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Case Reports
. 2020 Dec 29;6(4):431-434.
doi: 10.1089/cren.2020.0185. eCollection 2020.

Bioregenerative Umbilical Cord Amniotic Membrane Allograft Ureteral Wrap During Robot-Assisted Ureterolysis

Nathan Cheng  1 , Nermarie Velazquez  1 , Bethany R Desroches  2 , Ravi Munver  1   3   4
Affiliations
Case Reports

Bioregenerative Umbilical Cord Amniotic Membrane Allograft Ureteral Wrap During Robot-Assisted Ureterolysis

Nathan Cheng et al. J Endourol Case Rep. .

Abstract

Omental wrap is commonly performed after ureterolysis to prevent ureteral obstruction from recurrence of periureteral adhesions and fibrosis. We present the case of a 37-year-old Caucasian woman with a history of two cesarean sections and laparotomy for the treatment of endometriosis. She subsequently developed right flank pain caused by a right distal ureteral stricture requiring a chronic indwelling ureteral stent. Diagnostic laparoscopy revealed extrinsic compression of the ureter for which robot-assisted ureterolysis was performed. Because of inadequate omentum, we report the initial use of a cryopreserved bioregenerative umbilical cord amniotic membrane allograft to perform a ureteral wrap to promote ureteral tissue healing and serve as an adhesion barrier to prevent recurrence of the fibrosis.

Keywords: amniotic membrane allograft; omental wrap; retroperitoneal fibrosis; ureterolysis.

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Conflict of interest statement

N.C., N.V., and B.R.D. have no competing financial interests; R.M. is a lecturer in Boston Scientific, Inc. and TissueTech, Inc.

Figures

FIG. 1.
FIG. 1.
(A) Sagittal view of CT demonstrating soft tissue overlying distal right ureter, postureteral stent placement, distal to iliac vessels (arrow). (B) Intraoperative right retrograde pyelogram demonstrating distal right ureteral narrowing (arrow).
FIG. 2.
FIG. 2.
(A) Appendix (blue arrow) and right ovary (white arrow) adherent to the underlying ureter at the level distal to crossing of the iliac vessels. (B) Exposed ureter (blue arrow) surrounded by fibrotic tissue after salpingo-oophorectomy and appendectomy. (C) Dissection of the posterior fibrotic rind off of the ureter (blue arrow) during ureterolysis. (D) Global view of pelvis demonstrating the freed ureter (isolated with vessel loop) postureterolysis.
FIG. 3.
FIG. 3.
(A) White light image of right distal ureter isolated with vessel loop. (B) Near-infrared fluorescence image of right distal ureter (FireFly™; Intuitive Surgical, Inc.) confirming vascularity of ureter after intravenous indocyanine green administration.
FIG. 4.
FIG. 4.
(A) Securing of bioregenerative umbilical cord amniotic membrane allograft (CLARIX™; Amniox Medical, Inc.) around distal ureter. (B) Completed umbilical cord amniotic membrane allograft ureteral wrap.
See this image and copyright information in PMC

References

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