Robot-assisted segmental ureterectomy with psoas hitch ureteral reimplantation: Oncological, functional and perioperative outcomes of case series of a single centre

  • Erika Palagonia | erika.palagonia@gmail.com Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy; ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst, Belgium.
  • Simone Scarcella Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy.
  • Lucio Dell'Atti Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy.
  • Giulio Milanese Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy.
  • Peter Schatteman ORSI Academy, Melle; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst, Belgium.
  • Frederiek D'Hondt ORSI Academy, Melle; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst, Belgium.
  • Geert De Naeyer ORSI Academy, Melle; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst, Belgium.
  • Andrea B. Galosi Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy.
  • Alexander Mottrie ORSI Academy, Melle; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst, Belgium.

Abstract

Introduction: According to the Urology guidelines, in selected cases of distal upper tract urothelial carcinoma (UTUC) segmental ureterectomy (SU) can be offered. There is no consensus in the surgical technique of preference. Robot-assisted SU could be an option to overcome all the limitations of open and laparoscopic techniques. We describe our first experience of robot assisted SU with psoas hitch ureteral reimplantation (RAPHUR).
Materials and methods: 11 patients underwent RAPHUR for distal UTUC between 2013 and 2017 in a single centre. Pre-, intra-, and postoperative outcomes were assessed. Conventional imaging was performed after 1, 3, 6 months and 1 year from surgery as follow up protocol. We retrospectively evaluated the technical feasibility, oncological and functional outcomes.
Results: Median age was 71 years (57-91). The median length of the ureteral defect was 23 mm (10-40). Median preoperative creatinine level was 1.22 mg/dl (0.7-1.85) and median eGFR was 57.5 ml/min/1.73m2 (31-80). Five (45.5%) patients were symptomatic and 7 (63.6%) had hydronephrosis. Median operative time was 185 min (120-240), with a median blood loss of 100 ml (50-300). No case required conversion to open surgery. Overall, only 1 (9%) patient developed Clavien Dindo ≥ 3 postoperative complications. Average hospital stay was 7 (2-9) days. Mean postoperative creatinine was 1.05 mg/dl (0.8-1.85) and mean postoperative eGFR was 72 (36-83). During a median follow up time of 25.5 months (12-53), 4 (36.4%) patients experienced recurrence of urothelial cancer at conventional imaging follow up and 2 (18.2%) died due to its progression.
Conclusions: In our initial experience RAPHUR can be proposed to selected cases of distal ureteral carcinoma with optimal perioperative and functional outcomes. However, cancer control may be undermined compared to nephroureterectomy. Thus, further prospective studies are needed to confirm our findings.

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Published
2021-03-22
Info
Issue
Section
SIEUN Congress 2020: Original Papers, Reviews and Case Reports
Keywords:
Robotics; Segmental ureterectomy; Ureter; Urothelial carcinoma; Psoas hitch reimplantation
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How to Cite
Palagonia, E., Scarcella, S., Dell’Atti, L., Milanese, G., Schatteman, P., D’Hondt, F., De Naeyer, G., Galosi, A. B., & Mottrie, A. (2021). Robot-assisted segmental ureterectomy with psoas hitch ureteral reimplantation: Oncological, functional and perioperative outcomes of case series of a single centre. Archivio Italiano Di Urologia E Andrologia, 93(1), 101-106. https://doi.org/10.4081/aiua.2021.1.101