Complication from his kidney stone surgery

For six years, 42-year-old Lawrence Valenzano of Shamong couldn't do the simplest things he had once taken for granted:

He couldn't run around with his children, or ride his mountain bike. He couldn't even bend down to tie his own shoes.

It all started after he had a serious complication from kidney stone surgery, a large area of scar tissue that blocked urine from passing through the ureter from his left kidney to his bladder.

The recommended fix: major open surgery, with a significant risk of losing his kidney or developing additional complications. A less risky alternative was to return to the operating room every three to six months to exchange a stent that would run from his kidney to bladder. The stent would hold the ureter open to allow urine to drain properly and salvage his kidney, but he would have to live with the pain and discomfort associated with a stent.

He saw multiple specialists and was turned down for surgery at a well-known hospital before he was referred to our office at Temple. We evaluated him, but he said he would rather have repeated stent changes to avoid the risks of major surgery.

He managed to keep running his small business, but still had to cope with chronic pain and restricted mobility.

In 2014, while presenting at an international conference in Taiwan, I heard of a novel technique called a robotic-assisted buccal mucosa graft ureteroplasty, and thought of Lawrence.

It had been performed on only a handful of patients, but the early results seemed promising. It involved harvesting a skin graft from the inside lining of the cheek, known as buccal mucosa, and implanting the skin graft as a patch onto the blocked ureter to bypass the stricture.

This technique had been well-established in the urethra, but its application in the ureter was an innovation in its infancy. Using a robotic approach instead of making a large incision to tackle such a complex problem added the appeal of minimally invasive surgery for the patient, but potentially multiplied the technical challenges to the surgeon.

Lawrence was interested, but hesitated until I had completed several successful cases at Temple.

After a six-hour operation that went smoothly, a new stent was placed to give the graft time to heal. After a six-week wait, we found the graft was successful. I was elated to find that Lawrence's kidney drained easily on its own. For the first time in six years, Lawrence was stent-free.

Today, he says he is 100 percent back to having a normal life and doing the daily tasks he no longer takes for granted.

Daniel D. Eun is chief of robotic surgery and director of minimally invasive robotic urologic oncology and reconstructive surgery at Temple University Hospital, and associate professor of urology at the Lewis Katz School of Medicine at Temple University.