Ureteral strictures and bladder contracture are sequelae of advanced genitourinary tuberculosis (GUTB) and are frequently managed by reconstructive procedures in addition to anti-tubercular treatment. Minimally invasive surgical techniques lend themselves well to ureteral and bladder reconstruction. Ileal ureter and augmentation cystoplasty individually are well-established procedures, but only a few reports of combined reconstructions are described in the literature.

We demonstrate the technique of simultaneous ileal ureter with augmentation ileo-cystoplasty, highlighting the challenges, technical maneuvers, and ergonomic approach with a minimally invasive platform. Video-based illustration of two young males who presented with pan ureteral stricture and small capacity bladder secondary to GUTB has been described.

Augmentation was done in a clamp cystoplasty manner. The mean operating time was 380 min, and the estimated blood loss was 370 mL. The mean hospital stay was 8.5 days, with one patient having a Clavien-Dindo grade 1 complication. Suprapubic and per urethral catheters were removed after 21 days. Stent removal was done after six weeks. The patients have preserved renal function, no urinary symptoms, and a mean bladder capacity of 350 mL with insignificant post-void residual volume at six months of follow-up.

With strict adherence to the principles of open surgery, robotic simultaneous ureteral and bladder reconstruction is safe, effective and feasible. It provides a minimally invasive surgical option for ureteral reconstruction and significantly improves bladder capacity in patients with GUTB. With this modified technique, this complex and extensive reconstruction can be done easily with similar functional outcomes and minimal perioperative complications compared to open surgery.

Ethics approval and consent to participate
Ethics approval was obtained from the Institutional Ethical Committee, and Consent to participate was obtained from the patient.

Consent for publication
Written informed consent for publication of details, images and videos was obtained from the patient.

Authors' contributions
The authors alone are responsible for the content and writing of this article. SK, SSK and MA performed the surgery. SSK, SK, SKS, LND, MA and DA were the major contributor in preparing the manuscript.