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Chalya PL, Massinde AN, Kihunrwa A, Simbila S. Iatrogenic ureteric injuries following abdomino-pelvic operations: a 10-year tertiary care hospital experience in Tanzania. World J Emerg Surg 2015; 10:17. [PMID: 25774212 PMCID: PMC4359460 DOI: 10.1186/s13017-015-0011-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/25/2015] [Indexed: 11/16/2022] Open
Abstract
Background Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity and even mortality. There is paucity of data regarding iatrogenic ureteric injuries in Tanzania and Bugando Medical Centre in particular. This study describes our experience in the management and outcome of ureteric injuries following abdomino-pelvic operations outlining the causes, clinical presentation and outcome of management of this condition in our local setting. Methods This was a retrospective descriptive study of patients with iatrogenic ureteric injuries following abdomino-pelvic operations that were managed in Bugando Medical Centre between July 2004 and June 2014. Results A total of 164 patients (M: F = 1: 1.6) were studied. Of these, 154 (93.9%) were referred to Bugando Medical Centre having had their initial surgeries performed at other hospitals, whereas 10 (6.1%) patients sustained ureteric injuries during abdomino-pelvic surgery at Bugando Medical Centre. The median age at presentation was 36 years. The most common cause of iatrogenic ureteric injuries was total abdominal hysterectomy occurring in 69.2% of cases. The distal ureter was more frequently injured in 75.6% of cases. Suture ligation was the commonest type of injury accounting for 36.6% of patients. One hundred and sixteen (70.7%) patients had delayed diagnosis but underwent immediate repair. Ureteroneocystostomy was the most frequent reconstructive surgery performed in 58.0% of cases. Of the 164 patients, 152 (92.7%) were treated successfully. Twelve (7.3%) patients died in hospital. The main predictors of deaths were delayed presentation, deranged renal function tests on admission, missed ureteric injuries and surgical site infections (P < 0.001). The overall median length of hospital stay was 12 days. Follow up of patients was generally poor as more than half of patients were lost to follow up. Conclusion Total abdominal hysterectomy still accounts for most cases of iatrogenic ureteric injuries in our environment. Meticulous surgical technique as well as identification of the course of the ureter and associated anatomic locations where injury is most likely to occur is important to decrease the risk of ureteric injury. Timely recognition of ureteric injury and its management is associated with good outcome.
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Affiliation(s)
- Phillipo L Chalya
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Anthony N Massinde
- Department of Obstetrics /Gynecology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Albert Kihunrwa
- Department of Obstetrics /Gynecology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Samson Simbila
- Department of Urology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
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Possible complications of ureteroscopy in modern endourological era: two-point or "scabbard" avulsion. Case Rep Urol 2015; 2014:308093. [PMID: 25610699 PMCID: PMC4291154 DOI: 10.1155/2014/308093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 10/09/2014] [Accepted: 10/13/2014] [Indexed: 12/14/2022] Open
Abstract
Indication has led ureteroscopy to be a worldwide technique, with the expected appearance of multiple types of complications. Severe complications are possible including ureteral perforation or avulsion. Ureteral avulsion has been described as an upper urinary tract injury related to the action of blunt trauma, especially from traffic accidents, being the mechanism of injury, the result of an acute deceleration/acceleration movement. With the advent of endourology, that term is also applied to the extensive degloving injury resulting from a mechanism of stretching of the ureter that eventually breaks at the most weakened site, or ureteral avulsion is referred to as a discontinuation of the full thickness of the ureter. The paper presents a case report and literature review of the two-point or "scabbard" avulsion. The loss of long segment of the upper ureter, when end-to-end anastomosis is not technically feasible, presents a challenge to the urological surgeon. In the era of small calibre ureteroscopes these complications, due to growing incidence of renal stones will become more and more actual. Our message to other urologists is to know such a complication, to know the ways of treatment, and to analyse ureteroscopic signs, when to stop or pay attention.
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Kpatcha T, Tengué K, Anoukoum T, Botcho G, Sikpa K, Fall P, Diao B, Diagne B. Complications urologiques de la chirurgie pelvienne au CHU Aristide Le Dantec de Dakar. AFRICAN JOURNAL OF UROLOGY 2014. [DOI: 10.1016/j.afju.2014.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Briggs J, Wing L, Macdonald A, Tapping C. Suspected iatrogenic ureteric injury: An approach to diagnostic imaging. Clin Radiol 2014; 69:e454-61. [DOI: 10.1016/j.crad.2014.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 11/29/2022]
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Patel BN, Gayer G. Imaging of iatrogenic complications of the urinary tract: kidneys, ureters, and bladder. Radiol Clin North Am 2014; 52:1101-16. [PMID: 25173661 DOI: 10.1016/j.rcl.2014.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Iatrogenic complications of various severities may arise from many, if not all, forms of medical and surgical treatment. Most of these occur in spite of proper precautions. Every system in the human body may be affected, and the urinary tract is no exception. Radiologists are often the first to suspect and identify such iatrogenic injuries and, therefore, awareness of the pertinent imaging findings is vital. This review explores and illustrates many of the common and less common iatrogenic complications affecting the kidney, ureters, and bladder.
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Affiliation(s)
- Bhavik N Patel
- Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, 3808, Durham, NC 27710, USA
| | - Gabriela Gayer
- Division of Abdominal Imaging, Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94304, USA; Department of Radiology, Sheba Medical Center, 2 Derech Sheba, Tel-Hashomer, Ramat-Gan 52621, Israel.
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Cross-sectional imaging of iatrogenic complications after extracorporeal and endourological treatment of urolithiasis. Insights Imaging 2014; 5:677-89. [PMID: 25256564 PMCID: PMC4263803 DOI: 10.1007/s13244-014-0355-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/27/2014] [Accepted: 09/02/2014] [Indexed: 11/25/2022] Open
Abstract
Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) currently represent the mainstay treatment options for the vast majority of patients with urolithiasis, with limited contraindications and high success rates. However, minimally invasive extracorporeal and endourological treatments are associated with a non-negligible morbidity including occasional life-threatening occurrences. These complications represent a source of concern for urologists since they may result in prolonged hospitalisation, need for surgical, endoscopic or interventional treatment, long-term renal impairment, and sometimes even medical malpractice claims. Due to the increasing prevalence of urolithiasis and the large number of therapeutic procedures performed, in hospitals with active urologic practices radiologists are increasingly requested to investigate suspected post-procedural complications following ESWL, PCNL or ureteroscopic stone removal. Based upon our experience, this pictorial essay provides an overview of current extracorporeal and endourological treatment modalities for urolithiasis, including indications and possible complications according to the most recent guidelines from the European Association of Urology (EAU). Afterwards, we review the clinical features and cross-sectional imaging appearances of common and unusual complications with case examples, including steinstrasse, subcapsular, perirenal and suburothelial haemorrhages, severe urinary tract infections (such as pyeloureteritis, pyelonephritis, renal abscesses and pyonephrosis), ureteral injuries and delayed strictures. Teaching points • Extracorporeal lithotripsy, percutaneous nephrolitotomy and ureteroscopy allow treating urolithiasis. • Minimally invasive extracorporeal and endourological treatment have non-negligible morbidity. • Multidetector CT allows confident assessment of stone-free status and postprocedural complications. • Main complications include steinstrasse, bleeding, severe infections, ureteral injuries and strictures. • Imaging triage allows the choice among conservative, surgical, endoscopic or interventive treatment.
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Andersen P, Andersen LM, Iversen LH. Iatrogenic ureteral injury in colorectal cancer surgery: a nationwide study comparing laparoscopic and open approaches. Surg Endosc 2014; 29:1406-12. [DOI: 10.1007/s00464-014-3814-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 08/14/2014] [Indexed: 01/21/2023]
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Morey AF, Brandes S, Dugi DD, Armstrong JH, Breyer BN, Broghammer JA, Erickson BA, Holzbeierlein J, Hudak SJ, Pruitt JH, Reston JT, Santucci RA, Smith TG, Wessells H. Urotrauma: AUA guideline. J Urol 2014; 192:327-35. [PMID: 24857651 DOI: 10.1016/j.juro.2014.05.004] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE The authors of this guideline reviewed the urologic trauma literature to guide clinicians in the appropriate methods of evaluation and management of genitourinary injuries. MATERIALS AND METHODS A systematic review of the literature using the MEDLINE® and EMBASE databases (search dates 1/1/90-9/19/12) was conducted to identify peer-reviewed publications relevant to urotrauma. The review yielded an evidence base of 372 studies after application of inclusion/exclusion criteria. These publications were used to inform the statements presented in the guideline as Standards, Recommendations or Options. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low). In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS Guideline statements were created to inform clinicians on the initial observation, evaluation and subsequent management of renal, ureteral, bladder, urethral and genital traumatic injuries. CONCLUSIONS Genitourinary organ salvage has become increasingly possible as a result of advances in imaging, minimally invasive techniques, and reconstructive surgery. As the field of genitourinary reconstruction continues to evolve, clinicians must strive to approach clinical problems in a creative, multidisciplinary, evidence-based manner to ensure optimal outcomes.
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Affiliation(s)
- Allen F Morey
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Steve Brandes
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Daniel David Dugi
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - John H Armstrong
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Benjamin N Breyer
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Joshua A Broghammer
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Bradley A Erickson
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Jeff Holzbeierlein
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Steven J Hudak
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Jeffrey H Pruitt
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - James T Reston
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Richard A Santucci
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Thomas G Smith
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Hunter Wessells
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
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Abstract
Management of ureteric strictures is a challenging task. Subtle presentation, silent progression and complex aetiology may delay diagnosis. A wide range of available treatment options combined with the lack of adequate randomised trials has led to the introduction of personal bias in the management of this difficult group of patients. Metallic ureteric stents offer an alternative to the conventional treatment modalities. A review of the currently available metallic stents and their role in the long-term management of ureteric strictures is presented. Materials used in the manufacture of indwelling urological devices are evolving all the time. Improved endo-urological techniques combined with new devices made from better compounds will continue to improve patient experience.
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Affiliation(s)
- Ravi Kulkarni
- Department of Urology, Ashford and St Peter's Hospitals, Chertsey, Surrey, UK
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60
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How to manage total avulsion of the ureter from both ends: our experience and literature review. Int Urol Nephrol 2013; 45:1553-60. [PMID: 23884730 DOI: 10.1007/s11255-013-0505-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the treatment alternatives of total avulsion of the ureter from both ends including ureteropelvic junction (UPJ) and ureterovesical junction (UVJ). METHODS Total ureteral avulsion on both ends of the ureter was examined in 4 cases performing ureteroscopy. In two male patients of the four cases, avulsion was noticed intraoperatively and ureteral re-anastomosis at UPJ and re-implantation at UVJ were performed immediately. Boari flap was performed for one female patient immediately and for the other female patient who was referred from another hospital after the ureteroscopy, 4 days later. RESULTS One patient who had ureteral re-implantation was followed with 3-month intervals by ultrasonography and abdominal X-ray. At the end of 1 year, it was determined that kidney parenchyma was normal and the patient had kidney and upper ureteral stones. Percutaneous nephrolithotomy was performed, and the patient was stone-free at the end of the operation. Two years after the surgery, both kidneys were normal. This is the only case who had a successful ureteral re-implantation in literature. The other patient turned up a year later for routine checks after the ureteral stent was removed. Then, hydronephrosis and renal atrophy were detected. The patient did not accept nephrectomy or any other intervention and he was lost to follow-up. Boari flap procedure was performed after UPJ repair for the other two female patients. Their kidneys were both normal 3 months after the operation. CONCLUSIONS In case of ureteral avulsion from both ends of the ureter in the male patients, as bladder capacity is not enough for a Boari flap, proximal anastomosis and distal re-implantation could be a good choice for the management of this untoward event. This new approach also saves time for reconstructive treatments if necessary. If bladder capacity is enough to reach UPJ, Boari flap could be a good choice in female patients.
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Gao P, Zhu J, Zhou Y, Shan Y. Full-length ureteral avulsion caused by ureteroscopy: report of one case cured by pyeloureterostomy, greater omentum investment, and ureterovesical anastomosis. Urolithiasis 2013; 41:183-6. [PMID: 23503882 DOI: 10.1007/s00240-012-0541-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 12/18/2012] [Indexed: 12/01/2022]
Abstract
The aim of this report was to look for a good solution to full-length ureteral avulsion. This report retrospectively analyzed the data of the patient. The patient underwent ureteroscopic management. Full-length avulsion of ureter occurred during ureteroscopy. Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis were performed immediately. The patient was followed-up 25 months. After the first operation, the patient developed hydronephrosis because of press of fibrosis tissue outside ureter and anastomotic atresia of ureter-bladder. When we finished the second operation, the renal function recovered well. Full-length avulsion of ureter is a severe complication. Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis are probably a good choice.
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Iatrogenic Obliteration of Ureter with Spontaneous Recanalization. Case Rep Med 2013; 2013:290725. [PMID: 24082886 PMCID: PMC3776540 DOI: 10.1155/2013/290725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/02/2013] [Indexed: 11/17/2022] Open
Abstract
We report an unusual case of spontaneous and complete healing of a severe iatrogenic midureteral injury. Following percutaneous nephrostomy and 3 months on our surgical waiting list, the injured ureter underwent complete spontaneous recanalization. The patient is clinically well with no evidence of recurrent obstruction after 2 years of followup. To our knowledge, this is the first reported case of spontaneous recanalization of an iatrogenically induced complete ureteral obliteration.
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63
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Li J, Chen Z, Zhu Q, Zhao Y, Wang H, Liu W. Early Repair of Pelvic and Abdominal Nonurological Surgery-Induced Iatrogenic Ureteral Injuries in Three Distinct Waiting-for-Repair Time Periods. Am Surg 2012. [DOI: 10.1177/000313481207801137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to explore whether the time from pelvic and abdominal non-urological surgery-induced iatrogenic ureteral injuries to repair associates with outcomes. We retrospectively reviewed 81 cases of pelvic and abdominal nonurological surgery-induced iatrogenic ureteral injuries occurring in 78 patients treated at our hospital from January 2000 to December 2009. Time between injury and surgical repair, operative times, and incidence of complications were compared. Lower ureteral segment injuries occurred in 66 cases, middle segment injuries in 13, and upper segment injuries in two. Surgical repair methods included 36 ureteroneocystostomies, 17 ureteroneocystostomy with psoas hitch, 14 ureteroureterostomies/ureteral end-to-end anastomosis, and 10 ureteroneocystostomies with a Boari flap. Immediate intraoperative repair was carried out in 23 cases. In 42 cases, repair was delayed as a result of late identification and performed within 1 month after surgery. In 10 cases, repair was performed 3 months after surgery. No significant differences were observed in operative times of repair surgeries or incidence of postoperative complications. Delayed discovery of iatrogenic ureteral injury can still result in good therapeutic effects if the surgical repair is done within 1 month after injury under the premise that no serious urinary tract infection is present and the patient can tolerate surgery.
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Affiliation(s)
- Jingquan Li
- From the Department of Urology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Zhaoyan Chen
- From the Department of Urology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Qingguo Zhu
- From the Department of Urology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Yakun Zhao
- From the Department of Urology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Haiping Wang
- From the Department of Urology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Wei Liu
- From the Department of Urology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
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Xu Y, Fu W, Li G, Shi J, Tan H, Hu K, Cui F, Lin Q, Zhang X. Autologous urothelial cells transplantation onto a prefabricated capsular stent for tissue engineered ureteral reconstruction. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:1119-1128. [PMID: 22382733 DOI: 10.1007/s10856-012-4583-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 02/06/2012] [Indexed: 05/31/2023]
Abstract
In this study, we have fabricated an artificial ureter by transplantation of in vitro-expanded urothelial cells onto an in vivo-prefabricated capsular stent using tissue engineering methods. Spiral poly (L-lactic acid) (PLLA) stents were transplanted into the subcutaneous of Wistar rats for a period of 1, 2 or 3 weeks to induce the formation of connective tissue capsules on their surfaces. The capsular PLLA stents were then decellularized and further recellularized with bladder epithelial cells to fabricate artificial ureters. The results showed that the entrapped cells in all capsules remained continuously proliferation and lined up in continuous layers. In addition, the urothelial cells on the capsular stents with an embedding period of 2 or 3 weeks showed higher proliferative viability compared with the cells on the stents with an embedding time of 1 week (P < 0.05). The results of the study indicated that the prefabricated capsular stents could serve as alternative cell carriers for tissue engineered ureters, especially with embedding time from 2 to 3 weeks.
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Affiliation(s)
- Yongde Xu
- Department of Urology, PLA General Hospital, Military Postgraduate Medical College, Haidian District, Beijing, China
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Fu WJ, Xu YD, Wang ZX, Li G, Shi JG, Cui FZ, Zhang Y, Zhang X. New ureteral scaffold constructed with composite poly(L-lactic acid)-collagen and urothelial cells by new centrifugal seeding system. J Biomed Mater Res A 2012; 100:1725-33. [PMID: 22447771 DOI: 10.1002/jbm.a.34134] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 02/19/2012] [Accepted: 02/21/2012] [Indexed: 11/07/2022]
Abstract
A tissue-engineered ureteral scaffold was constructed with composited poly L-lactic acid (PLLA)-collagen endoluminal stent and uroepithelial cells (UECs) using a new seeding system. The electrospun PLLA-collagen nanofibrous mesh was seeded efficiently with human ureteral epithelial cells using a modified centrifugal seeding device. The cellular nanofibrous mesh was then wound around a spiral endoluminal stent to form a cellular composited PLLA-collagen ureteral scaffold. The cellular ureteral scaffold was subcutaneously implanted into nude mice. Cell attachment, distribution, and viability in vitro were investigated along with the cell fate in vivo. (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay showed that scaffolds seeded with centrifugal method had higher cellular activity than scaffolds seeded with static method (p < 0.05), and the metabolic activity per cell had no significant differences between the two methods (p > 0.05). Histologic analysis showed that the entrapped UECs remained in the scaffolds after 2 wk of implantation. The results of the study indicated that the composited PLLA-collagen endoluminal stent could serve as alternative cell carrier for tissue engineering ureter. In addition, the new modified centrifugal seeding system allowed rapid homogeneous distribution of cells onto the nanofibrous mesh, which will be useful to ureteral reconstruction.
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Affiliation(s)
- Wei-Jun Fu
- Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, Haidian District, Beijing 100853, People's Republic of China.
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[Endoscopic treatment with Wallgraft stenting of complete iatrogenic iliac ureteral injury in a high-risk surgical patient]. Urologia 2011; 78 Suppl 18:30-4. [PMID: 22081422 DOI: 10.5301/ru.2011.8774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Injury of the ureter is a potential complication of any difficult abdominopelvic surgical procedure, with an incidence ranging between 0.5% and 10% in most series. The treatment depends on the severity and the place of the lesion. The severe mid and upper ureteral injuries usually require complex treatment procedures, which can be contraindicated in case of severe comorbidities with high anesthesiologic risk. We report our experience in the endoscopic treatment with Wallgraft stenting of complete iatrogenic iliac ureteral injury in a high-risk surgical patient. METHODS A 74-year-old female patient was admitted at our department due to a complete lesion of the right iliac ureter following right iliac artery aneurysm repair with iatrogenic ileal injury. The patient was in coma, affected by severe respiratory insufficiency, sepsis and uroperitoneum. These conditions contraindicated a general anesthesia encumbering the positioning of a nephrostomy, and influenced our indication of Wallgraft stent placement. The Wallgraft endoprosthesis (10 x 50 mm) is a self-expanding super-alloy metallic high flexible stent covered by PET, which can be placed at the level of the lesion using fluoroscopy after introducing an angiographic catheter and guidewire. This procedure is usually indicated in the treatment of vascular lesions. RESULTS After positioning the Wallgraft stent, pyelography showed a complete closure of the lesion. The patient's clinical condition improved quickly and remained stable at a follow-up of 45 months. CONCLUSIONS Although the Wallgraft stent positioning cannot be considered as a standard treatment for all the complete ureteral lesions, it can be proposed in the management of some patients with severe comorbidities, which do not allow any other approach.
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Ge C, Li Q, Wang L, Jin F, Li Y, Wan J, Lan W, Liang P. Management of Complete Ureteral Avulsion and Literature Review: A Report on Four Cases. J Endourol 2011; 25:323-6. [PMID: 21050029 DOI: 10.1089/end.2010.0303] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chengguo Ge
- Department of Urology, Institute of Surgery Research, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Qiansheng Li
- Department of Urology, Institute of Surgery Research, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Luofu Wang
- Department of Urology, Institute of Surgery Research, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Fengshuo Jin
- Department of Urology, Institute of Surgery Research, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Yanfeng Li
- Department of Urology, Institute of Surgery Research, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Jianghua Wan
- Department of Urology, Institute of Surgery Research, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Weihua Lan
- Department of Urology, Institute of Surgery Research, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Peihei Liang
- Department of Urology, Institute of Surgery Research, Daping Hospital, The Third Military Medical University, Chongqing, China
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68
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Wolters HH, Heistermann HP, Stöppeler S, Hierlemann H, Spiegel HU, Palmes D. A New Technique for Ureteral Defect Lesion Reconstruction Using an Autologous Vein Graft and a Biodegradable Endoluminal Stent. J Urol 2010; 184:1197-203. [DOI: 10.1016/j.juro.2010.04.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Indexed: 12/22/2022]
Affiliation(s)
- Heiner H. Wolters
- Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
| | | | - Sandra Stöppeler
- Surgical Research, Muenster University Hospital, Muenster, Germany
| | - Helmut Hierlemann
- Institute of Textile Technology and Process Engineering, Denkendorf, Germany
| | | | - Daniel Palmes
- Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
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Conley SP, Lee BR, Hyams ES, Shah O, Karnabatidis D, Kallidonis P. Controversial case in endourology. J Endourol 2010; 24:899-903. [PMID: 20491570 DOI: 10.1089/end.2010.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sarah P Conley
- Tulane University School of Medicine , New Orleans, Louisiana, USA
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70
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Korkes F, Lopes-Neto AC, Mattos MHE, Pompeo ACL, Wroclawski ER. Patient position and semi-rigid ureteroscopy outcomes. Int Braz J Urol 2009; 35:542-7; discussion 548-50. [DOI: 10.1590/s1677-55382009000500005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2009] [Indexed: 11/22/2022] Open
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71
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Mechanical Ureteral Perforation by a Radiofrequency Electrode During Ablation of a Renal Tumor. Cardiovasc Intervent Radiol 2009; 32:1317-9. [DOI: 10.1007/s00270-009-9607-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 04/28/2009] [Accepted: 05/06/2009] [Indexed: 11/26/2022]
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Dos Santos Abreu LDA, Tanaka M, de Abreu SC, Kawano PR, Yamamoto H, Otsuka RAP, Travassos MR, Amaro JL, Fugita OE. Laparoscopic management of iatrogenic lesions. J Endourol 2008; 22:1279-83. [PMID: 18484884 DOI: 10.1089/end.2008.0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To present our series of patients who underwent laparoscopic correction of iatrogenic lesions and a review of the literature. PATIENTS AND METHODS We evaluated 23 patients who underwent laparoscopic correction of iatrogenic lesions. Thirteen patients had open surgery, 6 had an endoscopic procedure, and 4 had a laparoscopic approach as the first surgical procedure. Vesicovaginal fistulas (VVF) developed in seven patients after open abdominal hysterectomies, and 1 patient presented with a VVF after ureterolithotripsy. A urethral cutaneous fistula developed in one patient after a laparoscopic resection of endometriosis nodules, and 1 patient presented with a ureterovaginal fistula after a perineoplasty. Three patients presented with encrusted ureteral stents after ureterolithotripsy. Ureteral stenosis developed in seven patients: three after open abdominal surgery, three after ureteroscopy, and one after pyeloplasty. One patient had a ureteral injury during laparoscopic partial nephrectomy, and two patients had bowel injuries after a tension-free vaginal tape procedure and a laparoscopic radical prostatectomy. RESULTS All patients underwent laparoscopic correction of the iatrogenic injuries. One patient had an early recurrence of a VVF, and one patient had a recurrence of a ureteral stenosis. There was one conversion to open surgery because of technical difficulties and one major bleeding event that necessitated blood transfusion. A lower limb compartmental syndrome developed in one patient. CONCLUSION Despite the small number of patients and different types of surgeries performed, laparoscopic management of iatrogenic lesions seems to be feasible and safe in experienced hands. Its precise role in the management of this stressful condition still needs to be determined.
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Tanaka E, Ohnishi S, Laurence RG, Choi HS, Humblet V, Frangioni JV. Real-time intraoperative ureteral guidance using invisible near-infrared fluorescence. J Urol 2007; 178:2197-202. [PMID: 17870110 PMCID: PMC2505174 DOI: 10.1016/j.juro.2007.06.049] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 06/27/2007] [Indexed: 01/12/2023]
Abstract
PURPOSE Invisible near-infrared light is safe and it penetrates relatively deeply through tissue and blood without altering the surgical field. Our hypothesis was that near-infrared fluorescence imaging would enable visualization of the ureteral anatomy and flow intraoperatively and in real time. MATERIALS AND METHODS CW800-CA (LI-COR, Lincoln, Nebraska), the carboxylic acid form of near-infrared fluorophore IRDye 800CW, was injected intravenously, and its renal clearance kinetics and imaging performance were quantified in 350 gm rats and 35 kg pigs. High performance liquid chromatography and electrospray time-of-flight mass spectrometry were used to characterize CW800-CA metabolism in urine. The clinically available near-infrared fluorophore indocyanine green was also used via retrograde injection into the ureter. Using the 2 near-infrared fluorophores the ureters were imaged under the conditions of steady state, intraluminal foreign bodies and injury. RESULTS In rat models the highest signal-to-background ratio for visualization occurred after intravenous injection of 7.5 microg/kg CW800-CA with values of 4.0 or greater and 2.3 or greater at 10 and 30 minutes, respectively. In pig models 7.5 microg/kg CW800-CA clearly visualized the normal ureter and intraluminal foreign bodies as small as 2.5 mm in diameter. Retrograde injection of 10 microM indocyanine green also permitted the detection of normal ureter and pinpointed urine leakage caused by injury. Electrospray time-of-flight mass spectrometry, and absorbance and fluorescence spectral analysis confirmed that the fluorescent material in urine was chemically identical to CW800-CA. CONCLUSIONS A convenient intravenous injection of CW800-CA or direct injection of indocyanine green permits high sensitivity visualization of the ureters under steady state and abnormal conditions using invisible light.
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Affiliation(s)
- Eiichi Tanaka
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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75
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De Cicco C, Ret Dávalos ML, Van Cleynenbreugel B, Verguts J, Koninckx PR. Iatrogenic ureteral lesions and repair: a review for gynecologists. J Minim Invasive Gynecol 2007; 14:428-35. [PMID: 17630159 DOI: 10.1016/j.jmig.2007.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 12/27/2006] [Accepted: 01/07/2007] [Indexed: 10/23/2022]
Abstract
Ureter injuries are a well-known complication of gynecologic surgery and a frequent cause of medicolegal problems. Because there are no randomized, controlled trials and the available studies are small series and case reports, the evidence on which to base treatment is weak. We therefore reviewed the complete English-language literature of ureter repair since 1990. In total, 608 ureter injuries were reported. Although it is widely believed that for laceration or section the prognosis is affected by a delay in diagnosis, we could not find evidence to substantiate this. An obstruction requires stenting only. For a laceration, stenting with suturing was more effective than stenting only (p = .006). A ureter anastomosis was successful in over 94% of cases either by laparotomy or laparoscopy. In conclusion, the literature data are scanty and heterogeneous and do not permit solid conclusions. Evidence, however, is emerging that a laceration should be treated by stenting and suturing. A ureter anastomosis over a stent could become a valid option especially when performed by laparoscopy.
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Affiliation(s)
- Carlo De Cicco
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Pedro RN, Hendlin K, Weiland D, Ramani A, Köhler TS, Anderson JK, Monga M. In Vitro Evaluation of Ureteral Perforation Forces. Urology 2007; 70:592-4; discussion 594-5. [PMID: 17905132 DOI: 10.1016/j.urology.2007.04.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Revised: 03/05/2007] [Accepted: 04/02/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Ureteroscopy has become a very effective treatment option for ureteral and upper tract abnormalities. The reported complication rates have ranged from 1.5% to 13% for perforations and have been less than 1% for avulsions. We present a study that quantified the ureteral avulsion force in porcine ureters and ureteral perforation forces in human and porcine ureters. METHODS The avulsion force was measured in six porcine kidneys. A 2.4F stainless steel flat-wire basket was advanced through an incision made in the renal pelvis, and a 10-mm stone was placed in the extraction basket. The external end of the basket (handle) was attached to a miniature, low-force load cell and slowly pulled with increasing force until the ureter avulsed. The ureteral perforation forces were measured in 10 fresh porcine and 9 human ureters. Perpendicular perforation with either the blunt end of a CT-1 needle (0.038 in.) or the back end of a stiff guidewire (0.035 in.) was measured using the miniature, low-force load cell. RESULTS The average maximal force to avulse the pig ureter was 2.21 +/- 0.43 pound-mass (lb(m)). The force required to perforate the porcine ureter was significantly greater than that required to perforate the human ureter, irrespective of whether a needle (1.70 +/- 0.26 lb(m) versus 1.05 +/- 0.29 lb(m), P = 0.019) or guidewire (1.30 +/- 0.25 lb(m) versus 0.79 +/- 0.25 lb(m), P = 0.013) was used. Greater force was required to perforate with the needle than with the guidewire in both the porcine (P = 0.037) and the human (P = 0.26) ureter. CONCLUSIONS Quantifying the ureteral perforation forces will facilitate the design of endourologic devices, open the door for "smart devices" that sense forces and provide feedback, provide information critical to the design of endourologic and suturing simulators, and, finally, establish competency parameters for professionals in training.
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Affiliation(s)
- Renato N Pedro
- Department of Urologic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455-0392, USA
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Seo EJ, Kang TW, Noh JH. Severe Iatrogenic Ureteral Avulsions Caused by the Ureteroscopic Procedures. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.10.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Eun Ju Seo
- Department of Urology, Kwangju Christian Hospital, Gwangju, Korea
| | - Taek Won Kang
- Department of Urology, Chonnam University Medical School, Gwangju, Korea
| | - Jun Hwa Noh
- Department of Urology, Kwangju Christian Hospital, Gwangju, Korea
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Palacios Jaraquemada JM. Possibility of hidden damages with temporary uterine artery occlusion device. Hum Reprod 2006; 21:2721; author reply 2721-2. [PMID: 16997942 DOI: 10.1093/humrep/del103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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