1
|
Martin A, Wells A, Anderson ML, Chern JY, Rutherford TJ, Shahzad MM, Wenham RM, Hoffman MS. Trends in ureteral surgery on an academic gynecologic oncology service. Gynecol Oncol 2021; 163:552-556. [PMID: 34674890 DOI: 10.1016/j.ygyno.2021.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the incidence, complications, and trends associated with ureteral surgeries on a gynecologic oncology service in the context of a fellowship training program over a 24-year period. METHODS We conducted a retrospective cohort analysis of ureteral surgeries by gynecologic oncologists at either Moffitt Cancer Center or Tampa General Hospital from 1997 to 2020. Patient characteristics, predisposing factors, location and type of injury, repair method, postoperative management and complications were abstracted from the medical record. The recent cohort (2005-2020) was compared to our prior series (1997-2004). RESULTS Eighty-eight cases were included. The average number of ureteral surgeries per year decreased from 5.75 (1997-2004) to 2.63 (2005-2020). Of 46 iatrogenic injuries, 45 were recognized and repaired intraoperatively. Ureteral transection was the most common type (85% [39 of 46]) and the distal 5 cm was the most common location of injury (63% [29 of 46]). Ureteroneocystostomy was the most common method of repair (83% [73 of 88]). Postoperative management, including stenting and imaging, has not changed significantly. Length of urinary catheter usage decreased in the recent cohort without associated complications. Five patients had major postoperative complications and 4 involved the urinary tract. Of those with follow-up, 96% (66 of 69) of ureteroneocystostomies and 75% (9 of 12) of ureteroureterostomies had radiologically normal urinary tracts. CONCLUSIONS Ureteral surgery is necessary in the case of injury or involvement with invasive disease. There has been a decrease in number of procedures. Ureteroneocystostomy has remained the most common method of reconstruction for both injury and resection with acceptable postoperative complication rates.
Collapse
Affiliation(s)
- Alexandra Martin
- Department of Clinical Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, United States of America.
| | - Ali Wells
- Department of Obstetrics & Gynecology, University of South Florida College of Medicine, Tampa, FL, United States of America
| | - Matthew L Anderson
- Division of Gynecologic Oncology, University of South Florida College of Medicine, Tampa, FL, United States of America
| | - Jing-Yi Chern
- H. Lee Moffitt Cancer Center, Department of Gynecologic Oncology, Department of Oncologic Sciences, University of South Florida, Tampa, FL, United States of America
| | - Thomas J Rutherford
- Division of Gynecologic Oncology, University of South Florida College of Medicine, Tampa, FL, United States of America
| | - Mian M Shahzad
- H. Lee Moffitt Cancer Center, Department of Gynecologic Oncology, Department of Oncologic Sciences, University of South Florida, Tampa, FL, United States of America
| | - Robert M Wenham
- H. Lee Moffitt Cancer Center, Department of Gynecologic Oncology, Department of Oncologic Sciences, University of South Florida, Tampa, FL, United States of America
| | - Mitchel S Hoffman
- H. Lee Moffitt Cancer Center, Department of Gynecologic Oncology, Department of Oncologic Sciences, University of South Florida, Tampa, FL, United States of America
| |
Collapse
|
2
|
Ureteral reconstruction for complex strictures: a review of the current literature. Int Urol Nephrol 2021; 53:2211-2219. [PMID: 34524628 DOI: 10.1007/s11255-021-02985-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Frequently employed procedures for ureteral reconstruction include balloon dilation, pyeloplasty and ureteral re-implants. However, these procedures do not work for complex ureteral disease. The goal of this literature review is to report on techniques and success rates for the following techniques: buccal graft ureteroplasty, appendiceal interposition, transureteroureterostomy, ileal ureter and autotransplantation. METHODS A comprehensive literature search for English-language original and review articles was conducted using PubMed. The following terms were queried: "ureteral reconstruction", "buccal graft", "appendiceal interposition", "ileal ureter", "transureteroureterostomy", "autotransplantation". RESULTS Procedures involving the buccal mucosa or appendix offer minimally invasive techniques and low morbidity with good short-term success. Drawbacks to appendiceal interposition include the availability and length of appendix, and 10-20% of patients may have insufficient appendix upon intra-operative assessment. Transureteroureterostomy is typically limited to extensive exonerations due to concerns of injury to the contralateral kidney, even with reported success rates > 90%. Ileal ureter may carry a risk of metabolic acidosis in patients with renal insufficiency along with bowel-related complications. Ileal ureter and autotransplantation are reserved for the most severe cases due to their high morbidity but do offer options for the complex patient. CONCLUSION Ureteral stricture disease not amenable to pyeloplasty, ureteroureterostomy or ureteroneocystostomy offers a challenge to urologist. Careful patient selection with pre-operative assessment of renal and bladder is vital to a successful operation with minimal complications.
Collapse
|
3
|
Pinar U, Tremblay JF, Passot G, Dazza M, Glehen O, Tuech JJ, Pocard M. Reconstruction after ureteral resection during HIPEC surgery: Re-implantation with uretero-neocystostomy seems safer than end-to-end anastomosis. J Visc Surg 2017; 154:227-230. [PMID: 28709979 DOI: 10.1016/j.jviscsurg.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Resection of the pelvic ureter may be necessary in cytoreductive surgery for peritoneal carcinomatosis in combination with hyperthermic intraperitoneal chemotherapy (HIPEC). As the morbidity for cytoreductive surgery with HIPEC has decreased, expert teams have begun to perform increasingly complex surgical procedures associated with HIPEC, including pelvic reconstructions. After ureteral resection, two types of reconstruction are possible: uretero-ureteral end-to-end anastomosis and uretero-vesical re-implantation or uretero-neocystostomy (the so-called psoas hitch technique). By compiling the experience of three surgical teams that perform HIPEC surgeries, we have tried to compare the effectiveness of these two techniques. METHODOLOGY A retrospective comparative case-matched multicenter study was conducted for patients undergoing operation between 2005 and 2014. Patients included had undergone resection of the pelvic ureter during cytoreductive surgery with HIPEC for peritoneal carcinomatomosis; ureteral reconstruction was by either end-to-end anastomosis (EEA group) or re-implantation uretero-neocystostomy (RUC group). The primary endpoint was the occurrence of urinary fistula in postoperative follow-up. RESULTS There were 14 patients in the EEA group and 14 in the RUC group. The groups were comparable for age, extent of carcinomatosis (PCI index) and operative duration. Four urinary fistulas occurred in the EEA group (28.5%) versus zero fistulas in the RUC group (0%) (P=0.0308). CONCLUSION Re-implantation with uretero-neocystostomy during cytoreductive surgery with HIPEC is the preferred technique for reconstruction after ureteral resection in case of renal conservation.
Collapse
Affiliation(s)
- U Pinar
- Chirurgie digestive et cancérologique, hôpital Lariboisière, université Paris Diderot, Sorbonne Paris Cité, AP-HP, 75475 Paris, France
| | - J-F Tremblay
- Chirurgie digestive et cancérologique, hôpital Lariboisière, université Paris Diderot, Sorbonne Paris Cité, AP-HP, 75475 Paris, France
| | - G Passot
- Service de chirurgie viscérale et endocrinienne, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69310 Lyon, France
| | - M Dazza
- Département de chirurgie digestive, CHU de Rouen, 76000 Rouen, France
| | - O Glehen
- Service de chirurgie viscérale et endocrinienne, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69310 Lyon, France
| | - J-J Tuech
- Département de chirurgie digestive, CHU de Rouen, 76000 Rouen, France
| | - M Pocard
- Chirurgie digestive et cancérologique, hôpital Lariboisière, université Paris Diderot, Sorbonne Paris Cité, AP-HP, 75475 Paris, France.
| | | |
Collapse
|
4
|
Kawamura J, Tani M, Sumida K, Yazawa T, Kawasoe J, Yamamoto M, Harada H, Yamamoto H, Zaima M. The use of transureteroureterostomy during ureteral reconstruction for advanced primary or recurrent pelvic malignancy in the era of multimodal therapy. Int J Colorectal Dis 2017; 32:135-138. [PMID: 27714520 DOI: 10.1007/s00384-016-2672-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Cancerous involvement of a ureter is sometimes encountered in pelvic surgery for malignancy. We usually perform transureteroureterostomy (TUU) in cases of unilateral lower ureteral cancerous involvement. We report the outcomes in patients treated with TUU in our institute. METHODS We retrospectively reviewed the medical records of 11 patients who underwent TUU between June 2006 and September 2015. RESULTS The primary disease was colon cancer in five patients, rectal cancer in four, and uterine cervical cancer and ovarian cancer in one patient each. Early postoperative complications relevant to TUU occurred in four patients; however, three patients were managed conservatively and recovered quickly. Only one patient developed ureteral obstruction, which resulted from anastomotic hematoma. Follow-up periods ranged from 5 to 78 months with a median of 28 months. The median estimated glomerular filtration rate before and after TUU was 59 ml/min (range, 31-90 ml/min) and 62.0 ml/min (range, 43-127 mL/min), respectively. No patients experienced worsening of their renal function or recurrent urinary tract infection. CONCLUSIONS Short-term outcomes are good and long-term renal function is maintained following TUU. TUU is considered a feasible technique for ureteral reconstruction for pelvic malignancy, and TUU has great potential in the era of multimodal therapy.
Collapse
Affiliation(s)
- Junichiro Kawamura
- Department of Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan.
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno Higashi, Osaka Sayama, Osaka, 589-8511, Japan.
| | - Masaki Tani
- Department of Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan
| | - Kimiaki Sumida
- Department of Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan
| | - Takefumi Yazawa
- Department of Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan
| | - Junya Kawasoe
- Department of Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan
| | - Michihiro Yamamoto
- Department of Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan
| | - Hideki Harada
- Department of Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan
| | - Hidekazu Yamamoto
- Department of Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan
| | - Masazumi Zaima
- Department of Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan
| |
Collapse
|
5
|
Tan YG, Tan G, Tan D, Chia CS, Ang DY, Teo MCC. Urological reconstruction after pelvic oncological surgery: A single institution experience. Asian J Surg 2016; 40:389-395. [PMID: 27317102 DOI: 10.1016/j.asjsur.2016.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/03/2016] [Accepted: 02/16/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND In locally advanced pelvic malignancies, there is often involvement of urological organs, necessitating resection and reconstruction, which can be associated with significant complications. METHODS We retrospectively reviewed 20 patients undergoing urological reconstructions during pelvic oncological surgeries from January 2004 to December 2013. All patients had imaging-proven involvement of at least one urological organ preoperatively. Primary outcome was urological complication rate. Secondary outcomes were nonurological complication, recurrence rate, and overall survival. RESULTS Median age of presentation was 51 years. Six and 14 patients underwent resections for primary and secondary tumors, respectively. Colorectal tumors were the most common, followed by gynecological cancers. The ureter was the most common urological organ involved, followed by the bladder, prostate, and seminal vesicles. Reconstructive procedures included ileal and sigmoid conduits, ureteroneocystostomies, Boari flap, transureteroureterostomies (TUUs) and direct ureteroureterostomies. Six patients developed major urological complications, requiring endoscopic and surgical reinterventions. The follow-up time was 34 months. Thirteen patients developed recurrence, associated with higher tumor grade and lymphovascular invasion, and occurred at a median time of 10 months. These patients had an overall survival of 20 months, compared to 45 months in patients without recurrence. CONCLUSION Careful patient selection in pelvic oncological surgeries can significantly prolong survival. Recurrent tumors and greater intraoperative blood loss are associated with higher urological complications. A limited pelvic exenteration and lower radiation doses can reduce complication rates. If higher doses are necessary, conformal techniques and hyperfractionated radiotherapy should be explored. Urological reconstruction should be individualized, according to the extensiveness of urological involvement and exposure of radiation.
Collapse
Affiliation(s)
- Yu Guang Tan
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
| | - Grace Tan
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - David Tan
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Claramae S Chia
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Dun Yong Ang
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Melissa C C Teo
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| |
Collapse
|
6
|
|
7
|
Pisters PW, Pettaway CA, Liu P, Matin SF, Ward JF, Leibovici D. Is transureteroureterostomy performed during multi-organ resection for non-urothelial malignancy safe and effective? J Surg Oncol 2012; 106:62-5. [PMID: 22259198 DOI: 10.1002/jso.23039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 12/21/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multi-organ resection in patients with non-urothelial cancer may include segmental ureteral resection. The resulting ureteral defect can be reconstructed with a transureteroureterostomy (TUU); however, whether TUU is safe and effective in this patient group remains unclear. OBJECTIVES In the current retrospective analysis, we evaluated renal function before and after complex multi-organ resection that included TUU to determine whether TUU is safe and effective. METHODS We retrospectively reviewed the charts of patients who underwent TUU between 1995 and 2011. Renal imaging studies performed before and after TUU were used to determine whether hydronephrosis was present in either kidney. Kidney function was assessed by measuring serum creatinine levels and calculating the estimated glomerular filtration rate (eGFR) before and after TUU. RESULTS Twelve patients underwent TUU during multiorgan resection. Median follow-up time was 15 months. Three patients with cancer recurrence involving the TUU developed progressive hydronephrosis. Serum creatinine levels did not increase more than 0.5 mg/dl in any patient. Kidney function as assessed by eGFR was maintained in all patients (until the time of recurrence in the three patients with recurrence affecting the TUU). CONCLUSIONS TUU during multi-organ resection for non-urothelial malignancy is safe and effective. Long-term renal function is maintained in the majority of patients.
Collapse
Affiliation(s)
- Phillip W Pisters
- Department of Urology, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA.
| | | | | | | | | | | |
Collapse
|
8
|
Woodhouse C. Supra-vesical Urinary Diversion and Ureteric Re-implantation for Malignant Disease. Clin Oncol (R Coll Radiol) 2010; 22:727-32. [DOI: 10.1016/j.clon.2010.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 07/09/2010] [Indexed: 11/24/2022]
|
9
|
Iwaszko MR, Krambeck AE, Chow GK, Gettman MT. Transureteroureterostomy revisited: long-term surgical outcomes. J Urol 2010; 183:1055-9. [PMID: 20092851 DOI: 10.1016/j.juro.2009.11.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Indexed: 11/15/2022]
Abstract
PURPOSE Transureteroureterostomy is a treatment alternative for ureteral obstruction when more conventionally reconstructive techniques are not feasible. We report on long-term outcomes of patients treated with transureteroureterostomy. MATERIALS AND METHODS A retrospective chart review of all patients treated with transureteroureterostomy from January of 1985 to February of 2007 was performed. RESULTS We identified 63 patients who underwent transureteroureterostomy at our institution. Average treatment age was 31.5 years (range 1 to 83). Transureteroureterostomy was performed for 21 (33%) malignant and 42 (67%) benign indications. Reconstructions were 30 right-to-left (47.6%) and 33 left-to-right (52.4%) with 21 concurrent urinary diversions. There were 16 patients (25.4%) who received radiation before transureteroureterostomy. Postoperative complications occurred in 15 (23.8%) patients and were more common in those undergoing diversion for malignancy. Mean followup was 5.8 years (range 0.1 to 22.2) and 5 patients were lost to followup. Of the 56 patients with followup imaging the transureteroureterostomy was patent in 54 (96.4%) and obstructed in 2 (3.6%). Mean preoperative and recent calculated glomerular filtration rate for this cohort were 62.8 (range 13 to 154) and 71.8 (range 22 to 141) ml per minute, respectively (p = 0.04). Stone disease developed in 8 patients, and was treated with percutaneous nephrolithotomy (2), spontaneous passage (2), ureteroscopy (1) and surveillance (3). Subsequent urological intervention was required for obstruction or revision in 6 (10.3%) patients. CONCLUSIONS We demonstrated the long-term safety and effectiveness of transureteroureterostomy with sustained improvement of renal function compared to preoperative status. Recurrent stricture, distal obstruction and stone disease occur in a small percentage of patients, and can be treated in most with minimal intervention.
Collapse
Affiliation(s)
- Markian R Iwaszko
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | | | | |
Collapse
|
10
|
|