Robotic tubular pyeloureteroplasty using flap and lingual mucosal graft: a case report and literature review.

BACKGROUND

Recurrent ureteropelvic junction obstruction (UPJO) accompanied by long proximal ureteral obliteration presents significant challenges for conventional pyeloplasty, primarily due to the elevated tension at the surgical site. Additionally, previous surgeries often lead to scar tissue formation, complicating both the identification of healthy tissue and the success of reconstruction.

CASE DESCRIPTION: A 38-year-old patient with right UPJO successfully underwent robotic tubular pyeloureteroplasty using a flap and lingual mucosal graft (LMG). The surgical technique involved using the flap to form the posterior plate of the anastomosis, with the LMG serving as the anterior plate, resulting in a wide, tubularized, and well-vascularized ureteropelvic junction. Intraoperative blood loss was about 50 mL, and operative time was about 220 minutes. Follow-up ultrasound demonstrated sustained reduction in hydronephrosis, which was further confirmed by improved findings on computed tomography urography. Antegrade urography confirmed the absence of ureteral obstruction following removal of the Double-J stent, with no complications observed. During follow-up assessments, the patient reported no symptoms after surgery. By sixteen months postoperatively, the glomerular filtration rate of the right renal increased from 25.03 to 28.03 mL/min, and split renal function improved from 33.00% to 37.56%.

CONCLUSIONS

Robotic tubular pyeloureteroplasty using a flap and LMG is a safe and effective surgical option, offering a promising treatment for selected patients with UPJO. This technique serves as an alternative for those with complex anatomical challenges typically encountered in pyeloplasty.