点。
