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Zeng M, Zhu Z, Yuan W, Tang Z, Qing Z, Lu Q, Wu X, He J, Li Y, Li Z. Verapamil inhibits inflammation and promotes autophagy to alleviate ureteral scar by regulation of CaMK IIδ/STAT3 axis. Ren Fail 2024; 46:2387432. [PMID: 39177245 PMCID: PMC11346332 DOI: 10.1080/0886022x.2024.2387432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 07/08/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Ureteral stricture (US) is a pathological stenosis in the urinary tract characterized by increased collagen synthesis and inflammation. Autophagy activation has been shown to ameliorate tissue fibrosis and protect against fibrotic diseases. Verapamil has beneficial therapeutic benefits on fibrotic disorders. The pharmacological effects of verapamil on fibroblast autophagy in US and the underlying mechanism need to be investigated further. METHODS US patients were recruited to isolate scar tissues, hematoxylin-eosin (HE) and Masson trichrome staining were performed to analyze histopathological changes. The US animal model was established and administered with verapamil (0.05 mg/kg) in the drinking water. Transforming growth factor (TGF)-β1 was adopted to facilitate collagen synthesis in fibroblasts. The mRNA and protein expressions were examined by qRT-PCR, western blot, immunofluorescence and immunohistochemistry. ELISA was adopted to measure interleukin (IL)-1β and IL-6 levels. Molecular interaction experiments like dual luciferase reporter and chromatin immunoprecipitation (ChIP) assays were performed to analyze the interaction between signal transducers and activators of transcription 3 (STAT3) and RNA polymerase II associated factor 1 (PAF1). RESULTS Herein, our results revealed that verapamil activated TGF-β1-treated fibroblast autophagy and inhibited inflammation and fibrosis by repressing Ca2+⁄calmodulin-dependent protein kinase II (CaMK II) δ-mediated STAT3 activation. Our following tests revealed that STAT3 activated PAF1 transcription. PAF1 upregulation abrogated the regulatory effect of verapamil on fibroblast autophagy and fibrosis during US progression. Finally, verapamil mitigated US in vivo by activating fibroblast autophagy. CONCLUSION Taken together, verapamil activated TGF-β1-treated fibroblast autophagy and inhibited fibrosis by repressing the CaMK IIδ/STAT3/PAF1 axis.
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Affiliation(s)
- Mingqiang Zeng
- Department of Urology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, P.R. China
- Hunan Provincial Institute of Geriatrics, Research Center for Lower Urinary Tract and Pelvic Floor Functional Diseases, Changsha, Hunan Province, P.R. China
| | - Zhiwei Zhu
- Department of Urology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, P.R. China
| | - Wuxiong Yuan
- Department of Urology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, P.R. China
| | - Zhengyan Tang
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, P.R. China
| | - Zhibiao Qing
- Department of Urology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, P.R. China
| | - Qiang Lu
- Department of Urology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, P.R. China
| | - Xuecheng Wu
- Department of Urology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, P.R. China
| | - Junhuan He
- Department of Urology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, P.R. China
| | - Yuanwei Li
- Department of Urology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, P.R. China
| | - Zhuo Li
- Department of Urology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, P.R. China
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Ou Y, Zhang G, Zhu X, Yin H, Gou X, Deng Y. Evaluation of risk factors, treatment options, and prognostic-related factors in patients with benign ureteral strictures: An 8-year single-center experience. Int J Urol 2023; 30:847-852. [PMID: 37287392 DOI: 10.1111/iju.15211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the etiology, therapeutic effect, and prognosis-related factors of benign ureteral strictures. METHODS We analyzed the date of 142 patients with benign ureteral strictures from 2013 to 2021. Ninety-five patients received endourological treatment and 47 patients underwent reconstruction. Preoperative, intraoperative, and postoperative information were compared and analyzed. Symptomatic improvement and radiographic blockage alleviation defined therapeutic success. RESULTS Stone-related factors caused 85.2% of cases. The overall success rate of endourological treatment was 51.6% versus 95.7% of reconstruction (p < 0.01). However, endourological treatment was better in terms of postoperative hospital stay time, operation time, and intraoperative blood loss (p < 0.001). In endourological group, patients with stricture length ≤2 cm, mild-to-moderate hydronephrosis, proximal or distal stricture had a higher success rate. Multivariate regression analysis showed that the surgical method was the only independent risk factor affecting success and recurrence. Reconstruction success rate was higher than endourological treatment (p = 0.001, OR 0.057, 95% CI (0.011-0.291)), and recurrence rate was also lower (p = 0.001, HR 0.074, 95% CI (0.016-0.338)). No obvious recurrence was seen in reconstruction, and the median recurrence time in endourological treatment was 51 months. CONCLUSIONS Stone-related factors are an important cause of benign ureteral strictures. Reconstruction is the gold standard treatment due to its high success rate and low recurrence rate. Endourological therapy is also preferred as the initial treatment in proximal or distal ureter with length ≤2 cm and mild-to-moderate hydronephrosis. Further close follow-up is required after treatment.
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Affiliation(s)
- Yangjie Ou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Guoqing Zhang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xin Zhu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Hubing Yin
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xin Gou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuanzhong Deng
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Mazzon G, Smith D, Arumuham V, Celentano G, Bolgeri M, Allen S, Allen C, Choong S. Long-term Outcomes of Minimally Invasive Rendezvous Procedures to Treat Complex Ureteric Strictures and Injuries. EUR UROL SUPPL 2023; 49:53-59. [PMID: 36874605 PMCID: PMC9974967 DOI: 10.1016/j.euros.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/28/2023] Open
Abstract
Background Complex ureteric strictures and injuries occurring during major abdominal and pelvic operations may cause significant morbidity and distress to patients. A rendezvous procedure is an endoscopic technique used in case of such injuries. Objective To evaluate perioperative and long-term outcomes of rendezvous procedures to treat complex ureteric strictures and injuries. Design setting and participants We retrospectively reviewed patients undergoing a rendezvous procedure for ureteric discontinuity including strictures and injuries, treated between 2003 and 2017 at our Institution and completing at least 12 mo of follow-up. We divided patients into two groups: early postsurgical obstruction, leakage, or detachment (group A) and late strictures (oncological/postsurgical; group B). Outcome measurements and statistical analysis If appropriate, we performed a retrograde study ± rigid ureteroscopy to assess the stricture 3 mo after the rendezvous procedure, followed by a MAG3 renogram at 6 wk, 6 mo, and 12 mo, and annually thereafter for 5 yr. Results and limitations Forty-three patients underwent a rendezvous procedure, 17 in group A (median age 50 yr, range 30-78) and 26 in group B (median age 60 yr, range: 28-83). Ureteric strictures and ureteric discontinuities were stented successfully in 15 out of 17 patients in group A (88.2%) and 22 out of 26 patients (84.6%) in group B. For both groups, the median follow-up was 6 yr. In group A, of 17 patients, 11 (64.7%) were stent free with no further interventions, two (11.7%) had a subsequent Memokath stent insertion (38%), and two (11.7%) required reconstruction. Of 26 patients in group B, eight (30.7%) required no further interventions and were stent free, ten (38.4%) were maintained with long-term stenting, and one was managed with a Memokath stent (3.8%). Of the 26 patients, only three (11.5%) required major reconstruction, while four patients with malignancy (15%) died during follow-up. Conclusions With a combined antegrade and retrograde approach, the majority of complex ureteric strictures/injuries can be bridged and stented with an overall immediate technical success rate of above 80%, avoiding major surgery in unfavourable circumstances and allowing time for stabilisation and recovery of the patient. Additionally, in case of technical success, further interventions may be unnecessary in up to 64% of patients with acute injury and about 31% of patients with late stricture. Patient summary The majority of complex ureteric strictures and injuries can be resolved using a rendezvous approach, avoiding major surgery in unfavourable circumstances. Moreover, this approach can help avoid further interventions in 64% of such patients.
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Affiliation(s)
- Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Daron Smith
- Institute of Urology, University College Hospital London, London, UK
| | - Vimoshan Arumuham
- Institute of Urology, University College Hospital London, London, UK
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy
- Corresponding author. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy. Tel. +39 081 7462611; Fax: +39 081 7462611.
| | - Marco Bolgeri
- Department of Urology, St George's Hospital, London, UK
| | - Sian Allen
- Institute of Urology, University College Hospital London, London, UK
| | - Clare Allen
- Department of Radiology, University College Hospital London, London, UK
| | - Simon Choong
- Institute of Urology, University College Hospital London, London, UK
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Gaya JM, Territo A, Basile G, Gallioli A, Martínez C, Turco M, Baboudjian M, Verri P, Tedde A, Uleri A, Meneghetti I, Huguet J, Rosales A, Sanguedolce F, Rodriguez-Faba O, Palou J, Breda A. Optimizing decision-making process of benign uretero-enteric anastomotic stricture treatment after radical cystectomy. World J Urol 2023; 41:733-738. [PMID: 36725730 DOI: 10.1007/s00345-023-04298-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/14/2023] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To identify preoperative predictors of endo-urological treatment (EUT) failure while promoting a new diagnostic and therapeutic pathway for benign uretero-enteric anastomosis stricture (UES) management after radical cystectomy (RC). MATERIALS AND METHODS We relied on a prospectively maintained database including 96 individuals (122 renal units) who developed a benign UES at our institution between 1990 and 2018. UES was classified into two different types according to morphology: FP1 (i.e., sharp or duckbill) and FP2 (i.e., flat or concave). EUT feasibility, success rate, as well as intra and postoperative complications were recorded. Uni- and multivariable logistic regression analysis (MVA) assessed for predictors of EUT failure. RESULTS Overall, 78 (63.9%) and 32 (26.3%) cases were defined as FP1 and FP2, respectively. EUT was not feasible in 33 (27.1%) cases. After a median follow-up of 50 (IQR 5-240) months, successful treatment was reached only in 15/122 (12.3%) cases. EUT success rates raised when considering short (< 1 cm) (16.8%), FP1 morphology (16.7%) strictures, or the combination of these characteristics (22.4%). Overall, 5 (5.2%) cases had CD ≥ III complications. FP2 (OR: 1.91, 95%CI 1.21-5.31, p = 0.03) and stricture length ≥ 1 cm (OR: 9.08, 95%CI 2.09-65.71, p = 0.009) were associated with treatment failure at MVA. CONCLUSIONS Endoscopic treatment for benign UES after RC is feasible but harbors a low success rate. Stricture length and radiological morphology of the stricture are related to endoscopic treatment failure. Surgeons should be aware of the stricture features during the preoperative decision-making process to choose the optimal candidate for endoscopic treatment.
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Affiliation(s)
- Josep M Gaya
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain.
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Christian Martínez
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Morena Turco
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Michael Baboudjian
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Paolo Verri
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alessandro Tedde
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Iacopo Meneghetti
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Jordi Huguet
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Antonio Rosales
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
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Trivedi P, Saben JL, Liu L, Malamon JS, Pomfret E, Pshak T. Preliminary safety and efficacy of laser stricturotomy for treatment of refractory biliary anastomotic strictures following liver transplantation. Am J Transplant 2023; 23:573-576. [PMID: 36695697 DOI: 10.1016/j.ajt.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/15/2022] [Accepted: 12/07/2022] [Indexed: 01/05/2023]
Abstract
Biliary anastomotic stricture (BAS) is a frequent complication of liver transplantation and is associated with reduced graft survival and patient morbidity. Existing treatments for BAS involve dilation of the stricture though placement of 1 or more catheters for 6 to 24 months yielding limited effectiveness in transplant patients. In this case series, we present preliminary safety and efficacy of a novel percutaneous laser stricturotomy treatment in a cohort of 5 posttransplant patients with BAS refractory to long-term large bore catheterization. In all patients, holmium or thulium laser was used to excise the stricture and promote biliary re-epithelization. There were no periprocedural complications. Technical success was 100% and at mean follow-up time of 22 months, there have been no recurrences. In conclusion, percutaneous laser stricturotomy demonstrates preliminary safety and efficacy in treatment of refractory BAS following liver transplantation.
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Affiliation(s)
- Premal Trivedi
- Department of Radiology-Interventional, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Jessica L Saben
- Department of Surgery-Transplant Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education, Aurora, Colorado, USA
| | - Lisa Liu
- Department of Radiology-Interventional, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John S Malamon
- Department of Surgery-Transplant Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education, Aurora, Colorado, USA
| | - Elizabeth Pomfret
- Department of Surgery-Transplant Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education, Aurora, Colorado, USA
| | - Thomas Pshak
- Department of Surgery-Transplant Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
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Verapamil inhibited the development of ureteral stricture by blocking CaMK II-mediated STAT3 and Smad3/JunD pathways. Int Urol Nephrol 2022; 54:2855-2866. [PMID: 35922702 DOI: 10.1007/s11255-022-03284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/23/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Ureteral stricture (US) is a fibrotic process that leads to urinary tract obstruction and even kidney damage, with the characteristic of reduced extracellular matrix (ECM) degradation and increased collagen synthesis. Verapamil, as a calcium channel blocker, was reported to prevent scar formation. Our work aimed to investigate the biological effects and mechanism of verapamil in US. METHODS Fibroblasts were subjected to transforming growth factor-beta 1 (TGF-β1) to stimulate collagen synthesis, and the messenger ribonucleic acid (mRNA) and protein expressions in fibroblasts were assessed using quantitative real-time polymerase chain reaction (qRT-PCR) and western blot. The location of phosphorylation-signal transducer and activator of transcription 3 (p-STAT3) and Jund proto-oncogene subunit (JunD) in fibroblasts were determined by immunofluorescence (IF). The binding relationship between signal transducer and activator of transcription 3 (STAT3) and collagen type I alpha1 (COL1A1)/collagen type III alpha 1 chain (COL3A1) and the binding relationship between JunD and tissue inhibitor of metalloproteinases-1 (TIMP-1) were verified by dual luciferase reporter gene and chromatin Immunoprecipitation (ChIP) assays. RESULTS Herein, we found that verapamil could inhibit TGF-β1/Ca2 + ⁄calmodulin-dependent protein kinase II (CaMK II)-mediated STAT3 activation in fibroblasts, and STAT3 inhibition repressed collagen production. In addition, verapamil could inhibit TGF-β1/CaMK II-mediated Mothers against DPP homolog 3 (Smad3)/JunD pathway activation in fibroblasts, and JunD silencing inhibited TIMP1 (a matrix metalloproteinase inhibitor) expression. Our subsequent experiments revealed that STAT3 bound with COL1A1 promoter and COL3A1 promoter and activated their transcription, and JunD bound with TIMP1 promoter and activated its transcription. Moreover, as expected, STAT3 activation could eliminate the inhibitory effect of verapamil treatment on TGF-β1-induced collagen production in fibroblasts, and JunD overexpression reversed the inhibitory effect of verapamil treatment on TGF-β1-induced TIMP1 expression in fibroblasts. CONCLUSION Verapamil inhibited collagen production and TIMP-1 expression in US by blocking CaMK II-mediated STAT3 and Smad3/JunD pathways.
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Yamashita S, Inoue T, Kohjimoto Y, Hara I. Comprehensive endoscopic management of impacted ureteral stones: Literature review and expert opinions. Int J Urol 2022; 29:799-806. [PMID: 35475562 DOI: 10.1111/iju.14908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
Treatment of urolithiasis, a benign disease, requires high efficacy and safety. Endoscopic treatment of impacted ureteral stones remains a challenging procedure for urologists, despite recent remarkable advances in surgical technology in treatment of urolithiasis. The success rate of endoscopic treatment in patients with impacted stones is reported to be lower than that in patients with nonimpacted stones. Moreover, the presence of stone impaction is associated with high rates of intraoperative and postoperative complications. The best management for patients with impacted ureteral stones should therefore be devised based on the latest knowledge and techniques. The present review focuses on the preoperative prediction of stone impaction, the safest and most effective endoscopic surgical procedures, and the most appropriate management for postoperative ureteral strictures. We overview comprehensive endoscopic management for impacted ureteral stones based on literature review and expert opinions.
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Affiliation(s)
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Kobe, Japan.,Department of Urology, Kobe University, Kobe, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
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Lu H, Zheng C, Liang B, Xiong B. Analysis of long-term effect of ureteral balloon dilatation combined with internal and external drainage tube in the treatment of benign ureteral stricture. BMC Urol 2022; 22:4. [PMID: 35027021 PMCID: PMC8759268 DOI: 10.1186/s12894-022-00952-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE There are few reports about balloon dilatation combined with internal and external drainage tube in the treatment of ureteral stricture under interventional therapy. The aim of the study is to explore the safety, effectiveness and long-term efficacy of this treatment strategy. MATERIALS AND METHODS It is a retrospective and observational study. From October 2013 to October 2016, 42 patients with benign lower ureteral stricture received interventional treatment. Balloon dilatation combined with internal and external drainage tube implantation were used. There were 25 male patients and 17 female patients. There were 7 cases (16.7%) with congenital ureteral stricture, 12 cases (28.6%) with inflammation, 15 cases (35.7%) with ureteral stricture after lithotomy or lithotripsy, and 8 cases (19.0%) with ureteral stricture after pelvic or abdominal surgery. After the drainage tube was removed, B ultrasound, enhanced CTU or IVP of urinary system were reexamined every six months. The follow-up time was 12-60 months. RESULTS The age was 52.9 ± 11.6 years. The length of ureteral stricture was 1.1 ± 0.5 cm. 42 patients completed interventional treatment, the technical success rate was 100%, no ureteral perforation, rupture or other complications were identified. Preoperative urea nitrogen 9.2 ± 2.3 mmol/L and creatinine 175.8 ± 82.8umol/L. Urea nitrogen and creatinine were 3.8-9.1 mmol/L and 45.2-189.6 umol/L when removing the drainage tube. There were significant differences in the levels of urea nitrogen and creatinine before and after tube removal (P < 0.05). The ureteral patency rate was 100% at 6 months, 93% at 12 months, 83% at 18 months, 79% at 24 months, 76% at 30 months and 73% at 36-60 months. The overall success rate was 73%. Multivariate Cox regression analysis showed that stenosis length was a risk factor for postoperative patency (P < 0.05). CONCLUSION Balloon dilatation combined with internal and external drainage tube implantation in the treatment of benign lower ureteral stricture is safe and effective.
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Affiliation(s)
- Haohao Lu
- Interventional Therapy Department, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022 China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 China
| | - Chuansheng Zheng
- Interventional Therapy Department, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022 China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 China
| | - Bin Liang
- Interventional Therapy Department, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022 China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 China
| | - Bin Xiong
- Interventional Therapy Department, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022 China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 China
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Beale R, Sicilila S, Riestra P, Albala DM. Are robots the future? A case for robotic pyeloplasty as the gold standard treatment in ureteropelvic junction obstruction. Curr Opin Urol 2022; 32:109-115. [PMID: 34798638 DOI: 10.1097/mou.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Robotic pyeloplasty is still a relatively novel procedure. Clinically, early studies have shown high success rates, decreased complication rates, decreased length of hospital stay, and better cosmetic results. This goal of this article is to argue for the use of robotic pyeloplasty as the gold standard of ureteropelvic junction obstruction (UPJO) treatment. Results of studies that have compared robotic pyeloplasty with other procedures currently used are reviewed. RECENT FINDINGS Our study, a comprehensive review of published outcomes of robotic pyeloplasty and alternative therapies, consisted of 666 pediatric patients and 653 adult patients. Our review coincided with the previously established studies that robotic pyeloplasty shows equivalent surgical success rates as previous standard of care treatments. Open pyeloplasty has fallen out of favor as standard of care due to the increased length of hospital stay, increased adverse events, and the undesirable aesthetics. SUMMARY The use of robotic pyeloplasty has shown to have clinical outcomes that are consistent with other intervention for UPJO, with a potential decrease in length of stay and morbidity. More work has to be done to develop ways to decrease cost of the robot to help establish it as the gold standard for UPJO treatment.
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Affiliation(s)
- Robert Beale
- SUNY Downstate Health Sciences University, New York
| | | | - Paola Riestra
- Associated Medical Professionals, Syracuse, New York, USA
| | - David M Albala
- SUNY Downstate Health Sciences University, New York
- Associated Medical Professionals, Syracuse, New York, USA
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Panach-Navarrete J, Valls-González L, Martínez-Jabaloyas JM. Endoureterotomy with the Lovaco technique for treatment of ureterointestinal strictures: outcomes in an experienced center and factors associated with procedural success or failure. Scand J Urol 2021; 56:59-65. [PMID: 34775899 DOI: 10.1080/21681805.2021.2002401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The study aimed to present the outcomes of an endoureterotomy series using the Lovaco technique for the treatment of ureterointestinal strictures. Factors influencing the success or failure of this technique were also determined. MATERIALS AND METHODS Data were collected from all endoureterotomies for ureterointestinal strictures performed in a single-center between 2017 and 2020. Clinical variables and characteristics of the stricture were recorded in each case, and success was defined as the complete resolution of ureterohydronephrosis. Univariate analysis was used to correlate the variables recorded with procedural success or failure. RESULTS A total of 25 patients were recruited: 16 with strictures on the left side, 5 on the right, and 4 bilateral. With the first endoureterotomy, 52% of the cases (13 patients) were resolved, and in patients undergoing a second intervention 64% success (16 patients) was achieved. Infectious complications occurred in 23.3% of surgeries. Stricture length, poor renal function, and left side involvement were associated with endoureterotomy failure. CONCLUSIONS Endoureterotomy with the Lovaco technique is a useful method in the setting of ureterointestinal strictures, achieving complete resolution of the obstruction in more than 60% of cases. Factors that can negatively affect the success of the procedure include stricture length, poor renal function, and left side involvement.
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Affiliation(s)
- Jorge Panach-Navarrete
- Department of Urology, University Clinic Hospital of Valencia. INCLIVA, Instituto de Investigación Sanitaria. Facultat de Medicina i Odontologia. Universitat de València, Valencia, Spain
| | - Lorena Valls-González
- Department of Urology, University Clinic Hospital of Valencia. INCLIVA, Instituto de Investigación Sanitaria. Facultat de Medicina i Odontologia. Universitat de València, Valencia, Spain
| | - José María Martínez-Jabaloyas
- Department of Urology, University Clinic Hospital of Valencia. INCLIVA, Instituto de Investigación Sanitaria. Facultat de Medicina i Odontologia. Universitat de València, Valencia, Spain
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11
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Bar-Yaakov N, Hertzberg H, Marom R, Jikia J, Mano R, Beri A, Yossepowitch O, Sofer M. Introducing in clinical practice a new laser suction handpiece for percutaneous nephrolithotomy. Urologia 2021; 89:570-574. [PMID: 34256620 PMCID: PMC9551316 DOI: 10.1177/03915603211031874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: To assess a novel combined laser suction handpiece (LSH) for performing PCNL
in a clinical setting. Methods: The study comprised 40 consecutive PCNLs performed between May 2019 and
February 2020. The first 20 procedures (Group A) were performed with
conventional ultrasonic or pneumatic devices and the other 20 (Group B) were
performed with the use of the new LSH. All patients were treated by tubeless
supine PCNL. The groups were compared for demographics, clinical data,
operative time, lithotrite effectiveness, stone clearance rate (SCR), and
outcome. Results: Groups A and B were similar in age, and in stone size, complexity, and
density (Hounsfield units) (p < 0.05). The average
operative time was 99 and 78 min, SCR 143 and 200 mm3/min,
hospital stay 1.6 and 1.1 days, and stone-free rate 90% and 95%,
respectively. Despite a trend toward better results with the new LSH, none
of these comparisons reached statistical significance. Ineffective
lithotripsy with the initial device (ultrasonic) requiring conversion to
another modality (ballistic) occurred in six (30%) procedures in Group A,
while all procedures were effectively accomplished with the LSH in Group B
(p = 0.02). There were two complications in Group A and
none in Group B (p > 0.05). Conclusions: The LSH is as effective and safe as the traditional lithotrites for
performing PCNLs. This new tool completes the capabilities of the holmium
laser high-power machines, enabling them to serve as the sole platform for
all endourological treatments.
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Affiliation(s)
- Noam Bar-Yaakov
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Hertzberg
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Marom
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jemal Jikia
- Endourology Unit, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Mano
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Beri
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mario Sofer
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Endourology Unit, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Soria F, de La Cruz JE, Fernandez T, Budia A, Serrano Á, Sanchez-Margallo FM. Heparin coating in biodegradable ureteral stents does not decrease bacterial colonization-assessment in ureteral stricture endourological treatment in animal model. Transl Androl Urol 2021; 10:1700-1710. [PMID: 33968658 PMCID: PMC8100852 DOI: 10.21037/tau-21-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background We assessed an antireflux biodegradable heparin-coated ureteral stent (BraidStent®-H) in an animal model comparative study after endoscopic treatment of ureteral strictures. Methods A total of 24 female pigs underwent initial endoscopic, nephrosonographic, and contrast fluoroscopy assessment of the urinary tract. Afterward, unilateral laparoscopic ureteral stricture model was performed. Three weeks later, the animals underwent laser endoureterotomy and were randomly assigned to Group-I, in which a double-pigtail stent was placed for 6 weeks, or Group-II, in which a BraidStent®-H was placed. Follow-up was carried out by ultrasonography, contrast fluoroscopy, ureteroscopy, urinalysis and bacteriuria assessment at 3, 6, 12 and 5 months. Finally, a pathological study of the urinary system was performed. Results There were no animals in Group-II with vesicoureteral reflux, with significance at 6 weeks with Group-I. Distal ureteral peristalsis was maintained in 50–75% in Group-II at 1–6 weeks. The 91.7% of stents in Group-II were degraded between 3–6 weeks, without obstructive fragments. Bacteriuria in Group II was 33.3–50% at 3 and 6 weeks. The global success rate by groups was 91.6% and 87.5% in groups I and II, respectively, with no statistical significance. Conclusions BraidStent®-H has been shown to be as efficacious as current ureteral stents in the treatment of benign ureteral strictures following laser endoureterotomy. In addition, it reduces the morbidity associated with current stents and has a homogeneous and predictable degradation rate of about 6 weeks, with no obstructive fragments. Future studies are required to improve the antibacterial coating to reduce BraidStent®-H contamination in view of the results obtained with the heparin coating.
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Affiliation(s)
- Federico Soria
- Endourology Department, Jesús Usón Minimally Invasive Surgery Centre Foundation, Cáceres, Spain
| | - Julia E de La Cruz
- Endourology Department, Jesús Usón Minimally Invasive Surgery Centre Foundation, Cáceres, Spain
| | - Tomás Fernandez
- Urology Department, University Hospital Morales Meseguer, Murcia, Spain
| | - Alberto Budia
- Urology Department, University Hospital La Fe, Valencia, Spain
| | - Álvaro Serrano
- Urology Department, University Hospital Clínico San Carlos, Madrid, Spain
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13
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Rasyid N, Risky Raharja PA, Atmoko W, Birowo P. Minimally invasive transurethral laser incision for management of ectopic ureter orifice stenosis in adult patient. Urol Case Rep 2021; 35:101540. [PMID: 33391992 PMCID: PMC7773594 DOI: 10.1016/j.eucr.2020.101540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 11/20/2022] Open
Abstract
The aim of this report is to present our experience of performing transurethral laser incision for management of ectopic ureter orifice stenosis in adult patient. A 61-year-old male was presented with right flank pain. Computed tomography urography showed right complete double collecting system, upper moiety hydroureteronephrosis, and parenchymal thinning of the upper moiety. Cystoscopy showed right ectopic ureter orifice on the prostatic part of the urethra. Transurethral laser incision was performed at the 12 o'clock position of the stenotic orifice with Thulium laser. This report showed that transurethral laser incision was a minimally invasive procedure with good result.
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Affiliation(s)
- Nur Rasyid
- Department of Urology, Faculty of Medicine, Indonesia University, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Putu Angga Risky Raharja
- Department of Urology, Faculty of Medicine, Indonesia University, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Widi Atmoko
- Department of Urology, Faculty of Medicine, Indonesia University, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Ponco Birowo
- Department of Urology, Faculty of Medicine, Indonesia University, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
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14
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Mohyelden K, Hussein HA, El Helaly HA, Ibrahem H, Abdelwahab H. Long-Term Outcomes of Two Ipsilateral vs Single Double-J Stent After Laser Endoureterotomy for Bilharzial Ureteral Strictures. J Endourol 2020; 35:775-780. [PMID: 33096946 DOI: 10.1089/end.2020.0956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Laser endoureterotomy became a preferable choice for managing benign ureteral strictures. Ureteral stricture caused by bilharzias is characterized by focal destruction of ureteral musculature, ending by fibrosis, making it poor responder to endoureterotomy. There is no consensus about the ideal ureteral stent size after endoureterotomy. However, many researches recommend larger stents caliber (12-14F). We assess long-term efficacy of insertion of two ipsilateral Double-J stents vs single Double-J stent after laser endoureterotomy for bilharzial ureteral stricture. Materials and Methods: Within 4 years, 70 patients underwent retrograde laser endoureterotomy for bilharzial ureteral stricture (diagnosed by positive history of bilharziasis, positive serology test, and/or bilharzial cystoscopic finding). Patients with history of stone, urologic or pelvic surgery were excluded. Patients were randomized into two groups: the first group (35 patients) received ipsilateral two Double-J (7F each) postendoureterotomy, whereas the second group (35 patients) received one Double-J (7F). Double-Js were removed after 8 weeks. Follow-up was done regularly by clinical interpretation and imaging studies. Patients' characteristics, operative data, and postoperative outcomes (subjectively and objectively) were compared in both groups. Results: Sixty-three patients completed follow-up >18 months, mean follow-up 30 ± 4 months [19-41], and mean stricture length 1.4 ± 0.6 cm [0.5-3.0], with no statistical significance between both groups. Success proved by relief of symptoms and radiographic resolution of obstruction. The overall success rate was significantly better in 2-Double-J group than in 1-Double-J group (83.9% vs 53.1%) p = 0.009, and also for stricture >1.5 cm (85.7% vs 38.5%) p = 0.018, respectively. Conclusions: Insertion of two ipsilateral Double-J, after laser endoureterotomy for bilharzial ureteral stricture associated with long-term success rate better than insertion of 1-Double-J, especially for stricture segment >1.5 cm.
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Affiliation(s)
- Khaled Mohyelden
- Urology Department, Faculty of medicine, Fayoum University, Fayoum, Egypt
| | | | - Hisham A El Helaly
- Urology Department, Faculty of medicine, Fayoum University, Fayoum, Egypt
| | - Hamdy Ibrahem
- Urology Department, Faculty of medicine, Fayoum University, Fayoum, Egypt
| | - Hassan Abdelwahab
- Urology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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15
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Panach-Navarrete J, Tonazzi-Zorrilla R, Martínez-Jabaloyas JM. Endoscopic Treatment of Complete Ureterointestinal Stenosis Without Antegrade Ureteroscopy. J Endourol Case Rep 2020; 6:188-191. [PMID: 33102724 DOI: 10.1089/cren.2020.0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Ureterointestinal stenosis is a frequent complication after radical cystectomy, occurring in up to 10%-12% of cases. Endoscopic treatment of complete stenosis has been described through double access, with antegrade flexible ureteroscopy and simultaneous retrograde endoscopy through the intestinal diversion. We present a case of endoscopic treatment without use of antegrade ureteroscopy. Case Presentation: A 52-year-old man underwent surgery for peritoneal carcinomatosis secondary to mucinous adenocarcinoma. Ileocecal resection, omentectomy, sigmoidectomy, rectal resection, cystoprostatectomy, and ileal duct were performed. He had a complicated postoperative period because of enterocutaneous fistulas, peritonitis, and secondary intention wall closure, needing multiple surgeries. Four months later, he was diagnosed with left ureteroinestinal stenosis, for which endoscopic management was the chosen treatment. Intraoperative diagnosis was complete stenosis. To locate the stenosis, methylene blue was instilled using a percutaneous ureteral catheter. With a resectoscope inserted through the ileal duct, the stenosis was observed and opened using cold knife and Collins knife. The stenosis was resolved satisfactorily. Conclusion: Endoscopic management of complete ureterointestinal stenosis is a viable treatment option. Although stenosis localization has previously been described with two endoscopes using transillumination, we demonstrate another localization technique using methylene blue.
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Affiliation(s)
- Jorge Panach-Navarrete
- Department of Urology, University Clinic Hospital of Valencia, Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Rocío Tonazzi-Zorrilla
- Department of Urology, University Clinic Hospital of Valencia, Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - José María Martínez-Jabaloyas
- Department of Urology, University Clinic Hospital of Valencia, Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
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16
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Cheng S, Fan S, Wang J, Xiong S, Li X, Xu Y, Li Z, Guan H, Zhang P, Zhu H, Huang C, Zhang L, Yang K, Li X, Zhou L. Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy. Int Urol Nephrol 2020; 53:479-488. [PMID: 33037521 DOI: 10.1007/s11255-020-02679-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios. METHODS From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2-6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures. RESULTS A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2-6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time (P = 0.008), shorter postoperative hospital stay (P = 0.011) but higher hospital cost (P < 0.001). At a mean follow-up of 12.8 months, the overall success rate was 94.3%. There was no difference in postoperative complications or the success rate between the approaches. CONCLUSION Laparoscopic and robotic onlay flap/graft ureteroplasty can be safe and feasible to repair long proximal/middle ureteral strictures while robotic procedures showed higher efficiency, faster recovery but higher cost. Our algorithmic strategies may provide beneficial references for their standardization and dissemination into clinical care.
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Affiliation(s)
- Sida Cheng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Yangyang Xu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Chen Huang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
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17
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Zattoni F, De Giorgi G, Kungulli A, Ferraioli G, Valotto C, Dal Moro F. Endourological management of uretero-ileal anastomosis stricture after cystectomy and Vescica Ileale Padovana (V.I.P.) orthotopic neobladder reconstruction. UROLOGY VIDEO JOURNAL 2019. [DOI: 10.1016/j.urolvj.2019.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Luo J, Zhao S, Wang J, Luo L, Li E, Zhu Z, Liu Y, Kang R, Zhao Z. Bone marrow mesenchymal stem cells reduce ureteral stricture formation in a rat model via the paracrine effect of extracellular vesicles. J Cell Mol Med 2018; 22:4449-4459. [PMID: 29993184 PMCID: PMC6111875 DOI: 10.1111/jcmm.13744] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/18/2018] [Indexed: 02/06/2023] Open
Abstract
With no effective therapy to prevent or treat ureteral stricture (US), a multifactorial fibrotic disease after iatrogenic injury of the ureter, the need for new therapies is urgent. Mesenchymal stem cells (MSCs) have been widely studied for treating tissue defects and excessive fibrosis, and recent studies established that one of the main therapeutic vectors of MSCs is comprised in their secretome and represented by extracellular vesicles (EVs). Thus, we have determined to explore the specific role of MSCs‐derived EVs (MSC‐EVs) treatment in a pre‐clinical model of US. The results firstly showed that either a bolus dose of MSCs or a bolus dose of MSC‐EVs (administration via renal‐arterial) significantly ameliorated ureteral fibrosis and recuperated ureter morphological development in a US rat model. We confirmed our observations through MSCs or MSC‐EVs treatment alleviated hydronephrosis, less renal dysfunction and blunted transforming growth factor‐β1 induced fibration. Due to MSC‐EVs are the equivalent dose of MSCs, and similar curative effects of transplantation of MSCs and MSC‐EVs were observed, we speculated the curative effect of MSCs in treating US might on account of the release of EVs through paracrine mechanisms. Our study demonstrated an innovative strategy to counteract ureteral stricture formation in a rat model of US.
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Affiliation(s)
- Jintai Luo
- Department of Urology & Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shankun Zhao
- Department of Urology & Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiamin Wang
- Department of Urology & Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lianmin Luo
- Department of Urology & Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ermao Li
- Department of Urology & Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiguo Zhu
- Department of Urology & Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yangzhou Liu
- Department of Urology & Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ran Kang
- Department of Urology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Zhigang Zhao
- Department of Urology & Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Emiliani E, Talso M, Haddad M, Pouliquen C, Derman J, Côté JF, Doizi S, Millán F, Berthe L, Audouin M, Traxer O. The True Ablation Effect of Holmium YAG Laser on Soft Tissue. J Endourol 2018; 32:230-235. [DOI: 10.1089/end.2017.0835] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Esteban Emiliani
- Sorbonne Université, GRC n°20 LITHIASE RENALE, AP-HP, Hôpital Tenon, F-75020 Paris, France
- Fundación Puigvert, Department of Urology, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Michele Talso
- Sorbonne Université, GRC n°20 LITHIASE RENALE, AP-HP, Hôpital Tenon, F-75020 Paris, France
- Ospedale Policlinico di Milano-Universita' degli Studi di Milano, Milan, Italy
| | - Mattieu Haddad
- Sorbonne Université, GRC n°20 LITHIASE RENALE, AP-HP, Hôpital Tenon, F-75020 Paris, France
| | - Christelle Pouliquen
- Sorbonne Université, Department of Pathology, AP-HP, Hôpital Tenon, F-75020 Paris, France
| | - Jonathan Derman
- Sorbonne Université, Department of Pathology, AP-HP, Hôpital Tenon, F-75020 Paris, France
| | - Jean-François Côté
- Sorbonne Université, Department of Pathology, AP-HP, Hôpital Tenon, F-75020 Paris, France
| | - Steeve Doizi
- Sorbonne Université, GRC n°20 LITHIASE RENALE, AP-HP, Hôpital Tenon, F-75020 Paris, France
| | - Felix Millán
- Fundación Puigvert, Department of Urology, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Laurent Berthe
- Process and Engineering in Mechanics and Materials Laboratory (PIMM), UMR CNRS/ENSAM, Paris VI, France
| | - Marie Audouin
- Sorbonne Université, GRC n°20 LITHIASE RENALE, AP-HP, Hôpital Tenon, F-75020 Paris, France
| | - Olivier Traxer
- Sorbonne Université, GRC n°20 LITHIASE RENALE, AP-HP, Hôpital Tenon, F-75020 Paris, France
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20
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Whitehurst LA, Somani BK. Semi-rigid ureteroscopy: indications, tips, and tricks. Urolithiasis 2017; 46:39-45. [PMID: 29151118 PMCID: PMC5773664 DOI: 10.1007/s00240-017-1025-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/11/2017] [Indexed: 12/23/2022]
Abstract
Advances in ureteroscopic technology, alongside broadening treatment options have fuelled the rapid expansion of endourology. Semi-rigid ureteroscopy is a well-known procedure used globally for varying urological conditions, with high success rates. This article aims to provide ‘tips and tricks’ for the semi-rigid ureteroscopy procedure, and the management of commonly encountered pathology such as renal stones, ureteric strictures, and urothelial tumours.
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Affiliation(s)
- Lily A Whitehurst
- Department of Urology, Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
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21
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Rosales A, Emiliani E, Salvador JT, Peña JA, Gaya JM, Palou J, Villavicencio H. Laparoscopic Management of Ureteroileal Anastomosis Strictures: Initial Experience. Eur Urol 2016; 70:493-8. [DOI: 10.1016/j.eururo.2016.02.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
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The Use of Apnea During Ureteroscopy. Urology 2016; 97:266-268. [PMID: 27339027 DOI: 10.1016/j.urology.2016.06.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/03/2016] [Accepted: 06/14/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe and discuss the feasibility and the use of apnea during retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS A discussion of the current literature about the different anesthesia techniques and the use of apnea to improve RIRS by avoiding renal movements over diaphragmatic excursion was performed. RESULTS To date, there are no mentions in the literature about the use of apnea as a mechanism to facilitate this procedure that requires extremely precise laser use. A description of the feasibility of apnea during RIRS is described as a technical consideration and discussed. CONCLUSION The use of apnea during RIRS has facilitated the procedure, avoiding renal movements, particularly in special cases where extremely precise maneuvers during laser use are required.
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Parente A, Perez-Egido L, Romero RM, Ortiz R, Burgos L, Angulo JM. Retrograde Endopyelotomy with Cutting Balloon™ for Treatment of Ureteropelvic Junction Obstruction in Infants. Front Pediatr 2016; 4:72. [PMID: 27458574 PMCID: PMC4937023 DOI: 10.3389/fped.2016.00072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/30/2016] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The aim of this study is to analyze results of retrograde endopyelotomy with cutting balloon for treatment of ureteropelvic junction obstruction (UPJO) in infants. METHODS We routinely treat patients with UPJO under 18 months of age with retrograde high-pressure balloon dilatation of the pelviureteric junction (PUJ). During the procedure, in these cases where narrowing at the PUJ persists, endopyelotomy with cutting balloon is performed. Endopyelotomy is performed over guidewire with 5-mm Cutting Balloon™ under fluoroscopic control. Double-J stents is left in situ for 4 weeks. We retrospectively analyzed the postoperative, clinical, and radiological outcome infants treated with cutting balloon endopyelotomy between 2007 and 2015. RESULTS Sixteen patients required cutting balloon endopyelotomy to achieve complete resolution of narrowing of the waist observed during high-pressure balloon dilatation of the PUJ. Mean operative time was 35 ± 21 min (mean ± SD) and hospital stay was <24 h in all patients. Complete resolution of the narrowing at the PUJ under fluoroscopy was achieved in all cases, with no perioperative complications. One patient presented with urinary tract infection, postoperatively (Clavien grade II). Preoperatively, all cases had grade IV SFU hydronephrosis with parenchymal thinning. During follow-up, resolution of the hydronephrosis was observed in 11 patients (grade I SFU). In four infants, there was an improvement of the hydronephrosis (grade II SFU) and the renogram curve. In one case, an open pyeloplasty was required due to persistent hydronephrosis and obstructive curve. CONCLUSION We believe that endopyelotomy with cutting balloon could be a valid and safe option in minimally invasive management of UPJO in infants.
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Affiliation(s)
- Alberto Parente
- Paediatric Urology, Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Laura Perez-Egido
- Paediatric Urology, Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Rosa Maria Romero
- Paediatric Urology, Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Ruben Ortiz
- Paediatric Urology, Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Laura Burgos
- Paediatric Urology, Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Jose Maria Angulo
- Paediatric Urology, Hospital General Universitario Gregorio Marañón , Madrid , Spain
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Sener TE, Cloutier J, Audouin M, Villa L, Traxer O. A guidewire introducer as a ureteral foreign body: A case report. Can Urol Assoc J 2015. [PMID: 26225183 DOI: 10.5489/cuaj.2626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 63-year-old male, previously treated for a ureteral tumour by a right-sided segmental ureterectomy and end-to-end anastomosis of ureteral segments, was referred to our clinic for endoscopic follow-up. During his follow-up, he was diagnosed with partial right-sided ureteral stricture which eventually progressed to complete obstruction. During the ureteroscopy, as the stenotic segment did not allow passage of an hydrophilic guidewire, an antegrade-retrograde approach was decided. On the antegrade endoscopic view, a near-complete stenosis was diagnosed and a nephrostomy catheter (12 Fr) was placed. A second intervention was planned and from the nephrostomy tract, the ureteroscope was placed into the right pyelocaliceal system. The diagnostic ureteroscopy revealed a foreign object proximal to the stenotic area. Right-sided segmental ureterectomy of the stenotic segment with ureteroneocystostomy and removal of the foreign object was performed. This is the only case in literature to reveal a guidewire introducer as a ureteral foreign body. This case also highlights the importance of the fragility of the ureter, the importance of the equipment, of always being watchful during a surgery, and the importance of checking the integrity of the equipment at the end of each procedure.
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Affiliation(s)
- Tarik Emre Sener
- Urology Department, Tenon University Hospital, Pierre et Marie Curie University, Paris, France
| | - Jonathan Cloutier
- Urology Department, Tenon University Hospital, Pierre et Marie Curie University, Paris, France
| | - Marie Audouin
- Urology Department, Tenon University Hospital, Pierre et Marie Curie University, Paris, France
| | - Luca Villa
- Urology Department, Tenon University Hospital, Pierre et Marie Curie University, Paris, France
| | - Olivier Traxer
- Urology Department, Tenon University Hospital, Pierre et Marie Curie University, Paris, France
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Dołowy Ł, Krajewski W, Dembowski J, Zdrojowy R, Kołodziej A. The role of lasers in modern urology. Cent European J Urol 2015; 68:175-82. [PMID: 26251737 PMCID: PMC4526611 DOI: 10.5173/ceju.2015.537] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/03/2015] [Accepted: 04/17/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The functioning of modern urological departments and the high level of service they provide is possible through, among other things, the use of modern laser techniques. MATERIAL AND METHODS Open operations have been replaced by minimally invasive procedures, and classical surgical tools by advanced lasers. The search for new applications with lasers began as technology developed. Among many devices available, holmium, diode and thulium lasers are currently the most popular. RESULTS Depending on the wavelength, the absorption by water and hemoglobin and the depth of penetration, lasers can be used for coagulation, vaporization and enucleation. In many centres, after all the possibilities of pharmacological treatment have been exhausted, lasers are used as the primary treatment for patients with benign prostatic hyperplasia, with therapeutic results that are better than those obtained through open or endoscopic operations. The use of lasers in the treatment of urolithiasis, urinary strictures and bladder tumours has made treatment of older patients with multiple comorbidities safe, without further necessity to modify the anticoagulant drug treatment. Laser procedures are additionally less invasive, reduce hospitalization time and enable a shorter bladder catheterization time, sometimes even eliminating the need for bladder catherterization completely. Such procedures are also characterized by more stable outcomes and a lower number of reoperations. CONCLUSIONS There are also indications that with the increased competition among laser manufacturers, decreased purchase and maintenance costs, and increased operational safety, laser equipment will become mandatory and indispensable asset in all urology wards.
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Affiliation(s)
- Łukasz Dołowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Janusz Dembowski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Anna Kołodziej
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
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Affiliation(s)
- Thomas R W Herrmann
- Division of Endourology and Laparoscopy, Hanover Medical School (MHH), Dept. of Urology and Urological Oncology, Carl Neuberg Str. 1, Hanover, 30625, Germany,
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Rassweiler J. T. R. W. Herrmann and T. Bach (eds.): Editorial comment on "What is relevant for Lasers in Urology?". World J Urol 2015; 33:461-2. [PMID: 25680937 DOI: 10.1007/s00345-015-1499-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 01/25/2015] [Indexed: 10/24/2022] Open
Affiliation(s)
- Jens Rassweiler
- Department of Urology, SLK-Kliniken, Section of Uro-technology, Heilbronn, Germany,
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