Robot-assisted ureteral reconstruction using buccal mucosal graft for traumatic complete ureteral avulsion: a rare case report

Abstract

Background: Blunt ureteral avulsion represents a rare and serious condition; its treatment depends on many factors, including severity, location, timing, and patient condition. Complete ureteral avulsion makes it challenging to insert a ureteral stent or nephrostomy tube; it is often repaired immediately by open surgery. However, there are few reports of robot-assisted ureteral reconstruction (RAUR) using a buccal mucosal graft (BMG) for traumatic complete ureteral avulsion. Therefore, this study aimed to evaluate the feasibility and safety of the RAUR using BMG during a 14-month follow-up period. Case Description: We report the case of an 18-year-old man with blunt trauma from a motorcycle accident who was diagnosed with multiple organ injuries, including complete left proximal ureteral avulsion. Simultaneous antegrade and retrograde ureterography revealed separate ureter lengths of 55 mm. Eight months following nephrostomy tube insertion, the patient was successfully treated with RAUR using BMG for delayed definitive repair. After the follow-up period, no radiographic evidence of hydronephrosis or subjective symptoms was observed, and no significant complications were noted. Conclusions: Nephrostomy contributed to delayed definitive reconstruction. Our initial experience, which yielded good outcomes, demonstrates that RAUR using a BMG may be a feasible and safe treatment option for blunt ureteral avulsion.