Intestinal seromuscular tunneling: a novel method for ureteral replacement--an experimental design

Management of iatrogenic ureteral injury: Ureteral reimplantation with a bilateral Boari flap

Reconstruction of the ureter is still regarded as a sophisticated approach demanding absolute dedication of the urologists. Similarly, iatrogenic ureteral injuries, as well as strictures, are quite common complexities of the pelvic and gynecological surgeries which if left untreated could lead to short as well as long-term issues. Presently, a case of a post-caesarian section along with hysterectomy of 40 years old woman has been presented that has resulted in distal left ureteral injury. A bilateral Boari flap was performed for the mobilization of the bladder.

Long-segmental ureteral reconstruction using tubularization of ileal seromuscular fold: experimental canine study and preliminary clinical experience

Objective

This study was performed to investigate the feasibility of tubularization of the ileal seromuscular fold for long-segmental ureteral reconstruction in a canine model and assess the clinical application of this procedure.

Methods

The experimental study was conducted on six beagles. An ileal segment was chosen and folded along its longitudinal axis and thereafter sutured to tubularize the serous surface. The tubularization of the ileal seromuscular fold was designed to be 10 to 12 cm for ureteral substitution. The neo-ureters were pathologically examined. A patient in our hospital also underwent this reconstructive operation. Several blood parameters were assessed and urography was performed for postoperative evaluation.

Results

All animals and the patient tolerated the operation and recovered as planned. No severe postoperative complications occurred. Blood examination revealed that renal function was within the normal range. Urography indicated patency of urine excretion without leakage or stenosis. In the patient, antegrade urography showed rhythmic peristalsis of the neo-ureter. The pathologic examination revealed a healthy condition of the neo-ureter and an open lumen with a serous epithelial lining.

Conclusion

Ureteral reconstruction by tubularization of the ileal seromuscular fold is anatomically possible and was preliminarily validated in a patient in the clinical setting.

Ureteral reconstruction using a tapered non-vascularized bladder graft: an experimental study in a canine animal model

Background

Reconstruction of ureteral defects and strictures remains problematic for urologists. We aimed to investigate the possibility of a tapered non-vascularized bladder graft as a novel substitute for ureteral reconstruction.

Methods

This experimental study was conducted on nine beagles. Under general anesthesia, a full-thickness graft with 5–6 cm in length was disassociated from the anterior upper wall of the bladder, and tapered into 1/3 to 1/2 thickness, remaining the urothelial surface. After removal of 5 cm of right-sided mid-ureter, the tapered bladder graft was tubularized along the long axis and then respectively anastomosed to the upper and lower stumps of the ureter. A retrograde urography through a cystostomy was performed 8 weeks after the ureteral reconstruction. The animals were euthanized, and histopathologic examinations of the neoureters were performed.

Results

There were no severe complications during postoperative follow-up. The urography indicated patent urine excretion and no fistula or stenosis. Histopathologic examinations of the neoureters showed open lumen with urothelial lining. Nutrient vessels were observed in healthy submucosa, lamina muscularis and peripheral connective tissue.

Conclusions

Our study implied that ureteral reconstruction by a tapered non-vascularized bladder graft was anatomically possible in our animal model. Further studies are expected to confirm long-term and functional outcomes.

Unilateral long-segment ureteral reconstruction using a bilateral Boari flap bridge: An experimental model in dogs

OBJECTIVE

The aim of this experimental study was to evaluate the feasibility of a bilateral Boari flap bridge as a novel method for unilateral long-segment ureteral reconstruction.

MATERIALS AND METHODS

The study was conducted on eight dogs. After resection of 10 cm of right-sided distal ureter, bilateral Boari flaps were made from the anterior upper wall of the bladder and then anastomosed head to head, forming a flap bridge. The left base of the flap bridge was transected, and the free end was then anastomosed to the proximal stump of the ureter with a stent inside. A retrograde urography through a cystostomy was performed 8 weeks after the ureteral reconstruction. The animals were killed and the neoureters were examined histologically.

RESULTS

There were almost no obvious complications during the postoperative period. The urography suggested patent urine excretion and no obvious fistula or stenosis. Histopathological examinations showed an open lumen with complete urothelial lining and a healthy muscular layer with nutrient vessels.

CONCLUSION

This study showed that ureteral reconstruction by a bilateral Boari flap bridge was anatomically possible in an animal model. Further studies are needed to confirm long-term functional efficacy.