In novel surgery, NUH surgeons use tissue from mouth to repair narrowed ureter

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SINGAPORE - Surgeons from the National University Hospital (NUH) have successfully carried out a novel surgery to preserve a man’s kidneys by repairing his ureter using tissue from inside his mouth.

The ureter is a tube that carries urine from the kidney to the bladder.

At a media briefing on Dec 7, Associate Professor Tiong Ho Yee, senior consultant at NUH’s department of urology, and Dr Melissa Tay, consultant at NUH’s department of urology, said they conducted the four-hour surgery in September 2022 using a surgical robot, in what they believe is a first in Singapore.

They announced it more than a year after monitoring the results of the operation, as the graft is less likely to fail after a year.

The technique was first documented in a paper published in urology medical journal European Urology by doctors from the United States in November 2017.

The patient, Mr Kathavarayan Dhinakaran, underwent a surgery in India when he was 21 to remove a blockage at the ureteropelvic junction – where the kidney meets the ureter. This slows or stops the flow of urine out of the kidney, leading to swelling of the kidney.

Then in November 2021 in Singapore, Mr Dhinakaran, now 46, was hit by a bout of excruciating pain on the right side of his body.

“I was in so much pain I could not lie down. I also vomited a few times,” said Mr Dhinakaran, a senior engineer in an oil and gas company.

The next morning, he went to NUH’s emergency department, where he was referred to the urology department. Doctors found that his right ureter had narrowed as a result of scar tissues at the site of his first surgery. The condition is known as ureteral stricture, which can lead to urinary infections, stones and kidney problems.

Mr Dhinakaran underwent an endoscopic balloon dilation, where a balloon is inserted at the site of the obstruction to stretch it open. But his symptoms persisted, complicated by stones and urinary tract infections. His right kidney was functioning at just 30 per cent. A normal person with two healthy kidneys has a kidney function of 50 per cent each.

After th...

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