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Merickel JL, Lawrence J, Young SJ, Thomson CB. Cutaneous seeding of transitional cell carcinoma of the urinary bladder after placement of a subcutaneous ureteral bypass device in a dog with bilateral ureteral obstruction. J Am Vet Med Assoc 2021; 258:877-882. [PMID: 33825539 DOI: 10.2460/javma.258.8.877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 12-year-old spayed female Jack Russell Terrier was presented with pollakiuria and stranguria. CLINICAL FINDINGS Transitional cell carcinoma (TCC) of the urinary bladder trigone and urethra was diagnosed via CT, cystoscopic, and histologic examinations. Azotemia developed 2 weeks following diagnosis, secondary to bilateral ureteral obstruction. TREATMENT AND OUTCOME Percutaneous antegrade ureteral stenting was unsuccessful; therefore, a subcutaneous ureteral bypass (SUB) device with 2 nephrostomy and 1 cystostomy catheters was surgically placed. Two months following placement of the SUB device, the dog developed a firm, multilobulated cutaneous mass at the site of the subcutaneous access port of the SUB device. Results of cytologic examination of cells aspirated from the mass were consistent with TCC. Within 1 month of confirmation of TCC of the cutaneous mass, the mass was ulcerated and infected, and the dog was euthanized because of signs of pain and perceived poor quality of life. CLINICAL RELEVANCE Seeding of neoplastic cells is a known complication of needle aspiration or biopsy or surgery in people and dogs with carcinomas. The occurrence of TCC at the SUB port site suggested caution with the placement of a SUB device in dogs with obstructive TCC.
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Johnston SK, Bennett T, Miller AJ. Intestinal perforation involving the Dacron cuff of nephrostomy tubes following subcutaneous ureteral bypass system implantation for ureteral obstructions in two cats. JFMS Open Rep 2021; 7:20551169211013295. [PMID: 34178373 PMCID: PMC8202293 DOI: 10.1177/20551169211013295] [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] [Indexed: 11/16/2022] Open
Abstract
CASE SUMMARY This case report describes two cats that had subcutaneous ureteral bypass (SUB) systems implanted and subsequently developed duodenal perforations and septic peritonitis associated with the Dacron cuff of the nephrostomy tube. One cat recovered following surgical explantation of the SUB system with intestinal resection and anastomosis of the perforated small intestine, and - at the time of writing - is still alive. The other cat was humanely euthanased intraoperatively at the owner's request owing to its perceived prognosis. RELEVANCE AND NOVEL INFORMATION To our knowledge this is the first time this complication has been reported following SUB device placement.
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Affiliation(s)
| | | | - Amanda J Miller
- Small Animal Specialist Hospital, North Ryde, NSW, Australia
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Laso-García IM, Lorca-Álvaro J, Arias-Fúnez F, Díaz-Pérez D, Santiago-González M, Duque-Ruiz G, Burgos-Revilla FJ. Long-term results of the treatment of complex ureteral stenosis with extra-anatomic ureteral bypasses. Cent European J Urol 2020; 73:213-219. [PMID: 32782842 PMCID: PMC7407785 DOI: 10.5173/ceju.2020.0008] [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: 01/15/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Complex ureteral obstruction is a pathology that has always been a challenge for the urologist, especially in patients with high surgical risk or with a short life expectancy. Material and methods Between 2002 and 2017, 13 extra-anatomical bypasses were placed. A descriptive retrospective study was carried out. An analysis of the permeability time of the prosthesis was performed using Kaplan-Meyer curves. Demographic and etiological characteristics as well as early and late complications were analysed. Results Etiologies were benign in 39% (including 3 transplant recipients) and malignant in 69%. Permeability rates were 90.9% at each of 12, 24 and 48 months, respectively, and 75.8% at 60 months. There were no deaths in the early postoperative period, nor intraoperative complications. The most frequent complications were infections. Three of them were associated with bypass extrusion, which needed to be removed. A total of 5 prosthesis had to be removed. 40% of the patients did not present complications. Conclusions The extra-anatomical ureteral bypass is an alternative to permanent nephrostomy in the treatment of complex ureteral strictures. Their patency rates after long-term follow-up vary from 90% to 75% at 48 and 60 months, respectively. Their complication rates can be considered acceptable in the patients’ clinical contexts.
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Affiliation(s)
- Inés M Laso-García
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - Javier Lorca-Álvaro
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - Fernando Arias-Fúnez
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - David Díaz-Pérez
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - Marta Santiago-González
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - Gemma Duque-Ruiz
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
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Dirrig H, Lamb CR, Kulendra N, Halfacree Z. Diagnostic imaging observations in cats treated with the subcutaneous ureteral bypass system. J Small Anim Pract 2019; 61:24-31. [PMID: 31592537 DOI: 10.1111/jsap.13071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe pre- and post-operative ultrasonographic and fluoroscopic findings, including any abnormalities, in cats treated for ureteral obstruction with a subcutaneous ureteral bypass system. METHODS Retrospective review of imaging findings in cats with ureteral obstruction that had surgery to place the first version of the bypass system and at least one follow-up ultrasound or fluoroscopic study. Pre- and post-operative renal pelvic diameter on ultrasound, fluoroscopic appearance of the bypass system and any related abnormality were recorded. RESULTS Eighty-one cats were included (47 unilateral, 34 bilateral bypass systems). Median preoperative renal pelvic diameter was 9 mm (range 3 to 28 mm) and median renal pelvic diameter at the first postoperative ultrasound was 3 mm (range 2 to 23 mm). The median number of postoperative imaging studies was two (range 1 to 8) and the median follow-up period after surgery was 205 days (range 1 to 1378 days). Bypass system abnormalities were identified postoperatively in 43 (53%) cats, including nephrostomy or cystostomy catheter blockage due to an undetermined cause or kinking of the catheter, nephrostomy or cystostomy catheter leakage, non-obstructive kinking of the catheter and loose nephrostomy pig-tail loop. Many abnormalities required repeat surgery, but others were managed conservatively. Fifty-four percent of obstructed ureters became patent after bypass placement, although the majority remained slightly dilated or had irregular margins compatible with chronic inflammation. CLINICAL SIGNIFICANCE Bypass abnormalities, mainly tube blockage, occurred frequently in cats treated for ureteral obstruction. Ultrasonography and fluoroscopy were useful for postoperative examination, including documenting renewed ureteral patency and investigation of suspected abnormalities.
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Affiliation(s)
- H Dirrig
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
| | - C R Lamb
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
| | - N Kulendra
- North Downs Specialist Referrals, Bletchingley, RH1 4QP, UK
| | - Z Halfacree
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
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Sapora JA, Hardie RJ, Evans N. Use of a subcutaneous ureteral bypass device for treatment of bilateral proximal ureteral injury in a 9-month-old cat. JFMS Open Rep 2019; 5:2055116919831856. [PMID: 30886728 PMCID: PMC6415474 DOI: 10.1177/2055116919831856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Case summary A 9-month-old male domestic longhair cat presented following iatrogenic ureteral trauma after an attempted laparoscopic ovariectomy. Prior to identifying that the cat was male, both ureters were transected approximately 4 mm from the renal pelves. Initial management involved a left-sided Boari flap neoureterocystostomy, cystonephropexy and right ureteronephrectomy. Thirty-six hours later, the cat developed uroabdomen due to leakage from the neoureterocystostomy site. At a tertiary referral institution, the ureter was reconstructed via end-to-end anastomosis and a left-sided subcutaneous ureteral bypass (SUB) device was placed in the event the anastomosis failed. Five weeks after SUB placement, the cat was dysuric and stranguric. A urine culture was negative and clinical signs were attributed to sterile cystitis secondary to device placement. Blood urea nitrogen (BUN) was 22 mg/dl and creatinine was 1.2 mg/dl. Contrast pyelography confirmed device patency, but no contrast was identified through the ureteral anastomosis. At 12 months, BUN and creatinine were 1.5 mg/dl and 25 mg/dl, respectively, and a subclinical urinary tract infection was identified (Enterococcus faecalis). Antibiotic therapy was not prescribed in order to prevent multidrug resistance. At 42 months, BUN was 38 mg/dl and creatinine was 2.0 mg/dl. The cat had occasional and intermittent signs of pollakiuria and stranguria but was otherwise doing well. Relevance and novel information To our knowledge, this is the first case report to describe the use of a SUB device for management of traumatic proximal ureteral injury in a cat with one kidney. The case outcome provides valuable information about the direct effect of the SUB device and the presence of chronic Enterococcus species infection on long-term renal function.
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Affiliation(s)
- Joseph A Sapora
- University of Wisconsin School of Veterinary Medicine, Madison, WI, USA
| | - Robert J Hardie
- Department of Surgical Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, USA
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Chong JJ, Kum F, Hadjipavlou M, Mahmalji W, Hale J, Dickinson A, Glass J. Extra-Anatomic Stents in Ureteric Obstruction: Our Experience. J Endourol 2019; 33:242-247. [DOI: 10.1089/end.2018.0610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- James J.Y. Chong
- Department of Urology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Francesca Kum
- Department of Urology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Marios Hadjipavlou
- Department of Urology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Wasim Mahmalji
- Department of Urology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Jemma Hale
- Department of Urology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Andrew Dickinson
- Department of Urology, Derriford Hospital, Plymouth, United Kingdom
| | - Jonathan Glass
- Department of Urology, Guy's and St Thomas' Hospitals, London, United Kingdom
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7
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Clarke DL. Feline ureteral obstructions Part 2: surgical management. J Small Anim Pract 2018; 59:385-397. [DOI: 10.1111/jsap.12861] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/10/2017] [Accepted: 09/26/2017] [Indexed: 01/11/2023]
Affiliation(s)
- D. L. Clarke
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine; Philadelphia Pennsylvania, 19104 USA
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Clarke DL. Feline ureteral obstructions Part 1: medical management. J Small Anim Pract 2018; 59:324-333. [DOI: 10.1111/jsap.12844] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/10/2017] [Accepted: 09/26/2017] [Indexed: 01/08/2023]
Affiliation(s)
- D. L. Clarke
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine; Philadelphia Pennsylvania 19104 USA
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Aronson LR, Cleroux A, Wormser C. Use of a modified Boari flap for the treatment of a proximal ureteral obstruction in a cat. Vet Surg 2018; 47:578-585. [DOI: 10.1111/vsu.12780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/24/2017] [Accepted: 09/11/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Lillian R. Aronson
- Department of Clinical Sciences; Matthew J. Ryan Veterinary Hospital, University of Pennsylvania; Philadelphia Pennsylvania
| | - Andreanne Cleroux
- Department of Clinical Sciences; Matthew J. Ryan Veterinary Hospital, University of Pennsylvania; Philadelphia Pennsylvania
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Livet V, Pillard P, Goy-Thollot I, Maleca D, Cabon Q, Remy D, Fau D, Viguier É, Pouzot C, Carozzo C, Cachon T. Placement of subcutaneous ureteral bypasses without fluoroscopic guidance in cats with ureteral obstruction: 19 cases (2014-2016). J Feline Med Surg 2016; 19:1030-1039. [PMID: 27694368 DOI: 10.1177/1098612x16670572] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The purpose of this study was to describe the perioperative and postoperative complications as well as short-term and long-term outcomes in cats with ureteral obstructions treated by placement of a subcutaneous ureteral bypass (SUB) device without imaging control. The second objective of this study was to compare cats treated by SUB device with cats treated by traditional surgical intervention. Methods Data were obtained retrospectively from the medical records (2014-2016) of cats that underwent SUB placement (SUB cats) and cats that underwent traditional ureteral surgery (C cats). Results Nineteen SUB devices were placed without fluoroscopic, radiographic or ultrasonographic guidance in 13 cats. Fifteen traditional interventions (ureterotomy and neoureterocystostomy) were performed in 11 cats. Successful placement of the SUB device was achieved in all cats with only one major intraoperative complication (kinking of the kidney catheter) and one minor intraoperative complication (misplacement of the kidney catheter). Eleven SUB cats recovered from the surgical procedure; two SUB cats and three C cats died during the anaesthesia recovery period. Postoperative SUB complications included anaemia (n = 2), urinary tract infection (UTI) (n = 4), non-infectious cystitis (n = 5) and SUB device obstruction (n = 1). Postoperative traditional surgery complications included anaemia (n = 7), UTIs (n = 6), non-infectious cystitis (n = 1), re-obstruction (n = 4) and ureteral stricture (n = 1). Median postoperative duration of hospitalisation (3 days) was significantly shorter for SUB cats than for C cats ( P = 0.013). Ten SUB cats (76.9%) and four C cats (40%) were still alive at a median follow-up of 225 days and 260 days, respectively. Owners were completely (90%) or mostly (10%) satisfied with the SUB device placement. Conclusions and relevance SUB device placement appears to be an effective and safe option for treating ureteral obstruction in cats, and this study has shown that fluoroscopic guidance is not essential in all cases.
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Affiliation(s)
- Véronique Livet
- 1 Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France.,2 Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Paul Pillard
- 1 Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France.,2 Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Isabelle Goy-Thollot
- 3 SIAMU Intensive Care Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France.,4 APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - David Maleca
- 1 Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France.,2 Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Quentin Cabon
- 1 Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France.,2 Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Denise Remy
- 1 Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France.,2 Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Didier Fau
- 1 Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France.,2 Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Éric Viguier
- 1 Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France.,2 Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Céline Pouzot
- 3 SIAMU Intensive Care Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France.,4 APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Claude Carozzo
- 1 Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France.,2 Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Thibaut Cachon
- 1 Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France.,2 Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
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Elsamra SE, Leavitt DA, Motato HA, Friedlander JI, Siev M, Keheila M, Hoenig DM, Smith AD, Okeke Z. Stenting for malignant ureteral obstruction: Tandem, metal or metal-mesh stents. Int J Urol 2015; 22:629-36. [PMID: 25950837 DOI: 10.1111/iju.12795] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/04/2015] [Accepted: 03/22/2015] [Indexed: 12/11/2022]
Abstract
Extrinsic malignant compression of the ureter is not uncommon, often refractory to decompression with conventional polymeric ureteral stents, and frequently associated with limited survival. Alternative options for decompression include tandem ureteral stents, metallic stents and metal-mesh stents, though the preferred method remains controversial. We reviewed and updated our outcomes with tandem ureteral stents for malignant ureteral obstruction, and carried out a PubMed search using the terms "malignant ureteral obstruction," "tandem ureteral stents," "ipsilateral ureteral stents," "metal ureteral stent," "resonance stent," "silhouette stent" and "metal mesh stent." A comprehensive review of the literature and summary of outcomes is provided. The majority of studies encountered were retrospective with small sample sizes. The evidence is most robust for metal stents, whereas only limited data exists for tandem or metal-mesh stents. Metal and metal-mesh stents are considerably more expensive than tandem stenting, but the potential for less frequent stent exchanges makes them possibly cost-effective over time. Urinary tract infections have been associated with all stent types. A wide range of failure rates has been published for all types of stents, limiting direct comparison. Metal and metal-mesh stents show a high incidence of stent colic, migration and encrustation, whereas tandem stents appear to produce symptoms equivalent to single stents. Comparison is difficult given the limited evidence and heterogeneity of patients with malignant ureteral obstruction. It is clear that prospective, randomized studies are necessary to effectively scrutinize conventional, tandem, metallic ureteral and metal-mesh stents for their use in malignant ureteral obstruction.
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Affiliation(s)
- Sammy E Elsamra
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - David A Leavitt
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Hector A Motato
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Justin I Friedlander
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Michael Siev
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Mohamed Keheila
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - David M Hoenig
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Arthur D Smith
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Zeph Okeke
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
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Wang Y, Wang G, Hou P, Zhuang H, Yang X, Gu S, Wang H, Ji L, Xu Z, Meng J. Subcutaneous nephrovesical bypass: Treatment for ureteral obstruction in advanced metastatic disease. Oncol Lett 2014; 9:387-390. [PMID: 25435997 PMCID: PMC4247119 DOI: 10.3892/ol.2014.2679] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 10/15/2014] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study was to explore the value of subcutaneous nephrovesical bypass (SNVB) for the treatment of ureteral obstruction due to pelvic metastatic disease. SNVB stents (n=30) were implanted in 24 patients with advanced metastatic disease between January 2008 and December 2012. Urinalysis, serum creatinine (SCr), glomerular filtration rate (GFR), quality of life (QoL) scores, and renal ultrasonography were evaluated at follow-up. The SNVB procedures were successful in all 24 patients. Patient follow-ups occurred at an average of 10.6 months. Preoperative hydronephrosis was eliminated in 16 cases (53.3%) and reduced in the remaining patients. Following surgery, SCr levels reduced significantly from 256±46 to 124±23 μmol/l (P<0.001). GFRs increased from 25±4.8 to 45±5.3 ml/min (P<0.01). The mean QoL scores were 3.4±1.4 preoperatively and 7.6±1.0 postoperatively (P<0.001). The results showed that SNVB is a minimally invasive, effective and safe procedure for patients with ureteral obstruction resulting from advanced malignant disease. As an alternative procedure to percutaneous nephrostomy, SNVB offers patients a better QoL.
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Affiliation(s)
- Yunyan Wang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
| | - Gongcheng Wang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
| | - Peijin Hou
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
| | - Haijun Zhuang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
| | - Xiaosong Yang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
| | - Shuo Gu
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
| | - Hengbing Wang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
| | - Lu Ji
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
| | - Zongyuan Xu
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
| | - Junsong Meng
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
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Tyritzis SI, Wiklund NP. Ureteral strictures revisited…trying to see the light at the end of the tunnel: a comprehensive review. J Endourol 2014; 29:124-36. [PMID: 25100183 DOI: 10.1089/end.2014.0522] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A ureteral stricture is a rather rare urological event defined as a narrowing of the ureter causing a functional obstruction and renal failure, if left untreated. The aim of this review article is to summarize and discuss current knowledge on the incidence, pathogenesis, management, and follow up of proximal, mid, and distal ureteral strictures.
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Affiliation(s)
- Stavros I Tyritzis
- 1 Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm, Sweden
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Abstract
Practical relevance: Interventional radiology and interventional endoscopy (IR/IE) uses contemporary imaging modalities, such as fluoroscopy and endoscopy, to perform diagnostic and therapeutic procedures in various body parts. The majority of IR/IE procedures currently undertaken in veterinary medicine pertain to the urinary tract, and this subspecialty has been termed ‘endourology’. This technology treats diseases of the renal pelvis, ureter(s), bladder and urethra. In human medicine, endourology has overtaken traditional open urologic surgery in the past 20–30 years, and in veterinary medicine similar progress is occurring. Aim: This article presents a brief overview of some of the more common IR/IE procedures currently being performed for the treatment of urinary tract disease in veterinary patients. These techniques include percutaneous nephrolithotomy for lithotripsy of problematic nephrolithiasis, mesenchymal stem cell therapy for chronic kidney disease, sclerotherapy for the treatment of idiopathic renal hematuria, various diversion techniques for ureteral obstructions, laser lithotripsy for lower urinary tract stone disease, percutaneous cystolithotomy for removal of bladder stones, hydraulic occluder placement for refractory urinary incontinence, percutaneous cystostomy tube placement for bladder diversion, urethral stenting for benign and malignant urethral obstructions, and antegrade urethral catheterization for treatment of urethral tears. Evidence base: The majority of the data presented in this article is solely the experience of the author, and some of this has only been published and/or presented in abstract form or small case series. For information on traditional surgical approaches to these ailments readers are encouraged to evaluate other sources.
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15
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Kachrilas S, Bourdoumis A, Karaolides T, Nikitopoulou S, Papadopoulos G, Buchholz N, Masood J. Current status of minimally invasive endoscopic management of ureteric strictures. Ther Adv Urol 2013; 5:354-65. [PMID: 24294293 DOI: 10.1177/1756287213505671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Endourological techniques are used more often nowadays in the treatment of ureteric strictures of various etiologies. Advances in technology have provided new tools to the armamentarium of the endoscopic urological surgeon. Numerous studies exist that investigate the efficiency and safety of each of the therapeutic modalities available. In this review, we attempt to demonstrate the available and contemporary evidence supporting each minimally invasive modality in the management of ureteric strictures.
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Affiliation(s)
- Stefanos Kachrilas
- Endourology and Stone Services, Royal London Hospital, Barts Health NHS Trust, London, UK
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Friedlander JI, Duty BD, Okeke Z, Smith AD. Obstructive Uropathy from Locally Advanced and Metastatic Prostate Cancer: An Old Problem with New Therapies. J Endourol 2012; 26:102-9. [DOI: 10.1089/end.2011.0227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Justin I. Friedlander
- The Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Brian D. Duty
- The Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Zeph Okeke
- The Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Arthur D. Smith
- The Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
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Zaman F, Poullis C, Bach C, Moraitis K, Junaid I, Buchholz N, Masood J. Use of a segmental thermoexpandable metal alloy stent in the management of malignant ureteric obstruction: a single centre experience in the UK. Urol Int 2011; 87:405-10. [PMID: 22005456 DOI: 10.1159/000326081] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 01/11/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Memokath 051™ is a semipermanent inert metal alloy ureteric stent which can bridge strictures and, compared to double J stents, causes less bladder irritation and pain, is more resistant to external compression forces and may be more effective in patients with malignant ureteric obstruction. We present our experience with this novel stent in such cases. METHODS All suitable patients referred to us with malignancy-associated ureteric strictures over a 4-year period had ureteric Memokath 051™ stents inserted. Data on aetiology and position of the strictures as well as length of the Memokath stents used and their efficacy and complications were recorded prospectively. RESULTS 42 ureteric Memokath 051™ stents were inserted in 37 patients (mean age 64 years). 40.5% of strictures were related to gynaecological cancer, 21% to bowel cancer, 14% were post radiation, 14% occurred in prostate cancer patients and 9.5% were found in other cancers. The mean follow-up was 22 months (range 5-60 months). The main complications were stent migrations in 5, urinary tract infections in 3 and blockage of stent due to progressive transitional cell carcinoma of the ureter in 2 cases. CONCLUSION Memokath 051™ ureteric stents are safe, effective and durable in the long-term treatment of malignant strictures.
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Affiliation(s)
- F Zaman
- Endourology and Stone Services, Barts and the London NHS Trust, London, UK
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Muller CO, Meria P, Desgrandchamps F. Long-Term Outcome of Subcutaneous Pyelovesical Bypass in Extended Ureteral Stricture After Renal Transplantation. J Endourol 2011; 25:1389-92. [DOI: 10.1089/end.2011.0085] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Paul Meria
- Department of Urology, Saint Louis Hospital, Paris, France
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Reply. Urology 2010. [DOI: 10.1016/j.urology.2009.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Gerullis H, Schwartmann K, Eimer C, Bagner JW, Kocheril S, Otto T, Ecke TH, Heuck CJ. Reply. Urology 2010. [DOI: 10.1016/j.urology.2009.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gerullis H, Ecke TH, Schwartmann K, Heuck CJ, Eimer C, Bagner JW, Kocheril S, Otto T. Nephrocutaneous Bypass in Ureteral Obstruction. Urology 2010; 76:480-5. [DOI: 10.1016/j.urology.2009.10.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 10/29/2009] [Accepted: 10/30/2009] [Indexed: 10/19/2022]
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Editorial Comment. Urology 2010; 76:486-7; discussion 487. [DOI: 10.1016/j.urology.2009.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Revised: 11/29/2009] [Accepted: 12/01/2009] [Indexed: 11/19/2022]
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Remzi M, Schmidbauer J. Editorial Comment. Urology 2010; 76:485; discussion 485-6. [DOI: 10.1016/j.urology.2009.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 11/11/2009] [Accepted: 11/13/2009] [Indexed: 11/29/2022]
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Azhar RA, Hassanain M, Aljiffry M, Aldousari S, Cabrera T, Andonian S, Metrakos P, Anidjar M, Paraskevas S. Successful salvage of kidney allografts threatened by ureteral stricture using pyelovesical bypass. Am J Transplant 2010; 10:1414-9. [PMID: 20553448 DOI: 10.1111/j.1600-6143.2010.03137.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ureteral stricture is the most common urologic complication after renal transplantation. When endourologic management fails, open ureteral reconstruction remains the standard treatment. The complexity of some of these procedures makes it necessary to explore other means of repair. This study evaluated the intermediate-term outcome of subcutaneous pyelovesical bypass graft (SPBG) on renal transplant recipients. We reviewed 8 patients (6 male and 2 female; mean age 52 years) with refractory ureteral strictures postrenal transplantation, who received SPBG as salvage therapy. All patients failed endourologic management and half failed open management of their strictures. After a mean follow-up of 19.4 months, 7 out of 8 renal grafts have good function with mean GFR of 58.5 mL/min/1.73 m(2), without evidence of obstruction or infection. One patient lost his graft due to persistent infection of the SPBG and one patient developed a recurrent urinary tract infection managed with long-term antibiotics. SPBG offers a last resort in the treatment of ureteral stricture after renal transplantation refractory to conventional therapy.
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Affiliation(s)
- R A Azhar
- Department of Urology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Sountoulides P, Pardalidis N, Sofikitis N. Endourologic management of malignant ureteral obstruction: indications, results, and quality-of-life issues. J Endourol 2010; 24:129-42. [PMID: 19954354 DOI: 10.1089/end.2009.0157] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Obstruction of the upper urinary tract is a problem commonly faced by practicing urologists. The constant evolution in endourology has effectively facilitated minimally invasive management of upper-tract obstruction. In a case in which malignancy is the cause of obstruction, however, the situation significantly changes. Questions arise regarding the need for relieving the obstruction, the means to accomplish this, and the benefits and drawbacks of each technique regarding both their efficacy and their impact on the patients well-being and the crucial issue of quality of life in the face of malignancy.
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Vaidyanathan S, Soni BM, Hughes PL, Singh G, Mansour P, Oo T. Long-term nephrostomy in an adult male spinal cord injury patient who had normal upper urinary tracts but developed bilateral hydronephrosis following penile sheath drainage: pyeloplasty and balloon dilatation of ureteropelvic junction proved futile: a case report. CASES JOURNAL 2009; 2:9335. [PMID: 20062594 PMCID: PMC2803994 DOI: 10.1186/1757-1626-2-9335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 12/16/2009] [Indexed: 11/30/2022]
Abstract
Introduction The consequences of spinal cord injury upon urinary bladder are readily recognised by patients and health care professionals, since neuropathic bladder manifests itself as urinary incontinence, or retention of urine. But health care professionals and persons with spinal cord injury may not be conversant with neuropathic dysmotility affecting the ureter and renal pelvis. We report an adult male patient with spinal cord injury, who developed bilateral hydronephrosis after he started managing neuropathic bladder by penile sheath drainage. Case presentation A male patient, born in 1971, sustained spinal cord injury following a motorbike accident in September 1988. In November 1988, intravenous urography showed normal upper tracts. He was advised spontaneous voiding with 2-3 catheterisations a day. In February 1995, this patient developed fever, chills and vomiting. Blood urea: 23.7 mmol/L; creatinine: 334 umol/L. Ultrasound revealed marked hydronephrosis of right kidney and mild hydronephrosis of left kidney. Bilateral nephrostomy was performed in March 1995. Right pyeloplasty was performed in May 1998. In July 2005, this patient developed urine infection and was admitted to a local hospital with fever and rigors. He developed septicaemia and required ventilation. Ultrasound examination of abdomen revealed bilateral hydronephrosis and multiple stones in left kidney. Percutaneous nephrostomy was performed on both sides. Subsequently, extracorporeal shock wave lithotripsy of left renal calculi was carried out. Right nephrostomy tube slipped out in January 2006; percutaneous nephrostomy was performed again. In June 2006, left ureteric antegrade stenting was performed and nephrostomy tube was removed. Currently, right kidney is drained by percutaneous nephrostomy and left kidney is drained by ureteric stent. This patient has indwelling urethral catheter. Conclusion It is possible that regular intermittent catheterisations along with anticholinergic medication right from the time of rehabilitation after this patient sustained paraplegia might have prevented the series of urological complications. Key components to successful management of external drainage of kidney in this patient are: [1] use of size 14 French pigtail catheter for long-term nephrostomy, [2] anchoring the catheter to skin to with Percufix catheter cuff to prevent accidental tug [3], replacing the nephrostomy dressing once a week by the same team in order to provide continuity of care, and [4] changing nephrostomy catheter every six months by a senior radiologist.
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Affiliation(s)
- J. Stuart Wolf
- Department of Urology, University of Michigan, Ann Arbor, Michigan
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Kouba E, Wallen EM, Pruthi RS. Management of ureteral obstruction due to advanced malignancy: optimizing therapeutic and palliative outcomes. J Urol 2008; 180:444-50. [PMID: 18550089 DOI: 10.1016/j.juro.2008.04.008] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE Treatment of ureteral obstruction due to advanced abdominal or pelvic malignancy is a clinical challenge. We discuss improvements and modern day outcomes in the palliative treatment of patients with ureteral obstruction by antegrade or retrograde ureteral decompression. Also, potential areas of clinical investigation involving ureteral stent improvement and pharmacological management of relief of symptoms resulting from ureteral obstruction are discussed. MATERIALS AND METHODS A literature search was performed using the Entrez-PubMed(R) database. All relevant literature on ureteral obstruction, advanced malignancy and nephrostomy, ureteral stent and associated topics concerning palliative care and quality of life were reviewed and analyzed. RESULTS Presenting symptoms are varied and depend on the acuity of the underlying problem. Mechanisms underlying the pain and symptoms of extrinsic ureteral compression have not fully been explored but they may include prostaglandin and renin-angiotensin pathways with medical interventions potentially directed at such therapeutic targets. Progressive obstructive uropathy may likely lead to clinical manifestations, such as uremia, electrolyte imbalances and persistent urinary tract infections, if obstruction is not bypassed. New approaches to antegrade and retrograde stenting, and the evaluation of new stent materials may help minimize the complications and side effects of such procedures. Unfortunately the finding of ureteral obstruction due to malignancy carries a poor prognosis with a resulting median survival of 3 to 7 months. This prognosis highlights the importance of maintaining quality of life in these patients. CONCLUSIONS Patients presenting with symptoms of ureteral obstruction due to advanced malignancy should be informed of the therapeutic options in the context of the poor prognosis. In the meantime research is needed to find methods of urinary diversion and pharmacological intervention for symptomatic relief without compromising quality of life in patients at the end of life.
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Affiliation(s)
- Erik Kouba
- Division of Urologic Surgery and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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