Introduction: Encrusted indwelling ureteral stents may be difficult to manage and may require multiple endoscopic interventions, particularly if there is significant stone burden on both the distal and proximal curls of the stent. As the single-port (SP) robotic system has been popularized, its ability for target relocation has been utilized, not needing to reposition the patient nor replace robotic trocars to operate from the kidney down to the pelvis through a single incision. In this case, target relocation is utilized to perform cystolithotomy and pyelolithotomy for encrusted ureteral stent removal.
Methods: The patient is a 51-year-old male who had bilateral indwelling ureteral stents retained for a 4 month period with extensive calculus formation and was referred to our tertiary care center after inability to remove in the office cystoscopically. The first stage operation was cystourethroscopy with lithotripsy of his left ureteral stent that was encrusted and obstructing the bulbar urethra. He then elected for SP robotic encrusted ureteral stent removal. He was placed in right flank position with the SP port via an infraumbilical incision. Cystolithotomy was first performed, with the retained left ureteral stent segment removed, and the encrusted right indwelling ureteral stent transected and removed. Target relocation was then used to approach the right renal pelvis, which was incised into to reveal the encrusted proximal curl, which was extracted. The ureteropelvic junction was then closed over a new indwelling ureteral stent with 4-0 absorbable monofilament suture. Target relocation was used again to go back to the pelvis, and the bladder was closed in a single layer.
Results: Operative time was 1 hour and 45 minutes, estimated blood loss 25 mL, and length of stay 1 day. His Foley catheter was removed in 1 week, and his right indwelling ureteral stent was removed in 4 weeks. There were no 30-day complications.
Conclusions: The SP robotic system is an advantageous tool when needing to span from the kidney down the pelvis without the need to reposition patients nor place additional trocars (i.e. distal and proximally encrusted ureteral stents, nephroureterectomy, retroperitoneal lymph node dissections).