1
|
Soyster ME, Burns RT, Slaven JE, Zappia JL, Arnold PJ, Roth JD, Bihrle R, Francesca Monn M, Mellon MJ. Long-term Renal Preservation and Complication Profile With Ileal Ureter Creation. Urology 2024; 188:138-143. [PMID: 38657870 DOI: 10.1016/j.urology.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To examine long-term ileal ureter replacement results at over 32 years at our institution. Long segment or proximal ureteral strictures pose a challenging reconstructive problem. Ureteroureterostomy, psoas hitch, Boari flap, buccal ureteroplasty, and autotransplantation are common reconstructive techniques. We show that ileal ureter remains a lasting option. METHODS We performed a retrospective review of patients undergoing open ileal ureter creation from 1989-2021. Patient demographics, operative history, and complications were examined. All patients were followed for changes in renal function. Demographic data were analyzed and Cox proportional hazard models were performed. RESULTS One hundred and fifty-eight patients were identified with median follow-up time of 40 months. Eighty-one percent had a unilateral ileal ureter creation. Fifty percent were female, median age was 53.3. Twenty-seven percent of patients had radiation-induced strictures. Preoperatively, 56.3% of patients were chronic kidney disease stage 1-2 and 43.7% were stage 3-5. Post-operatively, 54% were stage 1-2 and 46% were stage 3-5. Cox proportional hazard models demonstrated no significant correlation between worsening renal function and stricture cause, bilateral repair, complications, or sex (biologically male or female). Seventy-seven percent had no 30-day complications. Clavien complications included grade 1 (18), grade 2 (4), grade 3 (9), and grade 4 (5). Long-term complications included worsening renal function (3%), incisional hernia (8.2%), and small bowel obstruction (6.9%). Five (3.1%) patients ultimately required dialysis and 5 (3.1%) patients developed metabolic acidosis. CONCLUSION Ileal ureteral reconstruction is often a last resort for patients with complex ureteral injuries. Clinicians can be reassured by our long-term data that ileal ureteral creation is a safe treatment with good preservation of renal function and low risk of hemodialysis and metabolic acidosis.
Collapse
Affiliation(s)
- Mary E Soyster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
| | - Ramzy T Burns
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - James E Slaven
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN
| | - Jason L Zappia
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Peter J Arnold
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Joshua D Roth
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Bihrle
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - M Francesca Monn
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN; Division of Urology, Southern Illinois University School of Medicine, Springfield, IL
| | - Matthew J Mellon
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| |
Collapse
|
2
|
Chen J, Gao X, Yang M, Li Y, Chai S, Zhou Y, Xiao X, Lei Z, Xing Y, Li B. The Whitaker test: a predictive tool for evaluating the surgical efficacy of upper urinary tract reconstruction in patients carrying a nephrostomy tube after surgery. Int Urol Nephrol 2024; 56:1817-1824. [PMID: 38285099 DOI: 10.1007/s11255-023-03927-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE To explore the role of the Whitaker test in evaluating the postoperative outcome of upper urinary tract reconstruction surgery in patients carrying a nephrostomy tube after surgery. PATIENTS AND METHODS This was a prospective observational study performed in 42 patients with nephrostomy tube undergoing the Whitaker test after upper urinary tract reconstruction surgery between January 2020 and December 2021. Data on clinical information, the Whitaker test and surgical procedure were collected prospectively, and the long-term follow-up results were analysed retrospectively. RESULTS The 46 ureters of 42 patients (right 16, left 22, bilateral 4) underwent six common upper urinary tract surgical reconstruction procedures and one combined procedure, including pyeloplasty, ureteroureterostomy, lingual mucosal onlay graft, appendiceal onlay flap, ureteral reimplantation, Boari flap, and ipsilateral lingual mucosal onlay graft combined ureteral reimplantation. All patients underwent the Whitaker test successfully without any discomfort after examination. The postoperative Whitaker test showed 43 kidneys without obstruction and 3 kidneys with obstruction. At a median follow-up of 18 months (range 13-31), the follow-up results showed that the overall success rate of the surgery was 100% (46/46). Concerning the concordance Whitaker test and follow-up results, the observed proportion of agreement was 93.5% (43/46). CONCLUSION The Whitaker test can achieve similar consistency with the long-term follow-up results after upper urinary tract reconstruction surgery and can be used as a tool to evaluate the surgical efficacy of upper urinary tract reconstruction surgery, which can provide a prognostic efficacy evaluation for patients carrying a nephrostomy tube after surgery.
Collapse
Affiliation(s)
- Jiawei Chen
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xincheng Gao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ming Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ying Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shuaishuai Chai
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuancheng Zhou
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xingyuan Xiao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ziqiao Lei
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
| | - Yifei Xing
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Bing Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.
- Institute of Urology, Wuhan University, Wuhan, China.
| |
Collapse
|
3
|
Engelmann SU, Yang Y, Pickl C, Haas M, Goßler C, Kälble S, Hartmann V, Breyer J, Burger M, Mayr R. Ureteroplasty with buccal mucosa graft without omental wrap: an effective method to treat ureteral strictures. World J Urol 2024; 42:116. [PMID: 38436781 PMCID: PMC10912248 DOI: 10.1007/s00345-024-04825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/16/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE Successful treatment options for ureteral strictures are limited. Surgical options such as ileal interposition and kidney autotransplantation are difficult and associated with morbidity and complications. Techniques such as Boari flap and psoas hitch are limited to distal strictures. Only limited case studies on the success of open buccal mucosa graft (BMG) ureteroplasty exist to this date. The purpose of this study was to evaluate the success of open BMG ureteroplasty without omental wrap. METHODS In this single-center retrospective study between July 2020 and January 2023, we included 14 consecutive patients with ureteric strictures who were treated with open BMG ureteroplasty without omental wrap. The primary outcome was the success of open BMG ureteroplasty. Further endpoints were complications and hospital readmission. Outcome variables were assessed by clinical examination, kidney sonography, and patient anamnesis. RESULTS Out of 14 patients, 13 were stricture and ectasia-free without a double-J stent at a median follow-up of 15 months (success rate 93%). No complications were observed at the donor site, and the complication rate overall was low with 3 out of 14 patients (21%) having mild-to-medium complications. CONCLUSIONS Open BMG ureteroplasty without omental wrap is a successful and feasible technique for ureteric stricture repair.
Collapse
Affiliation(s)
- Simon U Engelmann
- Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Yushan Yang
- Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Christoph Pickl
- Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Maximilian Haas
- Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Christopher Goßler
- Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Sebastian Kälble
- Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Valerie Hartmann
- Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Roman Mayr
- Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany.
| |
Collapse
|
4
|
Han C, Ma L, Li P, Yang Y, Wang J, Zhou X, Tao T, Zhao Y, Lyu X, Zhuo R, Zhou H. Robot-Assisted Ureteroplasty with Labial Mucosal Onlay Grafting for Long Left-Sided Proximal Ureteral Stenosis in Children and Adolescents: Technical Tips and Functional Outcomes. J Endourol 2024; 38:262-269. [PMID: 38205660 DOI: 10.1089/end.2023.0125] [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] [Indexed: 01/12/2024] Open
Abstract
Purpose: To evaluate functional outcomes of robot-assisted ureteroplasty with labial mucosa grafting for long proximal ureteral stenosis (LPUS) in children and adolescents. Methods: Included in this study were 15 patients who underwent robot-assisted ureteroplasty with labial mucosal grafting in our center between July 2017 and September 2021. The left affected stenotic ureter was repaired using labial mucosal grafting. If the ureter was simply strictured but not obliterated, the ureter was spatulated longitudinally along the ventral side and the labial mucosa graft was interposed and anastomosed in a continuous manner. Faced with the obliterated segment, it was excised and the spatulated portion re-anastomosed with a pelvic flap as the dorsal wall. The labial mucosa graft was placed as the ventral wall. The preoperative clinical data and follow-up outcomes were collected and evaluated. Results: Labial mucosa graft onlay ureteroplasty was well performed in all the 15 patients with no occurrence of intraoperative complications or surgical conversion. Five patients underwent an onlay ureteroplasty, and 10 patients underwent a dorsally augmented pelvic flap anastomotic ureteroplasty. The mean (range) stricture length was 7.1 (3-10) cm. The mean operative time was 371.2 (216-480) minutes, and the median blood loss was 40 mL. At the median follow-up of 35 months (range 12-58 months), the overall success rate was 93.3%. Conclusions: Labial mucosa grafting appears to be safe and feasible for repairing long ureteral strictures in pediatric and adolescent patients. Our experience may provide beneficial references and conveniences to solve complex problems in LPUS. This study was approved by the institutional review board, and written informed consent was obtained from each participant (ethics number: 2017-30).
Collapse
Affiliation(s)
- Ce Han
- Department of Pediatric Urology, Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Lifei Ma
- Department of Pediatric Urology, Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Pin Li
- Department of Pediatric Urology, Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Yang Yang
- Medical School of Chinese PLA, Beijing, China
| | - Jianan Wang
- Surgical Intensive Care Unit, the Second Medical Center of PLA General Hospital, Beijing, China
| | - Xiaoguang Zhou
- Department of Pediatric Urology, Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Tian Tao
- Department of Pediatric Urology, Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Yang Zhao
- Department of Pediatric Urology, Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Xuexue Lyu
- Department of Pediatric Urology, Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Ran Zhuo
- Department of Pediatric Urology, Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Huixia Zhou
- Department of Pediatric Urology, Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| |
Collapse
|
5
|
Hook S, Gross AJ, Netsch C, Becker B, Filmar S, Vetterlein MW, Kluth LA, Rosenbaum CM. [Update on ureteral reconstruction 2024]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:25-33. [PMID: 37989869 DOI: 10.1007/s00120-023-02232-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/23/2023]
Abstract
Ureteral strictures can occur along the entire course of the ureter and have many different causes. Factors involved in the development include, among other things, congenital anomalies, iatrogenic injuries during endoscopic as well as open or minimally invasive visceral surgical, gynecological, and urological procedures as well as prior radiation therapy. Planning treatment for ureteral strictures requires a detailed assessment of stricture and patient characteristics. Given the various options for ureteral reconstruction, various methods must be considered for each patient. Short-segment proximal strictures and strictures at the pyeloureteral junction are typically surgically managed with Anderson-Hynes pyeloplasty. End-to-end anastomosis can be performed for short-segment proximal and middle ureteral strictures. Distal strictures are treated with ureteroneocystostomy and are often combined with a Boari and/or Psoas Hitch flap. Particularly, the treatment of long-segment strictures in the proximal and middle ureter remain a surgical challenge. The use of bowel interposition is an established treatment option for this, offering good functional results but also potential associated complications. Robot-assisted surgery is increasingly becoming a minimally invasive treatment alternative to reduce hospital stays and optimize postoperative recovery. However, open surgical ureteral reconstruction remains an established procedure, especially after multiple previous abdominal operations.
Collapse
Affiliation(s)
- S Hook
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - S Filmar
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - M W Vetterlein
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - L A Kluth
- Klinik für Urologie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Deutschland
| | - C M Rosenbaum
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.
| |
Collapse
|
6
|
Rossanese M, Giannarini G, Scalia R, Macchione L, Crestani A, Simonato A, Ficarra V. Outcomes and treatment failure after open or robotic ureteral reconstruction for iatrogenic injuries. BJUI COMPASS 2023; 4:673-679. [PMID: 37818024 PMCID: PMC10560615 DOI: 10.1002/bco2.267] [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: 02/08/2023] [Revised: 05/28/2023] [Accepted: 06/04/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives The aim of this study is to assess the aetiology, perioperative outcomes and treatment failure of contemporary patients undergoing open or robot-assisted ureteral reconstruction for iatrogenic injuries. Patients and methods We retrospectively analysed consecutive patients who underwent ureteral reconstruction for iatrogenic injuries at two academic centres 07/2013 and 06/2022. A variety of open or robot-assisted procedures were performed, including uretero-cystoneostomy, Boari bladder flap, uretero-ureterostomy, ileal replacement and pyelo-ureteroplasty. All procedures were performed by a single surgeon with extensive experience in open and robot-assisted surgery and preference-based management. Outcome measures were aetiology, estimated blood loss, length of stay, postoperative complications and treatment failure, defined as upper tract obstruction requiring permanent urinary drainage. We also planned a subgroup analysis comparing the outcomes between open and robot-assisted procedures. Results Fifty-nine patients were included. Most injuries were consequent to endourological procedures (44%). The most frequently performed procedures were uretero-cystoneostomy (49.2%) and Boari bladder flap (32.2%). Forty (67.8%) were open, and 19 (32.2%) were robot-assisted procedures. Major postoperative complications were recorded in seven (11.9%) patients. After a median follow-up of 42 months (interquartile range 12-24), treatment failure was observed in seven (11.9%) cases. Robot-assisted versus open procedures were associated with decreased estimated blood loss (p = 0.01), length of stay (p < 0.001) and treatment failure (0/19 vs. 7/36, p = 0.04). Conclusion In our series of iatrogenic ureteral lesions requiring reconstructive surgery, endourological procedures were the most frequent cause. Major postoperative complications were infrequent, and treatment failure rate was low. The robot-assisted approach was associated with improved perioperative outcomes and lower failure rate compared with open.
Collapse
Affiliation(s)
- Marta Rossanese
- Gaetano Barresi Department of Human and Paediatric Pathology, Section of UrologyUniversity of MessinaMessinaItaly
| | | | - Riccardo Scalia
- Department of Surgical Oncological and Stomatological Sciences, Section of UrologyUniversity of PalermoPalermoItaly
| | - Luciano Macchione
- Gaetano Barresi Department of Human and Paediatric Pathology, Section of UrologyUniversity of MessinaMessinaItaly
| | | | - Alchiede Simonato
- Department of Surgical Oncological and Stomatological Sciences, Section of UrologyUniversity of PalermoPalermoItaly
| | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Section of UrologyUniversity of MessinaMessinaItaly
| |
Collapse
|
7
|
Yang K, Pang KH, Fan S, Li X, Osman NI, Chapple CR, Zhou L, Li X. Robotic ureteral reconstruction for benign ureteral strictures: a systematic review of surgical techniques, complications and outcomes : Robotic Ureteral Reconstruction for Ureteral Strictures. BMC Urol 2023; 23:160. [PMID: 37828505 PMCID: PMC10571348 DOI: 10.1186/s12894-023-01313-7] [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: 11/06/2022] [Accepted: 08/29/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Robotic ureteral reconstruction (RUR) has been widely used to treat ureteral diseases. To summarize the surgical techniques, complications, and outcomes following RUR, as well as to compare data on RUR with open and laparoscopic ureteral reconstruction. METHODS Our systematic review was registered on the PROSPERO (CRD42022309364) database. The PubMed, Cochrane and Embase databases were searched for publications in English on 06-Feb-2022. Randomised-controlled trials (RCTs) or non-randomised cohort studies with sample size ≥ 10 cases were included. RESULTS A total of 23 studies were included involving 996 patients and 1004 ureters from 13 non-comparative, and 10 retrospective comparative studies. No RCT study of RUR was reported. The success rate was reported ≥ 90% in 15 studies. Four studies reported 85-90% success rate. Meta-analyses for comparative studies showed that RUR had significantly lower estimated blood loss (EBL) (P = 0.006) and shorter length of stay (LOS) (P < 0.001) than the open approach. RUR had shorter operative time than laparoscopic surgery (P < 0.001). CONCLUSIONS RUR is associated with lower EBL and shorter LOS than the open approach, and shorter operative time than the laparoscopic approach for the treatment of benign ureteral strictures. However, further studies and more evidence are needed to determine whether RUR is more superior.
Collapse
Affiliation(s)
- Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Karl H Pang
- Division of Urology, Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
- Division of Urology, Queen Mary Hospital, Hong Kong, China
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Nadir I Osman
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christopher R Chapple
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China.
- Institute of Urology, Peking University, Beijing, China.
- National Urological Cancer Center, Beijing, China.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Guliev BG, Komyakov B, Avazkhanov Z, Shevnin M, Talyshinskii A. Laparoscopic ventral onlay ureteroplasty with buccal mucosa graft for complex proximal ureteral stricture. Int Braz J Urol 2023; 49:619-627. [PMID: 37450771 PMCID: PMC10482459 DOI: 10.1590/s1677-5538.ibju.2023.0170] [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: 04/19/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION There is lack of papers dedicated to the laparoscopic buccal mucosa graft (BMG) ureteroplasty of the complex upper ureteral stricture. The aim of this study is to evaluate the results of laparoscopic BMG ureteroplasty in patients with complex proximal ureteral stricture. MATERIAL AND METHODS Twenty-four patients underwent laparoscopic ventral onlay BMG ureteroplasty for long or recurrent proximal ureteral stricture not amenable to uretero-ureteral anastomosis over 2019-2022. Patient demographics, operative time, estimated blood loss, length of stay, follow-up, intra- and postoperative complication rate and percentage of stricture-free at last visit were analyzed. RESULTS The mean stricture length was 3.6 cm. The mean operative time was 208.3 min, while mean blood loss was 75.8 mL. The length of hospital stay was 7.3 days. No intraoperative complications were observed. Postoperatively, seven patients developed complications (29.2%). Five patients experienced a Grade II (according to Clavien nomenclature). Two patients developed a Grade IIIa complication, which included leakage of the anastomosis site. The mean follow-up was on the 22 months with stricture free rate 87.5%. CONCLUSION Patients with proximal ureteral strictures could be effectively treated by laparoscopic ventral onlay ureteroplasty with a buccal mucosa graft.
Collapse
Affiliation(s)
- B. G. Guliev
- North-Western State Medical University named after I. I. MechnikovDepartment of UrologySaint PetersburgRussiaDepartment of Urology, North-Western State Medical University named after I. I. Mechnikov, Saint Petersburg, Russia
- Urology Center with robot-assisted surgery of the Mariinsky HospitalDepartment of UrologySaint PetersburgRussiaDepartment of Urology, Urology Center with robot-assisted surgery of the Mariinsky Hospital; Saint Petersburg, Russia
| | - Boris Komyakov
- North-Western State Medical University named after I. I. MechnikovDepartment of UrologySaint PetersburgRussiaDepartment of Urology, North-Western State Medical University named after I. I. Mechnikov, Saint Petersburg, Russia
| | - Zhaloliddin Avazkhanov
- North-Western State Medical University named after I. I. MechnikovDepartment of UrologySaint PetersburgRussiaDepartment of Urology, North-Western State Medical University named after I. I. Mechnikov, Saint Petersburg, Russia
- Urology Center with robot-assisted surgery of the Mariinsky HospitalDepartment of UrologySaint PetersburgRussiaDepartment of Urology, Urology Center with robot-assisted surgery of the Mariinsky Hospital; Saint Petersburg, Russia
| | - Maksim Shevnin
- North-Western State Medical University named after I. I. MechnikovDepartment of UrologySaint PetersburgRussiaDepartment of Urology, North-Western State Medical University named after I. I. Mechnikov, Saint Petersburg, Russia
- Urology Center with robot-assisted surgery of the Mariinsky HospitalDepartment of UrologySaint PetersburgRussiaDepartment of Urology, Urology Center with robot-assisted surgery of the Mariinsky Hospital; Saint Petersburg, Russia
| | - Ali Talyshinskii
- North-Western State Medical University named after I. I. MechnikovDepartment of UrologySaint PetersburgRussiaDepartment of Urology, North-Western State Medical University named after I. I. Mechnikov, Saint Petersburg, Russia
- Urology Center with robot-assisted surgery of the Mariinsky HospitalDepartment of UrologySaint PetersburgRussiaDepartment of Urology, Urology Center with robot-assisted surgery of the Mariinsky Hospital; Saint Petersburg, Russia
| |
Collapse
|
10
|
Zhang TR, Mishra K, Blasdel G, Alford A, Stifelman M, Eun D, Zhao LC. Preoperative stricture length measurement does not predict postoperative outcomes in robotic ureteral reconstructive surgery. World J Urol 2023; 41:2549-2554. [PMID: 37486404 DOI: 10.1007/s00345-023-04525-6] [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: 05/20/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023] Open
Abstract
PURPOSE We sought to determine whether preoperative stricture length measurement affected the choice of procedure performed, its correlation to intraoperative stricture length, and postoperative outcomes. METHODS The Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database was queried for patients undergoing robotic ureteral reconstructive surgery from 2013 to 2021 who had surgical stricture length measurement. From this cohort, we identified patients with and without preoperative stricture length measurement via retrograde pyelogram or antegrade nephrostogram. Outcomes evaluated included intraoperative complications, 30-day complications greater than Clavien-Dindo grade II, hardware-free status, and need for additional procedures. RESULTS Of 153 patients with surgical stricture length measurements, 102 (66.7%) had preoperative radiographic measurement. No repair type was more likely to have preoperative measurement. The Pearson correlation coefficient between surgical and radiographic stricture length measurements was + 0.79. The average surgical measurement was 0.71 cm (± 1.52) longer than radiographic assessment. Those with preoperative imaging waited on average 5.0 months longer for surgery, but this finding was not statistically significant (p = 0.18). There was no statistically significant difference in intraoperative complications, 30-day complication rates, hardware-free status at last follow-up, or need for additional procedures between patients with and without preoperative measurement. The only significant predictive factor was preoperative stricture length on 30-day postoperative complications. CONCLUSIONS Despite relatively high prevalence of preoperative radiographic stricture length measurement, there are few measures where it offers clinically meaningful diagnostic information towards the definitive surgical management of ureteral stricture disease.
Collapse
Affiliation(s)
- Tenny R Zhang
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Kirtishri Mishra
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Gaines Blasdel
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Ashley Alford
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Michael Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Daniel Eun
- Department of Urology, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Lee C Zhao
- Department of Urology, NYU Langone Medical Center, New York, NY, USA.
| |
Collapse
|
11
|
You Y, Gao X, Chai S, Chen J, Wang J, Zhang H, Zhou Y, Yu Z, Cheng G, Li B, Xiao X. Oral mucosal graft ureteroplasty versus ileal ureteric replacement: a meta-analysis. BJU Int 2023; 132:122-131. [PMID: 36815226 DOI: 10.1111/bju.15994] [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] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To describe outcomes of oral mucosal graft ureteroplasty (OMGU) and ileal ureter replacement (IUR) and determine the relative merits of both procedures. METHODS Databases (including PubMed, Embase and Cochrane) were interrogated for eligible trials that assessed outcomes of OMGU or IUR from 2000 to 30 July 2022. The variables analysed were reconstruction success rates, stricture length, hospital stays, perioperative complications and long-term complications. RESULTS A total of 23 single-arm studies were included. The pooled reconstruction success rates for OMGU and IUR were 94.9% (95% confidence interval [CI] 91.0%-97.7%) and 85.8% (95% CI 81.0%-90.0%), respectively. Stricture length of patients in the OMGU and IUR groups were 3.73 (95% CI 3.17-4.28) and 11.55 (95% CI 9.82-13.29) cm, respectively. The maximal stricture length repaired by OMGU was 8 cm. The hospital stays were 5.85 (95% CI 3.88-7.82) and 11.55 (95% CI 6.93-16.17) days in the OMGU and IUR groups, respectively. The incidences of low-grade postoperative complications were 13.6% (95% CI 6.9%-20.3%) and 27.3% (95% CI 19.5%-35.1%), high-grade postoperative complications were 4.6% (95% CI 1.8I-8.5%) and 13.0% (95% CI 9.4%-17.1%), and long-term complications (occurred at > 3months) were 9.0% (95% CI 1.7%-20.0%) and 35.4% (95% CI 25.8%-45.6%) in the OMGU and IUR groups, respectively. CONCLUSION An OMGU is an effective, minimally invasive, and safe alternative to IUR for the management of long ureteric strictures. OMGU was the preferred treatment for long ureteric strictures, especially obstructed ureter segments of ≤8 cm.
Collapse
Affiliation(s)
- Yongqiang You
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xincheng Gao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuaishuai Chai
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiawei Chen
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianli Wang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuancheng Zhou
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zehao Yu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gong Cheng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bing Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingyuan Xiao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
12
|
Shimizu N, Naya Y, Sekine K, Hou K, Okato A, Suyama T, Araki K, Masuda H, Kojima S. Laparoscopic redo pyeloplasty with a buccal mucosal graft. IJU Case Rep 2023; 6:124-127. [PMID: 36874993 PMCID: PMC9978060 DOI: 10.1002/iju5.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Redo pyeloplasty can be difficult due to scar tissue or fibrosis. Ureteral reconstruction with a buccal mucosal graft is performed safely and successfully, but most reports of ureteral reconstruction using a buccal mucosal graft are of robot-assisted surgery, with few reports of laparoscopic-assisted surgery. A case of laparoscopic-assisted redo pyeloplasty using a buccal mucosal graft is presented. Case presentation A 53-year-old woman was diagnosed with ureteropelvic junction obstruction, and a double-J stent was placed to relieve backache. She visited our hospital 6 months after double-J stent placement. Three months later, laparoscopic pyeloplasty was performed. At 2 months postoperatively, anatomic stenosis occurred. Holmium laser endoureterotomy and balloon dilation were performed; however, the anatomic stenosis recurred, and laparoscopic redo pyeloplasty with a buccal mucosal graft was performed. After redo pyeloplasty, obstruction was improved, and her symptoms disappeared. Conclusion This is the first case of using a buccal mucosal graft for laparoscopic pyeloplasty in Japan.
Collapse
Affiliation(s)
- Nobuhiko Shimizu
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Yukio Naya
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Keita Sekine
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Kyokushin Hou
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Atsushi Okato
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Takahito Suyama
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Kazuhiro Araki
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Hiroshi Masuda
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Satoko Kojima
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| |
Collapse
|
13
|
Robotic versus laparoscopic ureteroplasty with a lingual mucosa graft for complex ureteral stricture. Int Urol Nephrol 2023; 55:597-604. [PMID: 36327006 DOI: 10.1007/s11255-022-03385-0] [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: 08/18/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Ureteroplasty with a lingual mucosa graft (LMG) for complex ureteral stricture was reported promising. We aimed to compare outcomes of robotic versus laparoscopic ureteroplasty using a LMG (RU-LMG vs. LU-LMG, respectively). METHODS From October 2018 to January 2021, 32 ureteroplasties using LMGs were performed by one experienced surgeon, including 16 robotic and laparoscopic procedures each. Patient demographics and peri-operative, post-operative, and follow-up data were prospectively collected and compared. RESULTS The robotic group had a higher rate of previous reconstruction than the laparoscopic group (62.50% vs. 18.75%; p = 0.012). The stricture length was significantly longer in the robotic group (4.8 ± 1.2 cm) than the laparoscopic group (3.7 ± 1.2 cm; p = 0.013). All procedures were completed successfully without open conversion. The operative time was shorter in the robotic group (192 ± 54 min) than the laparoscopic group (254 ± 46 min; p = 0.001). The robotic group had a shorter length of post-operative stay (6.1 ± 2.4 d vs. 8.9 ± 4.3 d; p = 0.033) but a higher hospital cost (76,801 ± 17,974 vs. 42,214 ± 15,757 RMB; p < 0.001) than the laparoscopic group. The mean follow-up time was 21 ± 7 months for the robotic group and 29 ± 9 months for the laparoscopic group respectively (p = 0.014). No difference was detected in the success rate (93.75% and 100%, respectively; p = 0.309) and complication rate (18.75% and 31.25%, respectively; p = 0.414) between the robotic and laparoscopic groups. CONCLUSION Both RU-LMG and LU-LMG are feasible, effective, and safe for repair of complex ureteral strictures. RU-LMG had a shorter operative time and a shorter length of post-operative stay but a higher hospital cost.
Collapse
|
14
|
Lee M, Lee Z, Houston N, Strauss D, Lee R, Asghar AM, Corse T, Zhao LC, Stifelman MD, Eun DD. Robotic ureteral reconstruction for recurrent strictures after prior failed management. BJUI COMPASS 2023; 4:298-304. [PMID: 37025480 PMCID: PMC10071084 DOI: 10.1002/bco2.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 02/19/2023] Open
Abstract
Objectives To describe our multi-institutional experience with robotic ureteral reconstruction (RUR) in patients who failed prior endoscopic and/or surgical management. Materials and Methods We retrospectively reviewed our Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database for all consecutive patients who underwent RUR between 05/2012 and 01/2020 for a recurrent ureteral stricture after having undergone prior failed endoscopic and/or surgical repair. Post-operatively, patients were assessed for surgical success, defined as the absence of flank pain and obstruction on imaging. Results Overall, 105 patients met inclusion criteria. Median stricture length was 2 (IQR 1-3) centimetres. Strictures were located at the ureteropelvic junction (UPJ) (41.0%), proximal (14.3%), middle (9.5%) or distal (35.2%) ureter. There were nine (8.6%) radiation-induced strictures. Prior failed management included endoscopic intervention (49.5%), surgical repair (25.7%) or both (24.8%). For repair of UPJ and proximal strictures, ureteroureterostomy (3.4%), ureterocalicostomy (5.2%), pyeloplasty (53.5%) or buccal mucosa graft ureteroplasty (37.9%) was utilized; for repair of middle strictures, ureteroureterostomy (20.0%) or buccal mucosa graft ureteroplasty (80.0%) was utilized; for repair of distal strictures, ureteroureterostomy (8.1%), side-to-side reimplant (18.9%), end-to-end reimplant (70.3%) or appendiceal bypass (2.7%) was utilized. Major (Clavien >2) post-operative complications occurred in two (1.9%) patients. At a median follow-up of 15.1 (IQR 5.0-30.4) months, 94 (89.5%) cases were surgically successful. Conclusions RUR may be performed with good intermediate-term outcomes for patients with recurrent strictures after prior failed endoscopic and/or surgical management.
Collapse
Affiliation(s)
- Matthew Lee
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Ziho Lee
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Nicklaus Houston
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - David Strauss
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Randall Lee
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Aeen M. Asghar
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Tanner Corse
- Department of Urology Hackensack Meridian School of Medicine Nutley New Jersey USA
| | - Lee C. Zhao
- Department of Urology New York University Grossman School of Medicine at New York University Langone Medical Center New York New York USA
| | - Michael D. Stifelman
- Department of Urology Hackensack Meridian School of Medicine Nutley New Jersey USA
| | - Daniel D. Eun
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | | |
Collapse
|
15
|
Tan Z, Fu S, Zuo J, Wang H, Wang J. A commentary on 'Self-expanding metal ureteral stent for ureteral stricture: experience of a large-scale prospective study from a high-volume center-cross-sectional study' (Int J Surg 2021; 95: 106161). Int J Surg 2023; 109:211-212. [PMID: 36799856 PMCID: PMC10389366 DOI: 10.1097/js9.0000000000000035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 02/18/2023]
Affiliation(s)
- Zhiyong Tan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Wuhua District, Kunming, Yunnan
| | - Shi Fu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Wuhua District, Kunming, Yunnan
| | - Jieming Zuo
- Department of Urology, The First Hospital of Suzhou University, Suzhou, Jiangsu, People’s Republic of China, China
| | - Haifeng Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Wuhua District, Kunming, Yunnan
| | - Jiansong Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Wuhua District, Kunming, Yunnan
| |
Collapse
|
16
|
Fan S, Han G, Li Z, Wang X, Li X, Xiong S, Li D, Zhang J, Meng C, Zhang P, Yang K, Li X, Zhou L. Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series. BMC Surg 2022; 22:435. [PMID: 36544120 PMCID: PMC9773509 DOI: 10.1186/s12893-022-01885-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Complete intracorporal robotic ileal ureteric replacement is challenging. We aimed to present the surgical technique of robotic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures. METHODS From March 2019 to March 2021, 18 patients underwent robotic ileal ureter replacement with extracorporeal ileal segment preparation by one experienced surgeon. The demographic, perioperative, and follow-up data were recorded. Success was defined as the resolution of the presenting symptom, a stable estimated glomerular filtration rate and unobstructive drainage on imaging examination. RESULTS All 18 surgeries were successfully completed without conversion. The median length of the intestinal tube used was 20 (12-30) cm. The median operative time was 248 (170-450) min, the median estimated blood loss was 50 (10-200) ml, and the median postoperative hospital stay was 7 (5-27) days. At a median follow-up of 16 (13-28) months, all patients were symptom-free. No or mild hydronephrosis was confirmed in 17 patients; 1 patient had moderate hydronephrosis without peristalsis of the ileal ureter. The renal function was stable in all patients. The overall success rate was 100%. Postoperative complications, including 4 cases of urinary infections (Grade I), 1 case of an incision hernia (Grade I), 4 cases of kidney stone formation (Grade I), 6 cases of metabolic acidosis (Grade I), 4 cases of incomplete ileus (Grade II), and 1 case of an incision infection (Grade IIIb). CONCLUSIONS Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation is safe, feasible, and effective for the treatment of long ureteral strictures, especially in high-volume tertiary referral centers with extensive robotic surgery experience capable of managing severe peri-operative complications.
Collapse
Affiliation(s)
- Shubo Fan
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - GuanPeng Han
- grid.11135.370000 0001 2256 9319Department 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
- grid.411472.50000 0004 1764 1621Nursing Department, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Xiang Wang
- grid.11135.370000 0001 2256 9319Department 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
- grid.11135.370000 0001 2256 9319Department 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
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Dan Li
- grid.411472.50000 0004 1764 1621Nursing Department, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Jun Zhang
- grid.411472.50000 0004 1764 1621Nursing Department, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Chang Meng
- grid.11135.370000 0001 2256 9319Department 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
- grid.414252.40000 0004 1761 8894Department of Urology, Emergency General Hospital, No. 29, Xibahenanli, Chaoyang District, Beijing, 100028 China
| | - Kunlin Yang
- grid.11135.370000 0001 2256 9319Department 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
- grid.11135.370000 0001 2256 9319Department 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
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| |
Collapse
|
17
|
Yuan C, Li Z, Wang J, Zhang P, Meng C, Li D, Gao J, Guan H, Zhu W, Lu B, Zhang Z, Feng N, Yang K, Li X, Zhou L. Ileal ureteral replacement for the management of ureteral avulsion during ureteroscopic lithotripsy: a case series. BMC Surg 2022; 22:262. [PMID: 35799183 PMCID: PMC9264655 DOI: 10.1186/s12893-022-01690-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/14/2022] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION To describe our initial experience with ileal ureteral replacement (IUR) for the management of ureteral avulsion (UA) during ureteroscopic lithotripsy. METHODS Between September 2010 and April 2021, ten patients received ileal ureteral replacement for ureteral avulsion during ureteroscopic lithotripsy. Anterograde urography and computed tomography urography (CTU) were applied to evaluate the lesion. Follow-up was performed with magnetic resonance urography and renal ultrasound as well as clinical assessment of symptoms. We retrospectively analysed the clinical data of ten patients treated with ileal ureteral replacement for the treatment of ureteral avulsion. RESULTS Four patients underwent open ileal ureteral replacement, two underwent laparoscopic ileal ureteral replacement, and four underwent robotic-assisted ileal ureteral replacement. The mean operative time (OT) was 310 min (range 191-530). The mean estimated blood loss (EBL) was 193 mL (range 10-1000). The mean length of the ileal graft was 21 cm (range 12-25). The median postoperative hospital time was 13 days (range 7-19). All surgeries were effectively completed, and no case required open conversion in laparoscopic and robotic-assisted surgeries. There was no obvious hydronephrosis according to contrast-enhanced computed tomography 3-dimensional reconstruction images without serious complications or progressive hydronephrosis during a median follow-up duration of 51 months (range 5-131), and the success rate was 100%. CONCLUSIONS Our initial results and experience showed that ileal ureteral replacement for the management of ureteral avulsion during ureteroscopic lithotripsy is safe and feasible.
Collapse
Affiliation(s)
- Changwei Yuan
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Zhihua Li
- Department of Nursing, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, No. 29, Xibahenanli St, Chaoyang District, Beijing, 100028, China
| | - Chang Meng
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Dan Li
- Department of Nursing, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Jingjing Gao
- Department of Nursing, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Hua Guan
- Department of Nursing, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Weijie Zhu
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Boyu Lu
- Department of Urology, Panjin Liaohe Oilfield Gem Flower Hospital, No. 26, YingBin St, Xinglongtai District, Panjin, 124010, China
| | - Zhichao Zhang
- Department of Urology, Qinhuangdao Jungong Hospital, No. 15, YuFeng St, Haigang District, 066001, Qinhuangdao, China
| | - Ninghan Feng
- Department of Urology, Affiliated Wuxi No. 2 Hospital, Nanjing Medical University, No. 68, Zhongshan St, Liangxi District, Wuxi, 214001, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| |
Collapse
|
18
|
Liang C, Wang J, Hai B, Xu Y, Zeng J, Chai S, Chen J, Zhang H, Gao X, Cheng G, Yang X, Hou T, Li W, Xiao X, Li B. Lingual Mucosal Graft Ureteroplasty for Long Proximal Ureteral Stricture: 6 Years of Experience with 41 Cases. Eur Urol 2022; 82:193-200. [PMID: 35618522 DOI: 10.1016/j.eururo.2022.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/26/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Management of a long proximal ureteral stricture is challenging. Lingual mucosal graft ureteroplasty (LMGU) is a novel minimally invasive technique for ureteral reconstruction that avoids the morbidity of bowel interposition or autotransplantation. OBJECTIVE To evaluate the long-term effectiveness of LMGU for managing long, complex proximal ureteral strictures in a multi-institutional cohort of patients. DESIGN, SETTING, AND PARTICIPANTS This retrospective study involved data for 41 patients treated with LMGU at three centers between June 2015 and January 2021. SURGICAL PROCEDURE LMGU was performed using either an onlay ureteroplasty in which the diseased ureter was incised ventrally and repaired with a lingual mucosal graft (LMG) to widen the ureteral lumen, or an augmented anastomotic technique in which the obliterated segment of the ureter was excised and reanastomosed primarily on dorsal side, and an LMG was placed on the ventral side. MEASUREMENTS Pre-, intra-, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. RESULTS AND LIMITATIONS Of 41patients, 40 were operated with laparoscopic procedures and one with a robot. Twenty-four (59%) patients underwent an onlay ureteroplasty, and 17 (41%) underwent an augmented anastomotic ureteroplasty. The reconstructed ureter was wrapped with omentum in 90% of cases. The median (range) stricture length was 4.8 cm (2.0-8.0), operative time was 166 min (98-306), and estimated blood loss was 65 ml (15-220). No open conversions and intraoperative complications occurred. At a median follow-up of 35 mo (range 13-80), the overall success rate was 97.6% (40/41). CONCLUSIONS LMGU is a safe, feasible, and effective long-term technique for managing long, complex proximal ureteral strictures. PATIENT SUMMARY We reported a novel technique for long proximal complex ureteral strictures using an onlay lingual mucosal graft (LMG). Our 6-yr outcomes demonstrate that onlay LMG ureteroplasty is a safe, feasible, and effective long-term procedure for ureteral reconstruction.
Collapse
Affiliation(s)
- Chaoqi Liang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jianli Wang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Hai
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yujie Xu
- Department of Urology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Jinmin Zeng
- Department of Urology, Jingzhou Central Hospital, Yangtze University, Jingzhou, China
| | - Shuaishuai Chai
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiawei Chen
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xincheng Gao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gong Cheng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiong Yang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Teng Hou
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wencheng Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingyuan Xiao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Bing Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Institute of Urology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
19
|
Gonzalez AN, Mishra K, Zhao LC. Buccal Mucosal Ureteroplasty for the Management of Ureteral Strictures: Patient Selection and Considerations. Res Rep Urol 2022; 14:135-140. [PMID: 35433528 PMCID: PMC9007613 DOI: 10.2147/rru.s291950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/19/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ashley N Gonzalez
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
- Correspondence: Ashley N Gonzalez, Email
| | - Kirtishri Mishra
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
- University Hospitals Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lee C Zhao
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
| |
Collapse
|
20
|
Li X, Qiao J, Xiong S, Wang J, Wang Q, Li Z, Guan H, Huang Y, Yang K, Li X, Zhou L. The surgical outcomes of reconstruction for the treatment of ureteral stricture after holmium laser lithotripsy: The comprehensive experience. Asian J Surg 2022; 45:2713-2718. [DOI: 10.1016/j.asjsur.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/17/2021] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
|
21
|
Yang K, Fan S, Wang J, Yin L, Li Z, Xiong S, Han G, Meng C, Zhang P, Li X, Zhou L. Robotic-assisted Lingual Mucosal Graft Ureteroplasty for the Repair of Complex Ureteral Strictures: Technique Description and the Medium-term Outcome. Eur Urol 2022; 81:533-540. [PMID: 35101303 DOI: 10.1016/j.eururo.2022.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/07/2021] [Accepted: 01/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Robot-assisted autologous graft ureteroplasty provides another treatment option for complex ureteral strictures, circumventing ileal ureter or renal autotransplantation. OBJECTIVE To report the medium-term outcome of robotic ureteroplasty with a lingual mucosal graft (RU-LMG) for managing complex ureteral strictures. DESIGN, SETTING, AND PARTICIPANTS Between June 2019 and September 2020, 12 patients underwent RU-LMG. The perioperative variables were prospectively collected, and the outcomes were assessed. SURGICAL PROCEDURE After ureteral stricture dissection, the narrow segment was cut longitudinally, and a lingual mucosal graft (LMG) of the required length was harvested, followed by double-J stent placement and LMG ventral onlay anastomosis. If the diseased ureter required transection, posteriorly augmented ureteral anastomosis could be performed before LMG harvest. Finally, the anastomotic area was wrapped by the omental flap. MEASUREMENTS A descriptive statistical analysis was performed. The criteria for complete success included the absence of both clinical symptoms and obstruction on radiography. RESULTS AND LIMITATIONS Seven patients (58%) had a history of failed ureteral reconstruction. The mean (range) stricture length was 4.7 (3-6.5) cm, LMG length was 4.4 (3-7) cm, LMG width was 1.5 (1-2) cm, operative duration was 197.1 (130-346) min, estimated blood loss was 49.2 (10-200) ml, and the duration of postoperative hospitalization was 6 (4-14) d. No open conversions and intraoperative complications occurred. The median follow-up time was 15 mo (range: 13-27 mo). The overall success rate was 92% (11/12). CONCLUSIONS These medium-term follow-up results demonstrate that RU-LMG is a safe and feasible technique for repairing ureteral strictures. PATIENT SUMMARY Our study proves that robotic ureteroplasty with a lingual mucosal graft is a safe and feasible technique for ureteral reconstruction that can serve as another choice for managing long, complex ureteral strictures.
Collapse
Affiliation(s)
- Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Lu Yin
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Chang Meng
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
| |
Collapse
|
22
|
Rai A, Hsieh A, Smith A. Contemporary Diagnosis and Management of Ureteropelvic Junction Obstruction. BJU Int 2022; 130:285-290. [DOI: 10.1111/bju.15689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Arun Rai
- Smith Institute for Urology Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Northwell Health New Hyde Park NY 11042 USA
| | - Alan Hsieh
- Scott Department of Urology Baylor College of Medicine 1 Baylor Plaza Houston TX 77030 USA
| | - Arthur Smith
- Smith Institute for Urology Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Northwell Health New Hyde Park NY 11042 USA
| |
Collapse
|
23
|
Gao X, Chen J, Jian Z, Wang M, Wang W, Peng L, Liu Z, Wei X. Initial Experience of Self-Expanding Metal Ureteral Stent in Recurrent Ureteral Stricture After Ureteroplasty. Front Surg 2022; 8:765810. [PMID: 34993227 PMCID: PMC8724242 DOI: 10.3389/fsurg.2021.765810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/29/2021] [Indexed: 02/05/2023] Open
Abstract
Background: The aim of this prospective study was to assess the safety and effectiveness of self-expanding metal ureteral stent (MUS) for the treatment of recurrent ureteral stricture after ureteroplasty. Methods: We prospectively included 24 patients who underwent MUS implantation between February 2019 and August 2020. The inclusion criteria for the procedure were recurrent ureteral strictures after ureteroplasty. A paired T test was used to compare continuous variables before and after surgery. Results: A total of 24 patients were finally included in this study. The stricture site was most common on the proximal ureter 19 (79.2%), followed by distal ureter 4 (16.7%) and middle ureter 1 (4.2%). The median length of ureteral stricture is 2.5 (range 1–18) cm. The median operative time was 51.5 min, and the median hospital stay time after surgery was 3 days. Post-operative complication included pain 1 (4.2%), urinary tract infection 2 (8.3%) and hematuria 2 (8.3%). After a median follow-up of 12 months, 19/24 (83.3%) patients were clinically and radiologically successful. We endoscopically adjusted or exchanged the failed stents. The volume of hydronephrosis (124.7 ± 132.5 vs. 66.4 ± 73.2 cm3, P = 0.015), blood creatinine level (104.5 ± 45.4 vs. 80.1 ± 23.2 μmol/L, P = 0.044) and urea nitrogen level (6.9 ± 2.4 vs. 4.8 ± 1.5 mmol/L, P = 0.003) decreased significantly after a median follow-up of 12 months. Conclusions: MUS is a safe and effective way to manage recurrent ureteral strictures after ureteroplasty. This technique provides a new choice for the treatment of recurrent stricture.
Collapse
Affiliation(s)
- Xiaoshuai Gao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Jixiang Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Menghua Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Wei Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Liao Peng
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Zhenghuan Liu
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
24
|
Long JA, Savoie PH, Boissier R. [Management of complications of upper urinary tract trauma (kidney and ureter)]. Prog Urol 2021; 31:1014-1021. [PMID: 34814985 DOI: 10.1016/j.purol.2021.07.009] [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: 06/20/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Complications of kidney and ureter trauma are directly in the field of the urologist. If they have a second place in the vital prognosis, a good knowledge of these pathologies is essential. METHODS A systematic review of the literature was carried out using the Medline database in order to identify the most relevant articles in English and French. RESULTS Urinary extravasation in the context of blunt kidney trauma has a good functional prognosis. Impaired function of the traumatized kidney is linked to vascular damage associated with grade IV and V. Non operative management is the treatment of choice with deferred management in the event of septic or painful deterioration. The lesions of the ureter are predominantly iatrogenic. While incomplete lesions can be treated endoscopically, complete lesions (stenosis or wound) require surgery. The most frequent lesions, in the distal ureter are easily treated by ureterovesical reimplantation. Large losses of substance may require ileal replacement. CONCLUSION Blunt kidney trauma causing urinary extravasation, with an excellent prognosis, are treated conservatively. Conversely, lesions of the ureter require in the majority of cases an intervention to restore continuity.
Collapse
Affiliation(s)
- J-A Long
- Centre hospitalier universitaire de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, La Tronche cedex 9, France.
| | - P-H Savoie
- Hôpital d'instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - R Boissier
- CHU de La Conception, AP-HM, 13005 Marseille, France
| |
Collapse
|
25
|
Wang J, Fan S, Guan H, Xiong S, Zhang D, Huang B, Wang X, Zhu H, Li Z, Xiong G, Zhang Z, Yang K, Li X, Zhou L. Should ureteroscopy be performed for patients after ureteral reconstruction with autologous onlay flap/graft? Transl Androl Urol 2021; 10:3737-3744. [PMID: 34804817 PMCID: PMC8575567 DOI: 10.21037/tau-21-583] [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] [Received: 07/02/2021] [Accepted: 08/26/2021] [Indexed: 11/06/2022] Open
Abstract
Background To analyze the safety and clinical significance of performing ureteroscopy after ureteral reconstruction with autologous onlay/graft. To describe the ureteroscopic appearances of the appendiceal onlay flap and lingual mucosa graft. Methods Beginning in August 2018, we conducted a prospective cohort study of autologous onlay/graft techniques to repair ureteral strictures. The perioperative data of 42 patients who had undergone surgery more than 6 months prior were collected prospectively. During the postoperative follow-up, ureteroscopy was performed in 27 patients (64.3%) after surgery (group A), and ureteroscopy was not performed in the other 15 patients (35.7%) (group B). We carried out a comparative study of these two groups of patients. Analyses were conducted mainly on complications related to ureteroscopy and the success rate of ureteral reconstruction surgery. Results There were no significant differences in patient demographic data or the length of ureteral reconstruction between the two groups (P>0.05). For the ureteroscopy group, the median time from repair surgery to ureteroscopy was 3 (range, 2-7) months, there was no poor healing of the anastomosis, and the ureteral lumen of all patients was unobstructed. Some expected observations can be found in the ureteral lumen, such as mucosa edema, stones, follicles and granulation tissue. Among the 27 patients, one patient (3.7%) developed bleeding intraoperatively and 7 patients (25.9%) were found to have low-grade (Clavien-Dindo I and II) postoperative complications, including 5 cases of fever and 2 cases of bleeding. The mean follow-up times of patients in group A and group B were 16.7±6.4 and 19.0±10.1 months, respectively. The objective success (imaging showed hydronephrosis ease) rate of the two groups was 100%. The subjective success (symptom relief) rates of group A and group B were 96.3% and 100%, respectively. Conclusions Patients after autologous onlay flap/graft ureteroplasty do not need to undergo routine ureteroscopy unless there is aggravation of hydronephrosis or other indications for ureteroscopy, such as stones.
Collapse
Affiliation(s)
- Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Dengxiang Zhang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Bingwei Huang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Xiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Gengyan Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhongyuan Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| |
Collapse
|
26
|
Gao X, Liang C, Wang J, Xiao X, Li B. Laparoscopic onlay lingual mucosal graft ureteroplasty combined with ureterovesical reimplantation for one-stage reconstruction of complex ureteral strictures: a case report. Transl Androl Urol 2021; 10:3907-3914. [PMID: 34804833 PMCID: PMC8575565 DOI: 10.21037/tau-21-639] [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: 07/20/2021] [Accepted: 09/15/2021] [Indexed: 11/12/2022] Open
Abstract
The treatment of ureteral stricture is a challenging task, especially when multiple strictures are present. Here, we report on a 63-year-old male patient diagnosed with hydronephrosis with left ureteral strictures who was admitted to our hospital. During treatment, a left percutaneous nephrostomy tube was inserted for hydronephrosis. Antegrade and retrograde pyelography were performed simultaneously. The results suggested there were 3 segment ureteral strictures in the left ureter: 2 located in the distal ureter and 1 in the proximal ureter. The treatment choices for multiple ureteral strictures are kidney autotransplantation or an ileal ureteral replacement (IUR), which are both morbid procedures and are technically challenging. With the excellent results of lingual mucosal graft (LMG) in ureteroplasty, this patient underwent a one-stage left ureter reconstruction with combined laparoscopic LMG ureteroplasty and ureterovesical reimplantation. However, disease of the oral mucosa and a reduced bladder volume caused by radio cystitis or chemical cystitis, may limit the use of this technique. Regular postoperative antegrade pyelography and the Whitaker test showed the unimpeded drainage of the left ureter. Based on the satisfactory outcome of this patient, combined laparoscopic LMG ureteroplasty and ureterovesical reimplantation for unilateral multiple ureteral strictures is a viable option that has fewer complications.
Collapse
Affiliation(s)
- Xincheng Gao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaoqi Liang
- Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jianli Wang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingyuan Xiao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bing Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
27
|
Yang CH, Lin YS, Weng WC, Lu CH, Hsu CY, Tung MC, Ou YC. Validation of robotic-assisted ureteroplasty with buccal mucosa graft for stricture at the proximal and middle ureters: the first comparative study. J Robot Surg 2021; 16:1009-1017. [PMID: 34748167 DOI: 10.1007/s11701-021-01331-3] [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: 09/21/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
Although ureteroplasty with buccal mucosa graft for long-segmental ureteral stenosis has been developed long ago, evidence was still restricted to case series in published literature. This study aims to validate ureteroplasty with buccal mucosa graft (BMG) in long-segment stricture at the proximal and middle ureters under designed comparative methods. From April 2015 to January 2019, we performed robotic-assisted ureteroplasty with BMG with a two-phase design and compared ureteroplasty and BMG (phase 2 surgery) with endoscopic stenting (phase 1 surgery). Paired data of effective renal plasma flow (ERPF), glomerular filtration rate (GFR), hydronephrosis grade, and physical and psychological domains of the World Health Organization Quality of Life (WHOQOL)-BREF were compared. A total of 29 patients were enrolled, and only three (10%) patients had hydronephrosis resolution after treatment with endoscopic stenting (p = 0.250 to baseline). Compared to endoscopic ureteral stent, Hedges' g of ureteroplasty with BMG was 0.56 (95% CI 0.43-0.69), 0.63 (95% CI 0.46-0.80), 0.80 (95% CI 0.56-1.04), and 1.06 (95% CI 0.69-1.43) in EGFR, GFR, physical domain of WHOQOL-BREF, and psychological domain of WHOQOL-BREF, respectively (All significance; p < 0.001). After 12-month follow-ups, no recurrence of stricture was reported. In conclusion, Robotic-assisted ureteroplasty with BMG onlay is efficient in reconstruction of long-segment stricture of the proximal and middle ureters.
Collapse
Affiliation(s)
- Che Hsueh Yang
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuqi Dist., Taichung City, 435403, Taiwan
| | - Yi Sheng Lin
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuqi Dist., Taichung City, 435403, Taiwan
| | - Wei Chun Weng
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuqi Dist., Taichung City, 435403, Taiwan.,Department of Nursing, Jen-Teh Junior College of Medicine. Nursing and Management, Miaoli, 356, Taiwan
| | - Chin Heng Lu
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuqi Dist., Taichung City, 435403, Taiwan
| | - Chao Yu Hsu
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuqi Dist., Taichung City, 435403, Taiwan.,PhD Program in Translational Medicine, National Chung Hsing University, Taichung, 402, Taiwan
| | - Min Che Tung
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuqi Dist., Taichung City, 435403, Taiwan
| | - Yen Chuan Ou
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuqi Dist., Taichung City, 435403, Taiwan.
| |
Collapse
|
28
|
Hebert KJ, Linder BJ, Gettman MT, Ubl D, Habermann EB, Lyon TD, Ziegelmann MJ, Viers BR. Contemporary Analysis of Ureteral Reconstruction 30-Day Morbidity Utilizing the National Surgical Quality Improvement Program (NSQIP) Database: Comparison of Minimally Invasive Versus Open Approaches. J Endourol 2021; 36:209-215. [PMID: 34663084 DOI: 10.1089/end.2021.0242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To characterize 30-day morbidity of upper ureteral reconstruction (UUR) and lower ureteral reconstruction (LUR) surgery by comparing open and minimally invasive surgery (MIS) approaches using a national surgical outcomes registry. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent UUR and LUR between 2007-2017. Primary endpoints included 30-day complications, transfusion, readmission, return to operating room (ROR), and prolonged postoperative length of stay (LOS). Multivariable logistic regression was performed to observe the association of MIS approach on 30-day outcomes. RESULTS 3042 patients were identified with 2116 undergoing UUR and 926 undergoing LUR. Of 2116 patients undergoing UUR, 1733 (82%) were performed via MIS approach. On multivariable analysis, open approach for UUR was associated with increased odds of any 30-day complication (odds ratio (OR) 1.6 [1.1-2.4]; p=0.014), major complication (OR 1.8 [1.04-3.0]; p=0.034), transfusion (OR 3.7 [1.2- 11.5]; p=0.025), ROR (OR 2.0 [1.0-3.9]; p=0.047), and prolonged LOS (OR 5.4 [3.9-7.6]; p<0.001). Of the 926 patients undergoing LUR, 458 (49%) were performed via a MIS approach. On multivariable analysis, open approach for LUR was associated with increased odds of any 30-day complication (OR 1.5 [1.1-2.1]; p=0.028), minor complication (OR 1.7 [1.1-2.6]; p=0.02), transfusion (OR 8.1 [2.7-23.7]; p<0.001), and prolonged LOS (OR 4.2 [2.4-7.3]; p<0.001). CONCLUSION Utilization of a national surgical database revealed an open approach was associated with increased 30-day morbidity across multiple postoperative outcome measures. These findings suggest a MIS approach should be considered, when feasible, for upper and lower ureteral reconstruction.
Collapse
Affiliation(s)
- Kevin J Hebert
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian J Linder
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel Ubl
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Department of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
29
|
Ureteral reconstruction for complex strictures: a review of the current literature. Int Urol Nephrol 2021; 53:2211-2219. [PMID: 34524628 DOI: 10.1007/s11255-021-02985-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Frequently employed procedures for ureteral reconstruction include balloon dilation, pyeloplasty and ureteral re-implants. However, these procedures do not work for complex ureteral disease. The goal of this literature review is to report on techniques and success rates for the following techniques: buccal graft ureteroplasty, appendiceal interposition, transureteroureterostomy, ileal ureter and autotransplantation. METHODS A comprehensive literature search for English-language original and review articles was conducted using PubMed. The following terms were queried: "ureteral reconstruction", "buccal graft", "appendiceal interposition", "ileal ureter", "transureteroureterostomy", "autotransplantation". RESULTS Procedures involving the buccal mucosa or appendix offer minimally invasive techniques and low morbidity with good short-term success. Drawbacks to appendiceal interposition include the availability and length of appendix, and 10-20% of patients may have insufficient appendix upon intra-operative assessment. Transureteroureterostomy is typically limited to extensive exonerations due to concerns of injury to the contralateral kidney, even with reported success rates > 90%. Ileal ureter may carry a risk of metabolic acidosis in patients with renal insufficiency along with bowel-related complications. Ileal ureter and autotransplantation are reserved for the most severe cases due to their high morbidity but do offer options for the complex patient. CONCLUSION Ureteral stricture disease not amenable to pyeloplasty, ureteroureterostomy or ureteroneocystostomy offers a challenge to urologist. Careful patient selection with pre-operative assessment of renal and bladder is vital to a successful operation with minimal complications.
Collapse
|
30
|
Crivelli JJ, Johnson BA, Steinberg RL, Gahan JC, Antonelli JA, Morey AF, Pearle MS, Cadeddu JA. Clinical and radiographic outcomes following salvage intervention for ureteropelvic junction obstruction. Int Braz J Urol 2021; 47:1209-1218. [PMID: 34469674 PMCID: PMC8486453 DOI: 10.1590/s1677-5538.ibju.2021.0303] [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: 04/12/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose: We aimed to assess failure rates of salvage interventions and changes in split kidney function (SKF) following failed primary repair of ureteropelvic junction obstruction (UPJO). Materials and Methods: A retrospective review of adult patients at an academic medical center who underwent salvage intervention following primary treatment for UPJO was performed. Symptomatic failure was defined as significant flank pain. Radiographic failure was defined as no improvement in drainage or a decrease in SKF by ≥7%. Overall failure, the primary outcome, was defined as symptomatic failure, radiographic failure, or both. Results: Between 2008-2017, 34 patients (median age 38 years, 50% men) met study criteria. UPJO management was primary pyeloplasty/secondary endopyelotomy for 21/34 (62%), primary pyeloplasty/secondary pyeloplasty for 6/34 (18%), and primary endopyelotomy/secondary pyeloplasty for 7/34 (21%). Median follow-up was 3.3 years following secondary intervention. Patients undergoing primary pyeloplasty/secondary endopyelotomy had significantly higher overall failure than those undergoing primary pyeloplasty/secondary pyeloplasty (16/21 [76%] vs. 1/6 [17%], p=0.015). Among patients undergoing secondary endopyelotomy, presence of a stricture on retrograde pyelogram, stricture length, and SKF were not associated with symptomatic, radiographic, or overall failure. Serial renography was performed for 28/34 (82%) patients and 2/28 (7%) had a significant decline in SKF. Conclusions: Following failed primary pyeloplasty, secondary endopyelotomy had a greater overall failure rate than secondary pyeloplasty. No radiographic features assessed were associated with secondary endopyelotomy failure. Secondary intervention overall failure rates were higher than reported in the literature. Unique to this study, serial renography demonstrated that significant functional loss was overall infrequent.
Collapse
Affiliation(s)
- Joseph J Crivelli
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Brett A Johnson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Ryan L Steinberg
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jeffrey C Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jodi A Antonelli
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Margaret S Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
31
|
Wang J, Zhang B, Fan J, Cheng S, Fan S, Yin L, Li Z, Guan H, Yang K, Li X. The application of the "omental wrapping" technique with autologous onlay flap/graft ureteroplasty for the management of long ureteral strictures. Transl Androl Urol 2021; 10:2871-2878. [PMID: 34430389 PMCID: PMC8350257 DOI: 10.21037/tau-21-305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022] Open
Abstract
Background To present our experience with the "omental wrapping" technique in laparoscopic and robotic ureteroplasty using onlay flaps or grafts for the management of long proximal or middle ureteral strictures. Methods This is a retrospective review of 25 patients with long proximal or middle ureteral strictures who underwent laparoscopic and robotic onlay flaps or grafts ureteroplasty using an omental flap to reinforce an anastomosis site between August 2018 and November 2019. Perioperative and follow-up data were collected. Results Sixteen laparoscopic procedures and nine robotic procedures were performed successfully. Sixteen patients underwent ureteroplasty with lingual mucosal graft (LMG), and nine patients with appendiceal onlay flap (AOF). The median stricture length was 4 cm (range, 2-6 cm). The mean operative time (OT) was 220.5±50.6 min, the estimated blood loss (EBL) was 66.0±38.9 mL, and the length of hospital stay (LHS) was 8.0±3.6 days. In the LMG group, four patients had tongue numbing and one had an oral ulcer, which relieved itself gradually without intervention. Two patients in the LMG group and four patients in the AOF group experienced urinary tract infection, and all responded well to antibiotic treatment. There were no complications attributed to "omental wrapping". The mean follow-up was 16.3±4.8 months. According to the standards regarding improvement in clinical symptoms, relief of obstruction radiologically and a stable estimate glomerular filtration rate, our surgical success rate was 100%. Conclusions The "omental wrapping" technique in laparoscopic and robotic onlay flaps or grafts ureteroplasty for long proximal or middle ureteral strictures is an efficient, safe, reproducible and simple technique.
Collapse
Affiliation(s)
- Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Baiyu Zhang
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Sida Cheng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Lu Yin
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| |
Collapse
|
32
|
Application of the "Yang-Monti principle" in children with iatrogenic ureteral injuries. J Pediatr Urol 2021; 17:543.e1-543.e7. [PMID: 34034956 DOI: 10.1016/j.jpurol.2021.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Iatrogenic ureteral injuries in children are rare, due to its retroperitoneal position. The Yang -Monti ileal substitution serves as a good surgical option in such injuries associated with long segment defects of the ureter. OBJECTIVES To review our experience using the Yang Monti principle of ileal ureter substitution in children with long segment ureteric defects and analyse its intermediate term outcomes. STUDY DESIGN This was a prospective study, conducted from 2014 to 2019. All children with iatrogenic ureteral injuries with delayed presentations, undergoing the Yang Monti principle of ileal ureter substitution, were included (as illustrated in summary image). These injuries were divided into upper, mid, and distal ureteral injuries and were diagnosed based on a standardized protocol. At follow up, findings of the CT urogram, functional isotope renogram, and renal functions were the key points monitored. The demographic, clinical profile, operative, post-operative complications and follow up data were collated and analyzed. RESULTS 22 children were diagnosed with iatrogenic ureteral injuries. Of these, 14 children with delayed presentations underwent the Yang Monti principle of ileal ureter substitution. The primary pathology was gangrenous appendicitis (9 cases), calculus cholecystitis (3 cases) and torsion ovary (2 cases). Laparoscopic procedures were the commonest approach for the injury (10). The average age was 11.5 years, with a male predominance. The right ureter was affected in 12 cases. The average time to detection was 7 days. All children underwent an ultrasound guided nephrostomy tube insertion at presentation and the mid ureter (9) was most affected. The mean length of ureteric injury was 3.75 cm. Intra operatively, one ileal segment (2), two ileal segments (11) and three ileal segments (1) were used according to the length of the ureteric defect. Complications were urinary tract infections (2), adhesions (3) and leak (2) which were conservatively managed with no redo surgeries. The median follow up period was 4 years. At follow up CT urogram and isotope diuretic renogram were normal, with preserved renal functions and no metabolic complications in all. DISCUSSION & CONCLUSION In children associated with iatrogenic ureteral injuries of long lengths, the "Yang Monti ileal substitution" serves as a good and simple option with lesser complications permitting the preservation of the renal function at follow up.
Collapse
|
33
|
Shakir NA, Zhao LC. Robotic-assisted genitourinary reconstruction: current state and future directions. Ther Adv Urol 2021; 13:17562872211037111. [PMID: 34377155 PMCID: PMC8326819 DOI: 10.1177/17562872211037111] [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] [Received: 12/29/2020] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
With the widespread dissemination of robotic surgical platforms, pathology previously deemed insurmountable or challenging has been treated with reliable and replicable outcomes. The advantages of precise articulation for dissection and suturing, tremor reduction, three-dimensional magnified visualization, and minimally invasive trocar sites have allowed for the management of such diverse disease as recurrent or refractory bladder neck stenoses, and radiation-induced ureteral strictures, with excellent perioperative and functional outcomes. Intraoperative adjuncts such as near-infrared imaging aid in identification and preservation of healthy tissue. More recent developments include robotics via the single port platform, gender-affirming surgery, and multidisciplinary approaches to complex pelvic reconstruction. Here, we review the recent literature comprising developments in robotic-assisted genitourinary reconstruction, with a view towards emerging technologies and future trends in techniques.
Collapse
Affiliation(s)
- Nabeel A Shakir
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Lee C Zhao
- Department of Urology, NYU Langone Medical Center, 222 41st Street, 11th Floor, New York, NY 10017, USA
| |
Collapse
|
34
|
Elbers JR, Rodríguez Socarrás M, Rivas JG, Autran AM, Esperto F, Tortolero L, Carrion DM, Sancha FG. Robotic Repair of Ureteral Strictures: Techniques and Review. Curr Urol Rep 2021; 22:39. [PMID: 34105032 DOI: 10.1007/s11934-021-01056-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW To provide an overview and description of the different surgical techniques for the robotic repair of ureteral strictures. RECENT FINDINGS The robotic repair of ureteral stenosis has emerged as a useful option for treating strictures unsuitable for endoscopic resolution with good results, lower morbidity, and faster recovery than open techniques. Depending on the stricture's length and location, the reconstructive options are reimplantation, psoas hitch, Boari flap, ureteroureterostomy, appendiceal onlay flap, buccal mucosa graft (BMG) ureteroplasty, ileal replacement, or renal autotransplantation. The robotic approach offers a magnified vision and the possibility of adding near-infrared fluorescence (NIRF) imaging, indocyanine green (ICG), and FireflyTM to facilitate the technique. Multicenter studies with extended follow-up still have to confirm the good results obtained in published case series. Robotic reconstructive techniques are useful for repairing ureteral strictures, obtaining good functional results with less morbidity and faster recovery than open procedures.
Collapse
Affiliation(s)
- Javier Reinoso Elbers
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| | - Moises Rodríguez Socarrás
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain.
| | - Juan Gómez Rivas
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| | - Ana Maria Autran
- Oficina de Investigacion CAU (Confederacion Americana de Urologia), Madrid, Argentina
| | | | | | - Diego M Carrion
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| | - Fernando Gómez Sancha
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| |
Collapse
|
35
|
Fan S, Yin L, Yang K, Wang J, Li X, Xiong S, Yu X, Li Z, Guan H, Zhu H, Zhang P, Li X, Zhou L. Posteriorly Augmented Anastomotic Ureteroplasty with Lingual Mucosal Onlay Grafts for Long Proximal Ureteral Strictures: 10 Cases of Experience. J Endourol 2021; 35:192-199. [PMID: 32878451 DOI: 10.1089/end.2020.0686] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To share the technique of posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts for long proximal ureteral strictures as well as our initial experience with the technique. Methods: From October 2018 to September 2019, 10 cases of robotic and laparoscopic posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts for long proximal ureteral strictures were recruited from our database of Reconstruction of Urinary Tract: Technology, Epidemiology and Result (RECUTTER). The perioperative and follow-up data were recorded. Complete success was defined as the absence of clinical symptoms, relieved stenosis on imaging, and a stable estimated glomerular filtration rate without serious complications. Results: All surgeries were completed without serious complications. There were eight laparoscopic surgeries and two robotic surgeries. The median length of defect after posteriorly augmented anastomosis was 3 cm (range, 3-5 cm). The median length of the lingual mucosa graft was 4 cm (range, 3-5 cm). The median operative time was 237 minutes (range, 189-310 minutes). The median estimated blood loss was 40 mL (range, 10-100 mL). The median postoperative length of stay was 7.5 days (range, 5-22 days). The Double-J stent was removed median 3.5 months (range, 2-7 months) after the surgery. At the median follow-up of 11 months (range, 7-20 months), all patients achieved the successful criteria of treatment. Conclusion: The posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts for long proximal ureteral strictures is a feasible and safe technique, which may be an option especially for strictures marginally longer than those that can be safely repaired via end-to-end anastomosis.
Collapse
Affiliation(s)
- Shubo Fan
- Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Lu Yin
- Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Kunlin Yang
- Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Jie Wang
- Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Xinfei Li
- Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Shengwei Xiong
- Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Xiaoteng Yu
- Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Zhihua Li
- Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Hua Guan
- Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Liqun Zhou
- Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| |
Collapse
|
36
|
Obiora D, Yang H, Gor RA. Robotic assisted reconstruction for complications following urologic oncologic procedures. Transl Androl Urol 2021; 10:2272-2279. [PMID: 34159109 PMCID: PMC8185667 DOI: 10.21037/tau.2020.03.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Despite technical refinements in urologic oncologic surgery, complications are inevitable and often carry significant morbidity. Similar to oncologic surgery, reconstructive surgery has realized a paradigm shift from mainly open to an increasingly minimally invasive approach. Robotic assisted surgery has facilitated this transition as it mitigates some of the limitations of traditional laparoscopy. With continued technological advances in robotic technology along with improved training and experience, the breadth and complexity of cases expand annually. Few head to head trials exist and data is overall heterogeneous. Herein, we review and summarize the currently available literature describing robotic assisted reconstruction for complications following urologic oncologic procedures.
Collapse
Affiliation(s)
- Daisy Obiora
- Division of Urology, Department of Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Hailiu Yang
- Division of Urology, Department of Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Ronak A Gor
- Division of Urology, Department of Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
| |
Collapse
|
37
|
Lee Z, Lee M, Lee R, Koster H, Cheng N, Siev M, Jun M, Munver R, Ahmed M, Zhao LC, Stifelman MD, Eun DD. Ureteral Rest is Associated With Improved Outcomes in Patients Undergoing Robotic Ureteral Reconstruction of Proximal and Middle Ureteral Strictures. Urology 2021; 152:160-166. [PMID: 33639184 DOI: 10.1016/j.urology.2021.01.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To evaluate the effect of ureteral rest on outcomes of robotic ureteral reconstruction. METHODS We retrospectively reviewed all patients who underwent robotic ureteral reconstruction of proximal and/or middle ureteral strictures in our multi-institutional database between 2/2012-03/2019 with ≥12 months follow-up. All patients were recommended to undergo ureteral rest, which we defined as the absence of hardware (ie. double-J stent or percutaneous nephroureteral tube) across a ureteral stricture ≥4 weeks prior to reconstruction. However, patients who refused percutaneous nephrostomy tube placement did not undergo ureteral rest. Perioperative outcomes were compared after grouping patients according to whether or not they underwent ureteral rest. Continuous and categorical variables were compared using Mann-Whitney U and 2-tailed chi-squared tests, respectively; P <.05 was considered significant. RESULTS Of 234 total patients, 194 (82.9%) underwent ureteral rest and 40 (17.1%) did not undergo ureteral rest prior to ureteral reconstruction. Patients undergoing ureteral rest were associated with a higher success rate compared to those not undergoing ureteral rest (90.7% versus 77.5%, respectively; P = .027). Also, patients undergoing ureteral rest were associated with lower estimated blood loss (50 versus 75 milliliters, respectively; p<0.001) and less likely to undergo buccal mucosa graft ureteroplasty (20.1% versus 37.5%, respectively; p=0.023). CONCLUSIONS Implementing ureteral rest prior to ureteral reconstruction may allow for stricture maturation and is associated higher surgical success rates, lower estimated blood loss, and decreased utilization of buccal mucosa graft ureteroplasty.
Collapse
Affiliation(s)
- Ziho Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
| | - Matthew Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Randall Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Helaine Koster
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Nathan Cheng
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Michael Siev
- New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Min Jun
- New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Ravi Munver
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Mutahar Ahmed
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Lee C Zhao
- New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Michael D Stifelman
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Daniel D Eun
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | | |
Collapse
|
38
|
Cheng S, Li X, Yang K, Xiong S, Li Z, Zhu H, Zhang P, Li X, Guan H, Li Z, Hao H, Zhang L, Li X, Zhou L. Modified Laparoscopic and Robotic Flap Pyeloplasty for Recurrent Ureteropelvic Junction Obstruction with a Long Proximal Ureteral Stricture: The "Wishbone" Anastomosis and the "Ureteral Plate" Technique. Urol Int 2021; 105:642-649. [PMID: 33567431 DOI: 10.1159/000512994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of the study was to present our modified flap pyeloplasty techniques for recurrent ureteropelvic junction obstruction (UPJO) with a long proximal ureteral stricture and compare outcomes of laparoscopic and robotic procedures. MATERIALS AND METHODS Between March 2018 and January 2020, 21 patients underwent modified laparoscopic or robotic flap pyeloplasty for recurrent UPJO with a long proximal ureteral stricture. Our surgical modifications included the "wishbone" anastomosis and "ureteral plate" technique. Demographic, perioperative, and follow-up data were recorded and compared retrospectively between the groups. Success was defined as subjective pain alleviation and hydronephrosis improvement. RESULTS Thirteen modified laparoscopic flap pyeloplasty (mLFP) and 8 modified robotic flap pyeloplasty (mRFP) were performed successfully without conversion. mRFP tended to have shorter overall operative time (142.4 vs. 179.1 min, p = 0.122) and anastomosis time (43.1 vs. 61.0 min, p = 0.093) than mLFP. No difference was found in estimated blood loss (p = 0.723) and pararenal draining time (p = 0.175) between the groups. The mean postoperative hospital stay of mRFP was significantly shorter than that of mLFP (5.0 vs. 8.2 days, p = 0.015). No major complications occurred. During the mean follow-up of 17.9 months, the overall success rate was 90.5%, and there was no significant difference between 2 groups. CONCLUSIONS The modified flap pyeloplasty could be considered a practical and effective treatment option with a high success rate for recurrent UPJO with a long proximal ureteral stricture, and the robotic procedures showed advantages of higher efficiency and faster recovery.
Collapse
Affiliation(s)
- Sida Cheng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Ziao Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Xuechao Li
- Department of Urology, The Fifth Medical Center, Chinese People's Liberation Army General Hospital/People's Liberation Army Medical School, Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China,
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| |
Collapse
|
39
|
Chow AK, Bhatt R, Cao D, Wahba B, Coogan CL, Vourganti S, Cherullo EE, Bhayani SB, Venkatesh RJ, Figenshau RS. A Case Series of Delayed Proximal Ureteral Strictures After Nephron-Sparing Treatment of Renal Masses. J Endourol Case Rep 2020; 6:544-547. [PMID: 33457725 DOI: 10.1089/cren.2020.0182] [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: 11/12/2022] Open
Abstract
Background: Delayed proximal ureteral stricture (DPUS) after nephron-sparing treatment (partial nephrectomy [PN] and image-guided percutaneous ablation) of renal masses is a rare complication that occurs because of an unrecognized injury to the proximal ureter and/or its associated vascular supply. We present a multi-institutional series of patients who developed DPUS after nephron-sparing treatment and review relevant tumor characteristics, timing of DPUS presentation, presenting symptoms, and outcome of stricture management. Case Presentation: Between 2000 and 2019, nine patients (five PN and four ablation) were found to have DPUS diagnosed at an average of 9 (6-119) months after PN and 5.5 (1-6) after ablation. Average tumor size was 4.5 (2.9-7.3) cm and 3.6 (3-4.1) cm for those treated with PN and ablation, respectively. Nephrometry score was 8.3 (6-11) and 6.5 (5-8), respectively. For resected tumors, all were located in the lower pole, but uniformity was not found as far as medial vs lateral (3 vs 2), anterior vs posterior (2 vs 2, 1 N/A), and right vs left (3 vs 2). For ablated tumors, all four tumors were right sided, anterior, medial, and lower pole. Initial signs and symptoms include sepsis (2), flank pain (5), and asymptomatic hydronephrosis (2). Concomitant urinoma (2) and retroperitoneal abscess (1) was found on imaging. Initial management included ureteral stenting (5) and percutaneous nephrostomy tube (4). Three underwent nephrectomy. Two had spontaneous resolution of DPUS after a course of ureteral stenting. Conclusion: Potential risk factors associated with DPUS after nephron-sparing treatment, including medial and lower pole tumors, and particularly right-sided anterior masses for ablation and higher complexity nephrometry score for PN. Recognition of delayed symptoms and imaging abnormalities in the surveillance period should cue clinical suspicion to DPUS.
Collapse
Affiliation(s)
- Alexander K Chow
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rohit Bhatt
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David Cao
- Division of Urology, Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brandon Wahba
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christopher L Coogan
- Division of Urology, Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Srinivas Vourganti
- Division of Urology, Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward E Cherullo
- Division of Urology, Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Sam B Bhayani
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ramakrishna J Venkatesh
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert Sherb Figenshau
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
40
|
Horiguchi A. Editorial Comment to Buccal mucosal ureteroplasty for the management of ureteric strictures: A systematic review of the literature. Int J Urol 2020; 28:195. [PMID: 33236387 DOI: 10.1111/iju.14449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Akio Horiguchi
- Department of Urology, National Defense Medical College, Saitama, Japan
| |
Collapse
|
41
|
Lee M, Lee Z, Koster H, Jun M, Asghar AM, Lee R, Strauss D, Patel N, Kim D, Komaravolu S, Drain A, Metro MJ, Zhao L, Stifelman M, Eun DD. Intermediate-term outcomes after robotic ureteral reconstruction for long-segment (≥4 centimeters) strictures in the proximal ureter: A multi-institutional experience. Investig Clin Urol 2020; 62:65-71. [PMID: 33258325 PMCID: PMC7801167 DOI: 10.4111/icu.20200298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/24/2020] [Accepted: 08/06/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose To report our intermediate-term, multi-institutional experience after robotic ureteral reconstruction for the management of long-segment proximal ureteral strictures. Materials and Methods We retrospectively reviewed our Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database to identify all patients who underwent robotic ureteral reconstruction for long-segment (≥4 centimeters) proximal ureteral strictures between August 2012 and June 2019. The primary surgeon determined the specific technique to reconstruct the ureter at time of surgery based on the patient's clinical history and intraoperative findings. Our primary outcome was surgical success, which we defined as the absence of ureteral obstruction on radiographic imaging and absence of obstructive flank pain. Results Of 20 total patients, 4 (20.0%) underwent robotic ureteroureterostomy (RUU) with downward nephropexy (DN), 2 (10.0%) underwent robotic ureterocalycostomy (RUC) with DN, and 14 (70.0%) underwent robotic ureteroplasty with buccal mucosa graft (RU-BMG). Median stricture length was 4 centimeters (interquartile range [IQR], 4–4; maximum, 5), 6 centimeters (IQR, 5–7; maximum, 8), and 5 centimeters (IQR, 4–5; maximum, 8) for patients undergoing RUU with DN, RUC with DN, and RU-BMG, respectively. At a median follow-up of 24 (IQR, 14–51) months, 17/20 (85.0%) cases were surgically successful. Two of four patients (50.0%) who underwent RUU with DN developed stricture recurrences within 3 months. Conclusions Long-segment proximal ureteral strictures may be safely and effectively managed with RUC with DN and RU-BMG. Although RUU with DN can be utilized, this technique may be associated with a higher failure rate.
Collapse
Affiliation(s)
- Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
| | - Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Helaine Koster
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Minsuk Jun
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY, USA
| | - Aeen M Asghar
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Randall Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - David Strauss
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Neel Patel
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Daniel Kim
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Sreeya Komaravolu
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Alice Drain
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY, USA
| | - Michael J Metro
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Lee Zhao
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY, USA
| | - Michael Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | |
Collapse
|
42
|
Heijkoop B, Kahokehr AA. Buccal mucosal ureteroplasty for the management of ureteric strictures: A systematic review of the literature. Int J Urol 2020; 28:189-195. [DOI: 10.1111/iju.14426] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/07/2020] [Indexed: 12/16/2022]
Affiliation(s)
| | - Arman A Kahokehr
- SA Health Adelaide South Australia Australia
- Flinders University Adelaide South Australia Australia
| |
Collapse
|
43
|
Moynihan MJ, Mandeville JA, Flacke S, Moinzadeh A. A Novel Technique of Ureteral Stricture Measurement: Impact on Diagnosis and Subsequent Management. J Endourol Case Rep 2020; 6:160-162. [PMID: 33102716 DOI: 10.1089/cren.2019.0145] [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: 11/13/2022] Open
Abstract
Background: Appropriate surgical management of ureteral strictures is dependent on not only the etiology of the stricture but also its location and characteristics. Stricture length and location play a significant role in potential surgical options, yet accurate evaluation of these features is limited. We present a case of a complex ureteral stricture where employment of an endoscopic tool in a novel manner helped to better evaluate the patient and provide more precise counseling in the preoperative setting. Case Presentation: A 65-year-old Caucasian man with a history of nephrolithiasis developed a complex ureteral stricture secondary to his calculus disease and prior instrumentation. His stricture was causing obstruction of his left collecting system and the patient was interested in a reconstructive procedure. We present a novel use for a pre-existing endoscopic tool that helped to more accurately delineate the characteristics of his ureteral stricture and improved preoperative planning. Conclusion: Determination of precise stricture length and location is of utmost importance for preoperative patient counseling and surgical planning. Where more sophisticated calibration technology is not available, use of an angiographic catheter during diagnostic endoscopy can improve preoperative assessment and surgical planning for complex ureteral reconstructive procedures.
Collapse
Affiliation(s)
- Matthew J Moynihan
- Department of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Jessica A Mandeville
- Department of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Sebastian Flacke
- Department of Interventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Alireza Moinzadeh
- Department of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| |
Collapse
|
44
|
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.
Collapse
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
| |
Collapse
|
45
|
Asghar AM, Lee Z, Lee RA, Slawin J, Cheng N, Koster H, Strauss DM, Lee M, Reddy R, Drain A, Lama-Tamang T, Jun MS, Metro MJ, Ahmed M, Stifelman M, Zhao L, Eun DD. Robotic Ureteral Reconstruction in Patients with Radiation-Induced Ureteral Strictures: Experience from the Collaborative of Reconstructive Robotic Ureteral Surgery. J Endourol 2020; 35:144-150. [PMID: 32814443 DOI: 10.1089/end.2020.0643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: Management of radiation-induced ureteral stricture (RIUS) is complex, requiring chronic drainage or morbid definitive open reconstruction. Herein, we report our multi-institutional comprehensive experience with robotic ureteral reconstruction (RUR) in patients with RIUSs. Patients and Methods: In a retrospective review of our multi-institutional RUR database between January 2013 and January 2020, we identified patients with RIUSs. Five major reconstruction techniques were utilized: end-to-end (anastomosing the bladder to the transected ureter) and side-to-side (anastomosing the bladder to an anterior ureterotomy proximal to the stricture without ureteral transection) ureteral reimplantation, buccal or appendiceal mucosa graft ureteroplasty, appendiceal bypass graft, and ileal ureter interposition. When necessary, adjunctive procedures were performed for mobility (i.e., psoas hitch) and improved vascularity (i.e., omental wrap). Outcomes of surgery were determined by the absence of flank pain (clinical success) and absence of obstruction on imaging (radiological success). Results: A total of 32 patients with 35 ureteral units underwent RUR with a median stricture length of 2.5 cm (interquartile range [IQR] 2-5.5). End-to-end and side-to-side reimplantation techniques were performed in 21 (60.0%) and 8 (22.9%) RUR cases, respectively, while 4 (11.4%) underwent an appendiceal procedure. One patient (2.9%) required buccal mucosa graft ureteroplasty, while another needed an ileal ureter interposition. The median operative time was 215 minutes (IQR 177-281), estimated blood loss was 100 mL (IQR 50-150), and length of stay was 2 days (IQR 1-3). One patient required repair of a small bowel leak. Another patient died from a major cardiac event and was excluded from follow-up calculations. At a median follow-up of 13 months (IQR 9-22), 30 ureteral units (88.2%) were clinically and radiologically effective. Conclusion: RUR can be performed in patients with RIUSs with excellent outcomes. Surgeons must be prepared to perform adjunctive procedures for mobility and improved vascularity due to poor tissue quality. Repeat procedures for RIUSs heighten the risk of necrosis and failure.
Collapse
Affiliation(s)
- Aeen M Asghar
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Randall A Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Jeremy Slawin
- Department of Urology, New York University, Langone Medical Center, New York City, New York, USA
| | - Nathan Cheng
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Helaine Koster
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - David M Strauss
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Rohit Reddy
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Alice Drain
- Department of Urology, New York University, Langone Medical Center, New York City, New York, USA
| | - Tenzin Lama-Tamang
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Min S Jun
- Department of Urology, New York University, Langone Medical Center, New York City, New York, USA
| | - Michael J Metro
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Mutahar Ahmed
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Michael Stifelman
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Lee Zhao
- Department of Urology, New York University, Langone Medical Center, New York City, New York, USA
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
46
|
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.
Collapse
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
| |
Collapse
|
47
|
Lee Z, Lee M, Koster H, Lee R, Cheng N, Jun M, Slawin J, Zhao LC, Stifelman MD, Eun DD. A Multi-Institutional Experience With Robotic Ureteroplasty With Buccal Mucosa Graft: An Updated Analysis of Intermediate-Term Outcomes. Urology 2020; 147:306-310. [PMID: 32798516 DOI: 10.1016/j.urology.2020.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To update our prior multi-institutional experience with robotic ureteroplasty with buccal mucosa graft and analyze our intermediate-term outcomes. Although our previous multi-institutional report provided significant insight into the safety and efficacy associated with robotic ureteroplasty with buccal mucosa graft, it was limited by small patient numbers. METHODS We retrospectively reviewed our multi-institutional database to identify all patients who underwent robotic ureteroplasty with buccal mucosa graft between October 2013 and March 2019 with ≥12 months follow up. Indication for surgery was a complex proximal and/or middle ureteral stricture not amenable to primary excision and anastomosis secondary to stricture length or peri-ureteral fibrosis. Surgical success was defined as the absence of obstructive flank pain and ureteral obstruction on functional imaging. RESULTS Of 54 patients, 43 (79.6 %) patients underwent an onlay, and 11 (20.4%) patients underwent an augmented anastomotic robotic ureteroplasty with buccal mucosa graft. Eighteen of 54 (33.3%) patients previously failed a ureteral reconstruction. The median stricture length was 3.0 (IQR 2.0-4.0, range 1-8) centimeters. There were 3 of 54 (5.6%) major postoperative complications. The median length of stay was 1.0 (IQR 1.0-3.0) day. At a median follow-up of 27.5 (IQR 21.3-38.0) months, 47 of 54 (87.0%) cases were surgically successful. Stricture recurrences were diagnosed ≤2 months postoperatively in 3 of 7 (42.9%) patients, and ≥10 months postoperatively in 4 of 7 (57.1%) patients. CONCLUSION Robotic ureteroplasty with buccal mucosa graft is associated with low peri-operative morbidity and excellent intermediate-term outcomes.
Collapse
Affiliation(s)
- Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
| | - Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Helaine Koster
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Randall Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Nathan Cheng
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Min Jun
- Department of Urology, Grossman School of Medicine at New York University Langone Health, New York, NY
| | - Jeremy Slawin
- Department of Urology, Grossman School of Medicine at New York University Langone Health, New York, NY
| | - Lee C Zhao
- Department of Urology, Grossman School of Medicine at New York University Langone Health, New York, NY
| | - Michael D Stifelman
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | | |
Collapse
|
48
|
Onlay Repair Technique for the Management of Ureteral Strictures: A Comprehensive Review. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6178286. [PMID: 32775430 PMCID: PMC7407031 DOI: 10.1155/2020/6178286] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 01/12/2023]
Abstract
Ureteroplasty using onlay grafts or flaps emerged as an innovative procedure for the management of proximal and midureteral strictures. Autologous grafts or flaps used commonly in ureteroplasty include the oral mucosae, bladder mucosae, ileal mucosae, and appendiceal mucosae. Oral mucosa grafts, especially buccal mucosa grafts (BMGs), have gained wide acceptance as a graft choice for ureteroplasty. The reported length of BMG ureteroplasty ranged from 1.5 to 11 cm with success rates of 71.4%-100%. However, several studies have demonstrated that ureteroplasty using lingual mucosa grafts yields better recipient site outcomes and fewer donor site complications than that using BMGs. In addition, there is no essential difference in the efficacy and complication rates of BMG ureteroplasty using an anterior approach or a posterior approach. Intestinal graft or flap ureteroplasty was also reported. And the reported length of ileal or appendiceal flap ureteroplasty ranged from 1 to 8 cm with success rates of 75%-100%. Moreover, the bladder mucosa, renal pelvis wall, and penile/preputial skin have also been reported to be used for ureteroplasty and have achieved satisfactory outcomes, but each graft or flap has unique advantages and potential problems. Tissue engineering-based ureteroplasty through the implantation of patched scaffolds, such as the small intestine submucosa, with or without cell seeding, has induced successful ureteral regeneration structurally close to that of the native ureter and has resulted in good functional outcomes in animal models.
Collapse
|
49
|
Lee M, Lee Z, Strauss D, Jun MS, Koster H, Asghar AM, Lee R, Chao B, Cheng N, Ahmed M, Lovallo G, Munver R, Zhao LC, Stifelman MD, Eun DD. Multi-institutional Experience Comparing Outcomes of Adult Patients Undergoing Secondary Versus Primary Robotic Pyeloplasty. Urology 2020; 145:275-280. [PMID: 32687842 DOI: 10.1016/j.urology.2020.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To describe surgical techniques and peri-operative outcomes with secondary robotic pyeloplasty (RP), and compare them to those of primary RP. METHODS We retrospectively reviewed our multi-institutional, collaborative of reconstructive robotic ureteral surgery (CORRUS) database for all consecutive patients who underwent RP between April 2012 and September 2019. Patients were grouped according to whether they underwent a primary or secondary pyeloplasty (performed for a recurrent stricture after previously failed pyeloplasty). Perioperative outcomes and surgical techniques were compared using nonparametric independent sample median tests and chi-square tests; P < .05 was considered significant. RESULTS Of 158 patients, 28 (17.7%) and 130 (82.3%) underwent secondary and primary RP, respectively. Secondary RP, compared to primary RP, was associated with a higher median estimated blood loss (100.0 vs 50.0 milliliters, respectively; P < .01) and longer operative time (188.0 vs 136.0 minutes, respectively; P = .02). There was no difference in major (Clavien >2) complications (P = .29). At a median follow-up of 21.1 (IQR: 11.8-34.7) months, there was no difference in success between secondary and primary RP groups (85.7% vs 92.3%, respectively; P = .44). Buccal mucosa graft onlay ureteroplasty was performed more commonly (35.7% vs 0.0%, respectively, P < .01) and near-infrared fluorescence imaging with indocyanine green was utilized more frequently (67.9% vs 40.8%, respectively; P < .01) for secondary vs primary repair. CONCLUSION Although performing secondary RP is technically challenging, it is a safe and effective method for recurrent ureteropelvic junction obstruction after a previously failed pyeloplasty. Buccal mucosa graft onlay ureteroplasty and utilization of near-infrared fluorescence with indocyanine green may be particularly useful in the re-operative setting.
Collapse
Affiliation(s)
- Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
| | - Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - David Strauss
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Min Suk Jun
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Helaine Koster
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Aeen M Asghar
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Randall Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Brian Chao
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Nathan Cheng
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Mutahar Ahmed
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Gregory Lovallo
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Ravi Munver
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Lee C Zhao
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Michael D Stifelman
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | | |
Collapse
|
50
|
Jun MS, Stair S, Xu A, Lee Z, Asghar AM, Strauss D, Stifelman MD, Eun D, Zhao LC. A Multi-Institutional Experience With Robotic Appendiceal Ureteroplasty. Urology 2020; 145:287-291. [PMID: 32681918 DOI: 10.1016/j.urology.2020.06.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To report a multi-institutional experience with robotic appendiceal ureteroplasty. METHODS This is a retrospective review of 13 patients undergoing right appendiceal flap ureteroplasty at 2 institutions between April 2016 and October 2019. The primary endpoint was surgical success defined by the absence of flank pain and radiographic evidence of ureteral patency. RESULTS Eight of 13 (62%) underwent appendiceal onlay while 5/13 (38%) underwent appendiceal interposition. Mean length of stricture was 6.5 cm (range 1.5-15 cm) affecting anywhere along the right ureter. Mean operative time was 337 minutes (range 206-583), mean estimated blood loss was 116 mL (range 50-600), and median length of stay was 2.5 days (range 1-9). Balloon dilation was required in 1/12 (8%). One patient died on postoperative day 0 due to a sudden cardiovascular event. Otherwise, there were no complications (Clavien-Dindo > 2) within 30 days from surgery. At a mean follow up of 14.6 months, 11/12 (92%) were successful. CONCLUSION Robotic appendiceal ureteroplasty for right ureteral strictures is a versatile technique with high success rates across institutions.
Collapse
Affiliation(s)
- Min Suk Jun
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Sabrina Stair
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Alex Xu
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Aeen M Asghar
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - David Strauss
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Michael D Stifelman
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall, Hackensack, NJ
| | - Daniel Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Lee C Zhao
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY.
| | | |
Collapse
|