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Case Reports
. 2024 Mar 5;7(3):250-254.
doi: 10.1002/iju5.12717. eCollection 2024 May.

Complete retroperitoneal cutaneous ureterostomy with robot-assisted radical cystectomy

Shiori Tanaka  1 , Goshi Kitano  1 , Manabu Kato  1 , Yuji Ogura  2 , Takahiro Kojima  1
Affiliations
Case Reports

Complete retroperitoneal cutaneous ureterostomy with robot-assisted radical cystectomy

Shiori Tanaka et al. IJU Case Rep. .

Abstract

Introduction: Cutaneous ureterostomy is beneficial for older patients in a hypoalimentation state, providing less invasive options than intestinal tract reconstruction techniques. However, complications such as ileus and stoma site hernia still pose risks owing to the anatomical location of the ureter. We introduce a novel method, complete retroperitoneal cutaneous ureterostomy, performed simultaneously with robot-assisted radical cystectomy.

Case presentation: Our technique involves extending the retroperitoneal space to minimize complications and achieve stent-free outcomes. The median procedure time for complete retroperitoneal cutaneous ureterostomy was approximately 30 min. The stent-free rates at 1 and 4 months postoperatively were 66.7% and 100%, respectively; no case of stent reinsertion after stent removal was reported.

Conclusion: Our approach is promising for avoiding postoperative intestinal tract complications.

Keywords: cutaneous ureterostomy; cystectomy; retroperitoneal space; robot‐assisted.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
(a) Position of da Vinci and assistant ports to perform RARC with CRCU. (b) The position of each port during right‐side CRCU. (c) The role of each arm during left‐side CRCU.
Fig. 2
Fig. 2
A step‐by‐step scheme of CRCU procedures. Step 1: A retroperitoneal space is created in an antegrade fashion. Step 2: A 12‐mm port is inserted from the stoma site to introduce the ureter. Step 3: The sheath of the port is pulled out to the abdominal wall. Step 4: A dissection is performed, and a retroperitoneal space is created in a retrograde fashion. Step 5: The 12‐mm port sheath is introduced into the retroperitoneal space to grasp and lead the ureter to the stoma site. Step 6: The peripheral peritoneum is sutured to place the ureter inside the retroperitoneal space. Step 7: The central peritoneum is sutured to place the ureter inside the retroperitoneal space.
Fig. 3
Fig. 3
Laparoscopic findings of right‐side CRCU. (a) A picture of Step 4. (b) A picture of Step 5. (c) A picture of Step 6.
See this image and copyright information in PMC

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