Robotic-Assisted Surgery for Ureteral Stricture in Adults

NYU Langone physicians often perform surgery to correct ureteral stricture and restore the normal flow of urine. Our doctors focus on using minimally invasive treatments whenever possible.

During surgery, your doctor removes scar tissue and may surgically reconstruct the ureter in a different location and reconnect it to the kidney. If the stricture is extensive, tissue from another part of the body, such as the inside of the mouth, may be used to help reconstruct the ureter—a technique pioneered at NYU Langone.

Our reputation is internationally recognized. Our surgeons have traveled around the world teaching others their techniques.

At NYU Langone, more than 90 percent of procedures to correct ureteral strictures are performed robotically, meaning the doctor uses a robotic surgery device to perform the surgery. Doctors at the Robotic Surgery Center use the latest generation of robots with enhanced imaging called the da Vinci® Xi surgical system to perform urinary tract reconstruction in people with ureteral strictures.

The system consists of tiny surgical instruments mounted on three separate robotic arms. A fourth arm contains a camera that creates magnified, high definition, three-dimensional images on a computer monitor that guide the surgeon during the procedure. Each incision used to insert these sophisticated instruments is a quarter of an inch long. The doctor then controls these instruments and the camera from a console.

During robotic-assisted laparoscopic surgery, doctors have an up close and detailed view of the urinary tract, surrounding organs, lymph nodes, blood vessels, and nerves. Doctors also use enhanced imaging technology, known as near infrared fluorescence, to monitor blood supply to the organs.

This approach often results in less bleeding, less scarring, fewer wound infections, and less postoperative pain than conventional surgery. It can also lead to a shorter recovery time in the hospital.

Surgical Approaches

The surgical approach and technique a doctor uses to fix the stricture is based on its location. At the Robotic Surgery Center, all surgical approaches and techniques can be performed using robotic-assisted surgery.

When the narrowing occurs at the ureteropelvic junction (UPJ), where the kidney meets the ureter, doctors perform a robotic pyeloplasty to remove the blockage and reconstruct the ureter. The urinary tract is then surgically reconstructed to repair any damage to the ureter and kidney caused by the blockage. This also helps to prevent future obstructions.

When the ureteropelvic junction is so scarred that a pyeloplasty cannot be performed, doctors may use an approach, known as a buccal mucosa ureteroplasty, that allows them to rebuild the ureter using tissue from the inside of the cheek.

Rarely, our surgeons manage these strictures with a ureterocalicostomy. This involves removing the bottom of the kidney and attaching the ureter to the inner part of the kidney, where urine forms and collects. 

When the blockage occurs in the top or middle section of the ureter, a surgeon may perform a ureteroureterostomy. During this procedure, the doctor removes the obstructed area and then connects the remaining portions of the ureter to each other. If the stricture is small enough, a laser maybe used to cut the stricture, in a procedure known as an endoureterotomy.

When there is an obstruction in the bottom portion of the ureter, where it meets the bladder, the surgeon performs ureteral reimplantation. He or she removes the ureter directly above the blockage, implanting it into another part of the bladder. To do so, the surgeon creates a new opening in the bladder and attaches the end of the ureter to this opening.

Our doctors having been using advanced robotic techniques to manage ureteral strictures for more than a decade, pioneered the use of many of the techniques used today, and have the largest published series of literature on robotic UPJ obstruction and ureteral stricture repair in adults in the world.

What to Expect After Surgery

After surgery, you may remain in the hospital for one to two days while the ureter begins to heal. During this time, NYU Langone pain management specialists ensure that you recover comfortably and receive the medications you need.

In each of these surgical procedures, the surgeon places a small, temporary tube called a stent in the ureter during surgery to help urine flow and promote healing. About one month after surgery, the stent is no longer needed, and your doctor removes it during a routine office visit. There is often no need for ongoing stenting.

Most people who have surgery to correct a stricture feel better about 7 to 10 days after surgery. About 97 percent of people who have surgery never have a recurrence and never require the long term use of a stent.

Follow-up visits typically occur every six months for two years. During these visits, your doctor may perform ultrasound tests to better view the ureter and ensure no strictures have formed.

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