Videosurgery
Robot-assisted intracorporeal combined ileal ureter replacement and augmentation cystoplasty in the treatment of genitourinary tuberculosis: an illustrated techniques video
Sidhartha Kalra, Swapnil Singh Kushwaha, Dorairajan Lalgudi Narayanan, Sreerag Kodakattil Sreenivasan, Mujahid Ali, Deepanshu Aggarwal
Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Citation: Kalra S, Kushwaha S S, Narayanan D L, et al. Robot-assisted intracorporeal combined ileal ureter replacement and augmentation cystoplasty in the treatment of genitourinary tuberculosis: an illustrated techniques video. www.ceju.online/journal/2022/ileal-ureter-replacement-augmentation-cystoplasty-robotic-surgery-2225.php
Key Words: robotic surgery • minimally invasive surgery • ileal ureter replacement • augmentation cystoplasty • ileo-cystoplasty • genitourinary tuberculosis

Ureteral strictures and bladder contracture are sequelae of advanced genitourinary tuberculosis (GUTB) and are frequently managed by reconstructive procedures in addition to anti-tubercular treatment. Minimally invasive surgical techniques lend themselves well to ureteral and bladder reconstruction. Ileal ureter and augmentation cystoplasty individually are well-established procedures, but only a few reports of combined reconstructions are described in the literature.

We demonstrate the technique of simultaneous ileal ureter with augmentation ileo-cystoplasty, highlighting the challenges, technical maneuvers, and ergonomic approach with a minimally invasive platform. Video-based illustration of two young males who presented with pan ureteral stricture and small capacity bladder secondary to GUTB has been described.

Augmentation was done in a clamp cystoplasty manner. The mean operating time was 380 min, and the estimated blood loss was 370 mL. The mean hospital stay was 8.5 days, with one patient having a Clavien-Dindo grade 1 complication. Suprapubic and per urethral catheters were removed after 21 days. Stent removal was done after six weeks. The patients have preserved renal function, no urinary symptoms, and a mean bladder capacity of 350 mL with insignificant post-void residual volume at six months of follow-up.

With strict adherence to the principles of open surgery, robotic simultaneous ureteral and bladder reconstruction is safe, effective and feasible. It provides a minimally invasive surgical option for ureteral reconstruction and significantly improves bladder capacity in patients with GUTB. With this modified technique, this complex and extensive reconstruction can be done easily with similar functional outcomes and minimal perioperative complications compared to open surgery.

Ethics approval and consent to participate
Ethics approval was obtained from the Institutional Ethical Committee, and Consent to participate was obtained from the patient.

Consent for publication
Written informed consent for publication of details, images and videos was obtained from the patient.

Authors' contributions
The authors alone are responsible for the content and writing of this article. SK, SSK and MA performed the surgery. SSK, SK, SKS, LND, MA and DA were the major contributor in preparing the manuscript.

Article history
Submitted: 28 June, 2022
Accepted: 18 July, 2022
Published online: 29 July, 2022
doi: 10.5173/ceju.2022.0135
Corresponding author
Sidhartha Kalra
email: sid6121984@gmail.com
Conflicts of interest:  The authors declare no conflicts of interest.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/).
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