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Kochkin A, Kalfountzos C, Gallyamov E, Biktimirov R, Sanzharov A, Sergeev V, Popov S, Dal Moro F, Tokas T, Gözen AS. Laparoscopic intracorporeal ileal ureter replacement: multi-institutional data from 102 patients. MINIM INVASIV THER 2024; 33:140-146. [PMID: 38265869 DOI: 10.1080/13645706.2024.2302889] [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: 07/12/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To present long-term results of our laparoscopic intracorporeal ileal ureter replacement (LIUR) cohort, including more complex cases of laparoscopic ileocalycostomy. MATERIAL AND METHODS We collected records of patients undergoing LIUR. Follow-up included a chemical profile and urine cultures. Imaging consisted of renal ultrasonography, excretory urography, cystography, and computer tomographic or magnetic resonance urography. RESULTS One hundred and two patients were included. Stricture location was left (46.1%), right (39.2%), or bilateral (14.7%). No open conversion was performed. Seventy-four patients (72.5%) underwent a total ureteral unit removal. The mean operative time was 289.4 (120 - 680) minutes. The estimated blood loss was 185.2 (10-400) mL. Three patients had intraoperative complications, and fifteen had early postoperative complications. The mean postoperative hospital stay was 12.2 (7-35) days. The mean follow-up duration period was 37.7 (12-162) months. Most patients' follow-up was uneventful (88%), and seven patients presented with Grade 2 late complications. CONCLUSIONS Intracorporeal laparoscopic ileal ureteral replacement in cases of extensive ureteral lesions offers optimal long-term outcomes and a low complication rate. Ileocalycostomy constitutes a viable option in the small group of patients with long proximal ureteral strictures and intrarenal pelvis.
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Affiliation(s)
- Alexey Kochkin
- Department of Urology, Urological Center of Russian Railways Hospital, Privolzhskiy Research Medical University, Nizhny Novgorod, Russia
| | - Christos Kalfountzos
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Viopolis, Larissa, Greece
| | - Eduard Gallyamov
- Department of Common Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Rafael Biktimirov
- Department of Urology, Federal Clinical Center of High Medical Technology of Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Andrey Sanzharov
- Department of Urology, Federal Scientific and Clinical Center for Specialized Methods of Medical Care and Medical Technologies of Federal Medical Biological Agency, Moscow, Russia
| | - Vladimir Sergeev
- Department of Urology, Russian State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Sergey Popov
- Department of Urology, I.I. Mechkikov North - Western State Medical University, St. Petersburg, Russia
| | - Fabrizio Dal Moro
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Theodoros Tokas
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
- Department of Urology, Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
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Wu G, Li H, Luo F, Zheng H, Yuegao Y, Xie L, Luo H, Chen Z, Ye D, Lai C. Total intracorporeal laparoscopic ileal ureter replacement in a single position for ureteral stricture based on membrane anatomy. BMC Surg 2024; 24:88. [PMID: 38481186 PMCID: PMC10935906 DOI: 10.1186/s12893-024-02363-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/17/2024] [Indexed: 03/17/2024] Open
Abstract
PURPOSE The aim of this study was to present our initial experience and prove the feasibility of total intracorporeal laparoscopic ileal ureter replacement (TILIUR) in a single position for ureteral stricture based on membrane anatomy. MATERIALS AND METHODS Between January 2021 and April 2023, six patients underwent TILIUR in a single position for ureteral strictures based on membrane anatomy. All patients with a past medical history underwent radical hysterectomy with bilateral pelvic lymph node dissection as well as extensive ureteral stricture due to radiotherapy. The procedure is performed completely laparoscopically. Dissection of the digestive system as well as ureteral stricture or renal pelvis is based on membrane anatomy. The surgery is performed in a single position. RESULTS TILIUR in a single position for ureteral stricture based on membrane anatomy was successfully performed without open conversion in all patients. Among the 6 patients, 3 patients underwent combined ileal ureter replacement (IUR) and abdominal wall ostomy, 2 underwent unilateral IUR, and 1 underwent bilateral IUR. The mean length of the ileal substitution was 22.83 cm (range: 15-28). The average operative time was 458 ± 72.77 min (range 385-575 min), and the average intraoperative blood loss was 158 mL (range 50-400 mL). The median postoperative hospital stay was 15.1 d (range: 8-32). The median duration of postoperative follow-up was 15 months (range: 3-29 months). The success rate was 100%. CONCLUSIONS TILIUR in a single position may be a promising option for ureteral stricture based on membrane anatomy in selected patients. Moreover, it has a positive effect on patients with renal insufficiency and urinary incontinence. Although IUR is difficult and risky, proficient surgeons can perform the procedure safely and effectively.
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Affiliation(s)
- Guohao Wu
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Haomin Li
- Department of Urology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Road, Guangzhou, 510630, China
| | - Feng Luo
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Handa Zheng
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Yuanzhi Yuegao
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Lishan Xie
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Huilan Luo
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Zhihui Chen
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Dongming Ye
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China.
| | - Caiyong Lai
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China.
- Department of Urology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Road, Guangzhou, 510630, China.
- Institute of Kidney Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Road, Guangzhou, China.
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Wang X, Chen S, Li X, Fan S, Han G, Li Z, Yang K, Zhang K, Zhou L, Li X. Robotic-assisted Laparoscopic Bilateral Ileal Ureter Replacement With Extracorporeal Ileal Segment Preparation for Bilateral Extensive Ureteral Strictures: The Initial Experience. Urology 2023; 176:213-218. [PMID: 37003474 DOI: 10.1016/j.urology.2023.03.026] [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: 01/27/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE To present our initial experience and evaluate perioperative, and follow-up outcomes following the novel technique of robot-assisted laparoscopic bilateral ileal ureter replacement (IUR) with extracorporeal ileal segment preparation for bilateral extensive ureteral strictures (BEUS). METHODS We prospectively enrolled 4 consecutive patients with BEUS undergoing robot-assisted laparoscopic bilateral IUR with extracorporeal ileal segment preparation between June 2021 and October 2021. A 4-arm technique was used. The demographic characteristics, perioperative data, and follow-up outcomes as well as the description of surgical technique were reported. RESULTS All the patients had BEUS, and the length of strictures was over 10.ßcm in both sides. All procedures were performed effectively with a median operative time of 312.5.ßminutes (range 227-433) and a median estimated blood loss of 75.ßmL (range 50-200). In one patient, additional partial small bowel resection procedure was performed. No case was converted to open surgery. The median length of the ileal graft was 29.ßcm (range 15-32). The median postoperative hospitalization was 10 days (range 6-13). Two patients developed metabolic acidosis, and no major complications during the perioperative and follow-up period were reported. All patients presented symptom-free, with no signs of restenosis and improved/stabilized hydronephrosis, during the median follow-up of 12 months (range 12-15). CONCLUSION We present the details and initial experience of robot-assisted laparoscopic bilateral IUR with extracorporeal ileal segment preparation. According to the median follow-up of 12 months, this minimally invasive procedure is a safe, feasible, and effective approach in the management of BEUS.
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Affiliation(s)
- Xiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Silu Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China; Department of Nursing, Peking University First Hospital, Peking University, Xicheng District, Beijing 100034, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Kai Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China.
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Li Z, Wang X, Ying Y, Li X, Zhu W, Meng C, Han G, Liu J, Wang J, Huang Y, Yang K, Zhang P, Zhu H, Guan H, Li X, Zhou L. Health-related quality of life (HRQoL), anxiety and depression in patients with ureteral stricture: a multi-institutional study. World J Urol 2023; 41:275-281. [PMID: 36469114 DOI: 10.1007/s00345-022-04227-5] [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: 07/31/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate health-related quality of life (HRQoL), anxiety and depression levels in patients with ureteral stricture (US) and to further investigate factors independently affecting this. METHODS We prospectively recruited a cohort of 275 consecutive patients with US between June 2020 and April 2021. The participants were required to provide complete sociodemographic, clinical and pathologic information. All patients were administered questionnaires to evaluate HRQoL, anxiety and depression. Multivariate linear regression analyses were performed to assess the contribution of covariates on HRQoL, anxiety and depression. RESULTS Patients with US, particularly iatrogenic US, scored significantly lower than the Chinese general population in all domains of the SF-36 (all p < 0.001), except SF. Increased age, female and high education attainment were independently associated with poor HRQoL. Interestingly, iatrogenic US, nephrostomy tube placement, urinary symptoms, high anxiety and depression level independently predicted poor HRQoL. Furthermore, the percentages of anxiety and depression cases in patients with US were 31.3% and 20.7%, respectively. Iatrogenic US and urinary symptoms, specifically waist discomfort, were the strongest predictors of increased levels of anxiety and depression. CONCLUSION Patients with US exhibited poor quality of life and emotional status. Various factors independently predicted worse HRQoL and emotion, which provide potential targets for medical, lifestyle-related, psychological interventions.
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Affiliation(s)
- Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.,Department of Nursing, Peking University First Hospital, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yicen Ying
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Weijie Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Chang Meng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jing Liu
- Department of Urology, Beijing Jiangong Hospital, No. 6 Rufuli St, Xicheng District, Beijing, 100034, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yanbo Huang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.,Department of Nursing, Peking University First Hospital, Peking University, 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 Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, No. 29 Xibahenanli St, Chaoyang District, Beijing, 100020, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, No. 6 Rufuli St, Xicheng District, Beijing, 100034, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.,Department of Nursing, Peking University First Hospital, Peking University, 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 Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
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