July 26, 2021
When Stela Persunaru, 67, of Chicago, Illinois, was diagnosed with stage 1B cervical cancer in 2005, she was treated with a hysterectomy and pelvic lymph node dissection. However, the surgery left her with adhesions — or bands of scar-like tissue — that led to narrowing in the tube that carries urine from the kidney to the bladder called the ureter.
After Stela’s physicians found the narrowed ureter, called a ureteral stricture, they managed it by inserting a plastic stent to hold the ureter open. However, Stela needed to have a surgical procedure every six months to have the stent exchanged.
Researching Other Options
During the nine years that Stela’s stent was in place, she experienced decreased quality of life and had multiple urinary tract infections. She also developed an abscess in her kidney after a July 2020 stent exchange procedure.
“After the kidney abscess, I wanted to do something about the stent,” said Stela, a retired IT Systems Analyst/Programmer and a current computer instructor. “I started doing research online to see if I could find a physician to help.”
Stela came across an online article about robotic ureter reconstruction written by Michael D. Stifelman, M.D., chair of Urology and director of Robotic Surgery at Hackensack University Medical Center and Professor and Founding Chair of Urology at Hackensack Meridian School of Medicine.
“I read Dr. Stifelman’s article and felt so much confidence,” said Stela. “I called his office and set up a consultation.”
“Stela was told that there was nothing that could be done about her condition, but was unwilling to accept a life with constant stent exchanges. So she decided to research other options,” says Dr. Stifelman. “When she reached out, we set up a telemedicine consult and quickly developed a plan to help.”
That plan included a robotic ureteral re-implantation, which would eliminate the need for a ureteral stent.
“Dr. Stifelman was so generous with his time at the first telemedicine visit, and he has a real talent for explaining everything clearly and in detail,” says Stela. “For the first time in almost 10 years of having a ureteral stent, I understood where the stricture of the ureter was exactly located.”
Dr. Stifelman walked Stela through all the procedures that would be done before, during and after surgery. Stela’s stay in New Jersey would be approximately two weeks, and Dr. Stifelman’s medical secretary assisted Stela and her husband in finding a nearby hotel. After her recovery was complete, Stela would be able to complete her follow-up at Hackensack University Medical Center every six months for two years via telemedicine visits and review of imaging.
On March 18, 2021, Dr. Stifelman removed Stela’s stent to “rest” the ureter, and on March 24, 2021, Dr. Stifelman performed Stela’s robotic ureteral re-implantation procedure.
During the procedure, George Mazpule, M.D., a general surgeon with extensive experience performing advanced robotic assisted surgery, first cleared the surgical area of bowel adhesions, allowing Dr. Stifelman to perform the ureteral re-implantation by, mobilizing the bladder and crafting a new ureter to bridge the diseased ureter known as a “Boari flap.”
“The precision of robotic surgery and leveraging of advanced Near Infra-Red Fluorescent imaging is ideal for surgeries like Stela’s,” says Dr. Stifelman. “Through four small quarter inch incisions, we are able to perform complex procedures without damaging nearby structures, confirm healthy tissue and blood flow and provide patients with excellent outcomes, reduced discomfort and faster recovery times.”
“Twelve hours after surgery, I was walking down the hall,” says Stela. “I had no pain.”
One week later, Stela was cleared to return home and released to the care of her local urologist. After a brief recovery, she has resumed normal activities and is pleased that she no longer has to deal with a stent or the side effects and complications that come with it.
“As Dr. Stifelman’s patient, I had the best experience and satisfaction in my medical history, and I also had a transformative experience on personal level. I am no longer the very private person as I always have been. All my health challenges from the last 15 years I shared only with my husband; not with my mother, my relatives or friends,” says Stela. “I am now willing to share my story with the whole world! The simple reason is to have a small part in spreading the word about the brilliant doctor and surgeon, Michael D. Stifelman, and his wonderful team at Hackensack University Medical Center, who corrected a problem that has long plagued my life.”
Stela also received another piece of good news after her surgery: a tissue biopsy performed by Dr. Stifelman showed that she did not have any recurrence of cancer.
“Dr. Stifelman, like a virtuoso musician, touches the soul of each patient by his kindness, compassion, brilliant surgical skills, excellent care and constant concern to ensure the best outcome for his patients,” says Stela. “I myself joined the long line of his patients who are extremely grateful to him.”
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