Robot-Assisted Laparoscopic Reverse 7 Ileal Ureter and Bladder Augmentation: A Complex Urological Case

Abstract

A 51-year-old male with acute myeloid leukemia status post total body radiation and stem cell transplant complicated by BK cystitis and renal insufficiency presented to our clinic for evaluation and management of bilateral ureteral strictures. He was found to have a small capacity bladder and an approximately 5F distal right ureteral stricture as well as an obliterated distal stricture left ureteral stricture. After counseling on a variety of management options, we mutually decided to pursue robot-assisted laparoscopic bladder augmentation with bilateral ureteral reconstruction using a reverse 7 ileal ureter technique. Surgery proceeded without complication. The patient’s JP drain was removed on postoperative day 5. He was discharged with bilateral PCNs, ureteral stents, and a Foley catheter. His Foley was removed at 3 weeks postoperatively. Postoperative renal ultrasound and renogram demonstrated bilaterally patulous renal collecting systems without obstruction. At 12-months follow-up, the patient has maintained renal function and is able to void per his urethra without obstruction or incontinence. We’ve shown that robot-assisted laparoscopic reverse 7 ileal ureter is a safe and effective option for management of bilateral ureteral strictures.