Buccal mucosal graft ureteroplasty: The new normal in ureteric reconstructive surgery - Our initial experience with the laparoscopic and robotic approaches.

INTRODUCTION: Upper ureteric stricture is always a challenging case to treat for any urologist. Due to chronic inflammation and multiple interventions, it becomes a complex entity to treat. Buccal Mucosal Graft (BMG) Ureteroplasty is a reconstructive surgery used to treat upper ureteric stricture but the results and experience with this modality is less explored so far. We present here our study of 16 cases of BMG ureteroplasty and its outcomes done by the laparoscopic and robotic approaches. PATIENTS AND METHODS: We analysed 16 cases of BMG ureteroplasty, which were performed both laparoscopically and robotically. All these cases were long ureteric strictures, not amenable to excision or endoscopic intervention. We performed using an onlay BMG without complete mobilisation of the ureter. The omentum or nearby fat was used as a bed for onlay BMG. RESULTS: All 16 patients underwent onlay ureteroplasty. The reconstructed ureter was wrapped with omentum in nine of the cases, while in seven patients, nearby fat was used. The median stricture length was 5.28 cm, and the median operative time was 143.5 min. The mean operative time was 143.5 min. 15 of 16 (93.75%) cases were successfully clinically and radiologically on follow-up. CONCLUSION: Long-segment upper ureteric strictures are a difficult entity to operate on. BMG ureteroplasty is a safe and effective way of managing such strictures. Robot-assisted ureteroplasty provides the benefits of improved ergonomics, easy manoeuvrability and precision surgery to the patients. Our experience with both laparoscopic and robotic ureteroplasty would encourage urologists all over to use BMG ureteroplasty as an effective long-term procedure for ureteral reconstruction.

Ureteroneocystostomy herniation leading to obstructive uropathy 10 years postrenal transplant: A rare case report.

Herniation of the urinary bladder is observed in around 1%-4% of cases. Bladder herniation rarely presents with obstructive uropathy; however, bladder herniation carrying ureteroneocystostomy and leading to obstructive uropathy of the graft is even rare. Here, we present a case of a 36-year-old male with deranged renal function test who had undergone renal transplant 10 years back. Computed tomography scan revealed bladder herniation with ureteroneocystostomy and hydronephrosis. He was surgically explored by Gibson incision and ureterolysis, and hernioplasty was performed. Although the cause of herniation was ureteroneocystostomy, it was managed immediately without any need for percutaneous nephrostomy.

Giant peritoneal mouse: A rare case presenting with lower urinary tract symptoms.

Peritoneal loose bodies called 'peritoneal mice' are rare entities that can grow to large sizes and produce lower urinary tract symptoms due to a mass effect. We describe a case that was managed with laparoscopic removal of the mass with complete resolution of symptoms.

Incidentally Detected Testicular Metastasis in a Case of Prostatic Adenocarcinoma.

Adenocarcinoma of the prostate is one of the common cancers among elderly men worldwide. However, testicular metastasis detected incidentally after orchiectomy is a rare presentation as most commonly we encounter patients presenting with bone metastasis at the time of primary diagnosis. Here, we describe a recently diagnosed case of prostatic carcinoma that had metastasis in a single testis, incidentally detected in the orchiectomy histopathological specimen, performed for surgical castration and emphasize the importance of routine microscopical examination of the testicular specimens.

Periureteric venous ring with renal calculi and transitional cell carcinoma: report of a rare case.

We describe a very rare congenital anomaly of the inferior vena cava in a case who presented with renal calculi and transitional cell carcinoma on the right side. The diagnosis of 'periureteric venous ring' was made on preoperative imaging and confirmed on surgical exploration. We also review the literature and discuss the embryological origin of this anomaly along with its clinical significance.