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Chen B, Chen X, Wang W, Shen J, Song Z, Ji H, Zhang F, Wu J, Na J, Li S. Tissue-engineered autologous peritoneal grafts for bladder reconstruction in a porcine model. J Tissue Eng 2021; 12:2041731420986796. [PMID: 33613958 PMCID: PMC7874343 DOI: 10.1177/2041731420986796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/18/2020] [Indexed: 01/08/2023] Open
Abstract
Ileal neobladder construction is a common treatment for patients with bladder cancer after radical cystectomy. However, metabolic disorders caused by transposed bowel segments occur frequently. Bladder tissue engineering is a promising alternative approach. Although numerous studies have reported bladder reconstruction using acellular and cellular scaffolds, there are also disadvantages associated with these methods, such as immunogenicity of synthetic grafts and incompatible mechanical properties of the biomaterials. Here, we engineered an autologous peritoneal graft consisting of a peritoneal sheet and the seromuscular layer from the ileum. Three months after the surgery, compared with the neobladder made from the ileum, the reconstructed neobladder using our new method showed normal function and better gross morphological characteristics. Moreover, histopathological and transcriptomic analysis revealed urothelium-like cells expressing urothelial biomarkers appeared in the neobladder, while no such changes were observed in the control group. Overall, our study provides a new strategy for bladder tissue engineering and informs a variety of future research prospects.
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Affiliation(s)
- Biao Chen
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Department of Urology, The First Hospital of Tsinghua University, Beijing, China
| | - Xia Chen
- Center for Stem Cell Biology and Regenerative Medicine, School of Medicine, Tsinghua University, Beijing, China
| | - Wenjia Wang
- Department of Urology, The First Hospital of Tsinghua University, Beijing, China
| | - Jun Shen
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Zhiqiang Song
- Department of Urology, The First Hospital of Tsinghua University, Beijing, China
| | - Haoyu Ji
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Department of Urology, The First Hospital of Tsinghua University, Beijing, China
| | - Fangyuan Zhang
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Department of Urology, The First Hospital of Tsinghua University, Beijing, China
| | - Jianchen Wu
- Department of Urology, The First Hospital of Tsinghua University, Beijing, China
| | - Jie Na
- Center for Stem Cell Biology and Regenerative Medicine, School of Medicine, Tsinghua University, Beijing, China
| | - Shengwen Li
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Department of Urology, The First Hospital of Tsinghua University, Beijing, China
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Kim SH, Kim WB, Kim JH, Lee SW. Robot-assisted laparoscopic pyeloureterostomy for ureteropelvic junction rupture sustained in a traffic accident: A case report. World J Clin Cases 2020; 8:5802-5808. [PMID: 33344577 PMCID: PMC7716323 DOI: 10.12998/wjcc.v8.i22.5802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/26/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ureteral reconstruction is a highly technical type of laparoscopic or open surgery. The incidence of ureteral injury is low; however, ureteral injuries tend to be overtreated. Robotic surgery for urinary reconstructive surgery is growing in popularity, which has made procedures such as pyeloplasty, ureteroureterostomy, and ureteroneocystostomy possible, with minimal damage to the patient. To the best of our knowledge, this is the first report of robot-assisted laparoscopic pyeloureterostomy in Korea, in a 17-year-old female patient with a ureteral injury.
CASE SUMMARY The patient, a 17-year-old girl without previous medical history, was presented at the emergency room and complained of abdominal and back pain. Tenderness in the right upper quadrant was observed on physical examination. Hemorrhage in the right perirenal space was observed without abdominal organ injuries on the initial enhanced abdomen computed tomography (CT) scan. Ureteral injury was not suspected at this time. The patient was stabilized via conservative treatment, but complained of right flank pain 3 wk later and revisited the emergency room. An enhanced abdominal CT scan revealed a huge urinoma in the right perirenal space with hydronephrosis of the right kidney. Retrograde and antegrade pyelography were performed. Extravasation and discontinuity of the ureter were found. A rupture of the ureteropelvic junction was diagnosed and reconstructive surgery was performed. After 3 mo, the patient did not complain of any symptoms without any abnormal radiologic findings.
CONCLUSION This case report discusses the safety and effectiveness of this minimal invasive procedure as an alternative to conventional open or laparoscopic surgery.
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Affiliation(s)
- Si Hyun Kim
- Department of Urology, Soonchunhyang University Cheonan Hospital, Cheonan 31151, South Korea
| | - Woong Bin Kim
- Department of Urology, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul 04401, South Korea
| | - Sang Wook Lee
- Department of Urology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, South Korea
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Ficarra V, Rossanese M, Crestani A, Caloggero S, Alario G, Novara G, Giannarini G, Valotto C. A Contemporary Case Series of Complex Surgical Repair of Surgical/Endoscopic Injuries to the Abdominal Ureter. Eur Urol Focus 2020; 7:1476-1484. [PMID: 32814683 DOI: 10.1016/j.euf.2020.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/14/2020] [Accepted: 07/24/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Iatrogenic ureteral injuries are devastating complications potentially resulting in irreversible impairment of renal function and/or infectious sequelae. Only few data are available on the management of such injuries to the abdominal ureter. OBJECTIVE To report the etiology, perioperative outcomes, and treatment failure rate of different reconstructive surgical interventions for iatrogenic injuries to the abdominal ureter in a contemporary case series. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed consecutive patients who underwent reconstructive surgery for iatrogenic injuries to the abdominal ureter at our academic centers between July 2013 and April 2019. All interventions were performed via either an open or a robot-assisted approach by a single expert surgeon. SURGICAL PROCEDURE Different surgical reconstructive procedures, such as Boari bladder flap, ureteroureterostomy, ileal replacement, and pyeloureteroplasty, have been adopted. MEASUREMENTS Outcome measures were the etiology of iatrogenic injuries, rate of postoperative complications, and rate of treatment failure, defined as upper urinary tract obstruction requiring permanent urinary drainage. RESULTS AND LIMITATIONS Nineteen patients were included. Injuries were consequent to endourological procedures in nine (47.4%), gynecological procedures in two (10.5%), colonic surgery in two (10.5%), vascular surgery in two (10.5%), and other surgeries in four (21.1%) cases. Boari bladder flap was performed in 12 (63.2%), ureteroureterostomy in two (10.5%), ileal substitution in two (10.5%), and pyeloureteroplasty in three (15.8%) cases. Only four (21.1%) procedures were performed robotically. Major postoperative complications were recorded in three (15.8%) patients. After a median follow-up of 16 (interquartile range 12-24) mo, treatment failure was observed in two (15.8%) cases. We accept the limitations of a small retrospective single-surgeon series with preference-based management choice. CONCLUSIONS In our series, endourological procedures were the most frequent cause of iatrogenic injuries to the abdominal ureter requiring reconstructive surgery. A Boari bladder flap was the preferred option to bridge extensive ureteral defects. Despite the complexity of such procedures, major postoperative complications were infrequent and treatment failure rate was low. PATIENT SUMMARY We report on a contemporary series of patients with disparate iatrogenic injuries to the abdominal ureter requiring complex reconstructive surgery. Despite the difficulty of such procedures, we found that major postoperative complications were infrequent and treatment failure rate was low.
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Affiliation(s)
- Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy.
| | - Marta Rossanese
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | | | | | - Giuseppe Alario
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology and Gastroenterology, Urology Unit, University of Padua, Padua, Italy
| | - Gianluca Giannarini
- Urology Unit, "Santa Maria della Misericordia" Academic Medical Centre, Udine, Italy
| | - Claudio Valotto
- Urology Unit, "Santa Maria della Misericordia" Academic Medical Centre, Udine, Italy
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Goel A. Editorial Comment from Dr Goel to Total proximal ureter substitution using buccal mucosa. Int J Urol 2017; 24:323. [DOI: 10.1111/iju.13327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Apul Goel
- Department of Urology; King George's Medical University; Lucknow India
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Buffi NM, Lughezzani G, Hurle R, Lazzeri M, Taverna G, Bozzini G, Bertolo R, Checcucci E, Porpiglia F, Fossati N, Gandaglia G, Larcher A, Suardi N, Montorsi F, Lista G, Guazzoni G, Mottrie A. Reply to Marc A. Bjurlin, Lee C. Zhao, and Michael D. Stifelman's Letter to the Editor Re: Nicolò Maria Buffi, Giovanni Lughezzani, Rodolfo Hurle, et al. Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.022. Eur Urol 2016; 71:e92-e93. [PMID: 27641789 DOI: 10.1016/j.eururo.2016.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Nicolò Maria Buffi
- Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy.
| | - Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Gianluigi Taverna
- Department of Urology, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Giorgio Bozzini
- Department of Urology, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Riccardo Bertolo
- San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Enrico Checcucci
- San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | | | - Nicola Fossati
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium
| | - Giorgio Gandaglia
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium
| | - Alessandro Larcher
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nazareno Suardi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuliana Lista
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Guazzoni
- Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium
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