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Groundbreaking Ureter Repair Using Mouth Tissue at NUH

In a remarkable surgical feat, surgeons at National University Hospital (NUH) in Singapore have successfully repaired a patient’s damaged ureter using tissue from his mouth.

This pioneering procedure has set a new standard in the realm of urological surgeries.

The Plight of Mr. Kathavarayan Dhinakaran

46-year-old Mr Kathavarayan Dhinakaran battled with a debilitating ureteropelvic junction (UPJ) obstruction. Characterized by excruciating pain, urinary stones, and deteriorating kidney function, this condition posed a significant challenge to his quality of life. UPJ obstruction, with an incidence rate of one in 1,500, typically manifests in childhood, but some cases, like Mr Dhinakaran’s, emerge in adulthood.

The Evolution of Treatment

Initially, Mr Dhinakaran underwent an open pyeloplasty in India at the age of 21, which provided temporary relief. However, when symptoms recurred, he sought help at NUH. An initial attempt with endoscopic balloon dilatation failed to yield lasting results, paving the way for a more innovative approach.

The Surgical Innovation at NUH

In a groundbreaking four-hour operation in September 2022, a dedicated team led by A/Prof Tiong Ho Yee and Dr Melissa Tay embarked on a laparoscopic redo buccal mucosa pyeloplasty. This sophisticated procedure involved harvesting the buccal mucosa, or cheek lining, and grafting it to the narrowed part of the ureter, using the Da Vinci surgical robot for precision and minimal invasiveness.

The Procedure in Detail

This meticulous surgery required the combined expertise of specialists in kidney surgery, transplantation, and functional urology. The team delicately sutured the patient’s buccal mucosa to the ureter, ensuring a blood supply through the omentum. The choice of the buccal mucosa was strategic, given its resilience and compatibility with urinary tract tissues.

The First of Its Kind at NUH

While the use of buccal mucosa for urethral repairs is established in medical literature, this was the first instance at NUH of its application in ureter reconstruction. This technique, as A/Prof Tiong noted, is particularly advantageous in complex ureteral strictures, often a result of scar tissue from previous surgeries.

The Bigger Picture: Treating Ureteral Strictures

Ureteral strictures, often arising from surgery, radiation, or conditions like endometriosis, pose significant challenges. Traditional treatments, while effective, have limitations, especially in the presence of extensive scar tissue. The NUH team’s innovative approach opens a new chapter in managing these complex cases.

The Advantages of the New Technique

This novel technique offers several benefits over traditional methods:

  1. Minimally Invasive: The robotic-assisted laparoscopic approach reduces recovery time and post-operative discomfort.
  2. Patient-Specific Solution: Using the patient’s tissue reduces the risk of rejection and complications associated with synthetic grafts.
  3. Avoids More Morbid Procedures: It circumvents the need for more complex surgeries that might involve intestinal conduits.
  4. Long-Term Efficacy: Early indications suggest promising long-term outcomes, crucial for patient quality of life.

Future Implications and Hope

This breakthrough at NUH offers renewed hope for Mr. Dhinakaran and countless others facing similar urological challenges. It underscores NUH’s commitment to cutting-edge medical solutions and patient-centric care. As the medical community continues to evolve, such innovative techniques are pivotal in enhancing surgical outcomes and patient experiences.

In Conclusion: A Step Forward in Urological Surgery

The successful implementation of this novel technique at NUH is more than just a surgical success; it represents a beacon of hope and a testament to the relentless pursuit of medical excellence. As Singapore’s medical landscape continues to advance, such innovations promise a brighter, healthier future for patients worldwide.

Photo caption – Mr Kathavarayan Dhinakaran (seated), Associate Professor Tiong Ho Yee (right), wife Madam Dhinakaran Arivunila (centre), Consultant Dr Melissa Tay (left)
Photo credit – National University Hospital

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