Chen Silu, Yang Kunlin, Li Zhenyu, Li Zhihua, Tao Zihao, Zhang Yiming, Wang Xiang, Li Xuesong
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
Transl Androl Urol. 2024 Oct 31;13(10):2330-2337. doi: 10.21037/tau-24-335. Epub 2024 Oct 28.
Buccal mucosal graft (BMG) ureteroplasty, particularly with the anterior-onlay technique, shows promise for treating complex ureteral strictures. However, long and circumferential strictures remain challenging. This study aimed to present the surgical technique of the posterior-inlay and anterior-onlay technique in robotic ureteroplasty with a BMG (RU-BMG). A 37-year-old male patient with a medical background of failed laparoscopic ureteroplasty and multiple endourological interventions was admitted to our hospital. Preoperative anterograde and retrograde pyelography revealed a 5-cm ureteral stricture. During the surgical procedure, the ureteral posterior wall was insufficient to facilitate a complete posterior augmented anastomosis, resulting in a posterior defect subsequent to the partial posterior augmented anastomosis. Ultimately, a BMG was utilized to address the posterior defect initially, followed by anterior-onlay ureteroplasty with a BMG. The Foley catheter was removed 2 weeks after surgery, while the nephrostomy tube was clamped on postoperative day 14. The double-J stent was removed 3 months after surgery. The preoperative serum creatine was 102.9 μmol/L. The surgery was performed successfully within 240 min, with estimated blood loss of 100 mL. The postoperative hospitalization was 4 days. Throughout the 12-month follow-up period, no symptoms or complications were observed, with a serum creatine of 82.0 μmol/L. Computed tomography urography indicated relieved hydronephrosis. In conclusion, RU-BMG using a combination of posterior-inlay and anterior-onlay technique is safe and feasible in the management of ureteral stricture. More cases and longer follow-up for this procedure are needed for better perfection of this procedure.
颊黏膜移植片（BMG）输尿管成形术，尤其是采用前入路覆盖技术时，在治疗复杂性输尿管狭窄方面显示出前景。然而，长段和环形狭窄仍然具有挑战性。本研究旨在介绍机器人辅助下使用BMG进行输尿管成形术（RU - BMG）时后入路嵌入和前入路覆盖技术的手术技巧。一名37岁男性患者因腹腔镜输尿管成形术失败及多次腔内泌尿外科干预的病史入院。术前顺行和逆行肾盂造影显示输尿管有5厘米狭窄。手术过程中，输尿管后壁不足以完成完整的后入路增强吻合，部分后入路增强吻合后导致后壁缺损。最终，首先使用BMG修复后壁缺损，随后再进行BMG前入路输尿管成形术。术后2周拔除Foley导尿管，术后第14天夹闭肾造瘘管。术后3个月取出双J支架。术前血清肌酐为102.9μmol/L。手术在240分钟内成功完成，估计失血量为100毫升。术后住院4天。在整个12个月的随访期内，未观察到任何症状或并发症，血清肌酐为82.0μmol/L。计算机断层扫描尿路造影显示肾积水缓解。总之，联合使用后入路嵌入和前入路覆盖技术的RU - BMG在输尿管狭窄的治疗中是安全可行的。需要更多病例及更长时间的随访以进一步完善该手术。
