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IDENTIFICATION OF SITE OF URETER STRICTURE USING A FOGARTY CATHETER DURING ROBOTIC URETERAL RECONSTRUCTION SURGERY
Shannon McNall, MD, Alex Vanni, MD, Alireza Moinzadeh, MD, MHL.
Lahey Hospital and Medical Center, Burlington, MA, USA.
BACKGROUND: Identification of the site of ureter stricture during robotic ureteral reconstruction can be challenging. Common techniques to assist in identification include use of indocyanine green (ICG), performing intraoperative ureteroscopy and estimation based on preoperative radiographic imaging. We describe our technique and outcomes for using a Fogarty embolectomy catheter to identify ureteral stricture during robotic ureteral reconstruction.
METHODS: We retrospectively reviewed 47 patients who underwent robotic ureteral reconstruction between August 2016 and December 2022. In each case, a pyelotomy or ureterostomy was made through which the Fogarty catheter was inserted into the ureter unfilled beyond the stricture point. The Fogarty catheter was filled with 0.3 mL of sterile saline making the balloon 6mm in diameter. Ureteral stricture was identified by the presence of resistance when the catheter was pulled back or pushed forward. All patients were assessed for clinical success, defined as the absence of flank pain and no evidence of obstruction on follow up imaging.
RESULTS: The Fogarty technique was applied to 47 patients undergoing ureteral reconstruction for ureteral stricture. Among these patients 21/47 presented with flank pain. Stricture etiology included nephrolithiasis (n=21), prior abdominopelvic surgery (n=11), prior transurethral resection of bladder tumor (n=3), radiation (n=2), cystitis glandularis (n=1), bladder malakoplakia (n=1) and unknown (n=7). The procedures included ureteral reimplantation (n=22), ureteroplasty with buccal mucosal graft (n=11), ureteroureterostomy (n=7), ileal ureter (n=4), appendiceal ureteroplasty (n=2) and pyeloplasty (n=1). There were no complications related to Fogarty catheter use. At a mean follow-up time of 21.2 months, 40/47 (85%) ureteral reconstructions were clinically and radiologically successful.
CONCLUSIONS: The Fogarty catheter technique can be utilized for a variety of robotic ureteral reconstruction surgeries to assess ureter stricture location and length. The Fogarty method is safe, effective, reproducible and gives the surgeon another tool for real-time intraoperative assessment of ureter stricture characteristics.
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