Introduction

Ureteroileal strictures are diagnosed in 2-10% of patients following radical cystectomy and urinary diversion. Poor vascularity of the distal ureteric stumps is a well-known cause factor. Indocyanine-green (ICG) is an exogenous tracer that helps in assessing the vascularity of tissues. Herein, we report a proof-of-concept and our initial experience in using ICG prior performing intracorporeal ureteroileal anastomosis following robotic radical cystectomy (RRC).

Methods

From April to November 2016, the use of ICG was analyzed in 10 patients who underwent RRC with intracorporeal urinary diversion (IUD). Intravenous ICG (25mg) was administered prior to ureteroileal anastomosis and the non-enhanced distal ureters were excised prior to ureteric spatulation. Anastomosis was performed in routine manner with 4-0 vicryl sutures over ureteric stents.

Results

Among 10 patients who underwent to RRC-IUD (5 neobladders and 5 ileal conduits), ICG revealed poor distal ureteric enhancement in 7 patients (70%). Three (30%) patients required bilateral distal ureteral resection, three (20%) patients required left distal ureteral resection and one (10%) patient required right distal ureteral resection. Median resected ureteral length was 2 cm (1-4). Median operative time was 480 minutes (410-620), median EBL was 200 ml (100-650) and median hospital of stay was 5.5 days (3-9). Three patients experienced Clavien 2 complications (fever, n=2 and ileus, n=1). At a median follow-up of 81 days (7-198), no anastomotic strictures were identified.

Conclusions

Intravenous injection of ICG prior to ureteroileal anastomosis is a useful tool to evaluate distal ureter vascularity and to identify and excise the transition point of the non-vascularized ureteral segment. Longer follow-up is required to evaluate rates of anastomotic strictures.

Funding

none