1
|
Cho EY, Chaudry AE, Puri D, Kim S, Viers BR, Witthaus M, Buckley JC. Outcomes of Robot-Assisted Appendiceal Ureteroplasty from a Multi-institutional Experience. Urology 2024:S0090-4295(24)00628-9. [PMID: 39069159 DOI: 10.1016/j.urology.2024.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES To evaluate the viability of robot-assisted appendiceal ureteroplasty as an innovative surgical approach for the reconstruction of ureteral strictures in cases where traditional methods are unsuitable. METHODS We conducted a retrospective review of 14 patients who underwent robot assisted appendiceal ureteroplasty for right sided UTSD at three academic centers between March 2018 and November 2022. Patients were selected based on stricture characteristics, tissue quality, and the need for tissue transfer techniques. Surgical outcomes, including stricture-free rates, renal function, and complication rates, were analyzed. RESULTS The median patient age was 63 years, with a balanced gender distribution. The median stricture length was 4.75 cm. The majority of strictures were located in the proximal ureter (50%). Surgical approaches included appendiceal onlay flaps (71.4%) and interposition flaps (28.6%). The median operative time was 268 minutes, with an average estimated blood loss of 75 mL. Postoperatively, ureteral patency was achieved in 92.9% of patients. Two patients (14.3%) experienced urinary tract infections requiring readmission. There was no significant change in serum creatinine levels postoperatively. Hydronephrosis grade significantly improved following surgery (p = 0.025). CONCLUSIONS Robot-assisted appendiceal ureteroplasty is a safe and effective technique for managing ureteral strictures. It offers a high success rate with minimal complications, making it a valuable addition to the urologic surgeon's armamentarium for complex ureteral reconstructions.
Collapse
Affiliation(s)
- Eric Y Cho
- Department of Urology, University of California San Diego, San Diego, CA
| | - Ameen E Chaudry
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Dhruv Puri
- Department of Urology, University of California San Diego, San Diego, CA.
| | - Sunchin Kim
- Department of Urology, University of Arizona College of Medicine - Tucson, Tucson, AZ
| | | | | | - Jill C Buckley
- Department of Urology, University of California San Diego, San Diego, CA
| |
Collapse
|
2
|
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
|
3
|
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
|
4
|
Avci E, Atıcı SD, Uylas U, Kamer E. Stentless repair of left urethral defect with appendiceal interposition: A case report. Int J Surg Case Rep 2022; 91:106805. [PMID: 35121285 PMCID: PMC8818895 DOI: 10.1016/j.ijscr.2022.106805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Various methods have been described in the repair of ureteral defects. Here, it is aimed to present the repair performed with appendiceal interposition without any double J stent for the left ureteral defect in a patient who was operated on urgently due to obstruction with metastatic and locally advanced colon tumor. CASE PRESENTATION An 82-year-old male patient was taken to an emergency operation with the diagnosis of ileus. A tumor involving the left ureter was detected in the sigmoid colon, and a 6 cm defect occurred in the left ureter after resection. This defect was repaired with appendiceal interposition without double J stent placement. Hydroureteronephrosis and stricture were not observed in the patient's 2nd and 8th-month follow-up imaging. CONCLUSION The appendix interposition for left ureter reconstruction is a safe and feasible option. Also, this procedure can be done without any ureteral stent.
Collapse
Affiliation(s)
- Emran Avci
- University of Health Sciences, Tepecik Training and Research Hospital, Tepecik, İzmir, Turkey
| | - Semra Demirli Atıcı
- University of Health Sciences, Tepecik Training and Research Hospital, Tepecik, İzmir, Turkey
| | - Ufuk Uylas
- University of Health Sciences, Tepecik Training and Research Hospital, Tepecik, İzmir, Turkey.
| | - Erdinc Kamer
- University of Health Sciences, Tepecik Training and Research Hospital, Tepecik, İzmir, Turkey
| |
Collapse
|
5
|
Damaskos C, Garmpis N, Nikolettos K, Patsouras A, Schizas D, Garmpi A, Georgakopoulou VE, Syllaios A, Dimitroulis D. Comment on renal autotransplantation: A final option to preserve the kidney after an iatrogenic ureteral injury. Arch Ital Urol Androl 2021; 93:497-498. [PMID: 34933543 DOI: 10.4081/aiua.2021.4.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
To the Editor, Autologous Renal Transplantation (ART) since firstly described in 1963 by Hardy, has been used in various cases. There are various reasons for the transplantation such as iatrogenic ureteral damage, chronic kidney pain, unresectable renal tumors or renovascular diseases. Indications concerning the suitable patients for this kind of procedure are gradually increasing. Nevertheless, each case is unique, and the treatment must be personalized [...].
Collapse
Affiliation(s)
- Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, Athens; N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens.
| | - Nikolaos Garmpis
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens and Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens.
| | - Konstantinos Nikolettos
- Obstetric and Gynecologic Clinic, Medical School, Democritus University of Thrace, Alexandroupolis.
| | - Alexandros Patsouras
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens.
| | - Dimitrios Schizas
- First Department of Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens.
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens.
| | | | - Athanasios Syllaios
- First Department of Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens.
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens.
| |
Collapse
|
6
|
O'Rourke TK, Gn M, Patel HV, Fakes C, Jones N, Cancian M, Elsamra SE. The Urologist and the Appendix: A Review of Appendiceal Use in Genitourinary Reconstructive Surgery. Urology 2021; 159:10-15. [PMID: 34695504 DOI: 10.1016/j.urology.2021.10.007] [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: 07/05/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022]
Abstract
Recently, genitourinary reconstruction has experienced a renaissance. Over the past several years, there has been an expansion of the literature regarding the use of buccal mucosa for the repair of complex ureteral strictures and other pathologies. The appendix has been an available graft utilized for the repair of ureteral stricture disease and has been infrequently reported since the early 1900s. This review serves to highlight the use of the appendix for reconstruction in urology, particularly focusing on the anatomy and physiology of the appendix, historical use, and current applications, particularly in robotic upper tract reconstruction.
Collapse
Affiliation(s)
- Timothy K O'Rourke
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Martus Gn
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Hiren V Patel
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Christina Fakes
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nyasia Jones
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Madeline Cancian
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sammy E Elsamra
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| |
Collapse
|
7
|
Koszutski T, Smyczek Krakowczyk D, Pastuszka A, Tobor S, Kudela G, Hyla-Klekot L. 28 years of functioning of the ileal ureter - own experience and systematic review. J Pediatr Urol 2021; 17:692-699. [PMID: 34162519 DOI: 10.1016/j.jpurol.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
A SHORT INTRODUCTION Irreversible ureteral damage is a rare and challenging problem for pediatric urologists. Ileal replacement has become one of the limited surgical options for ureteral reconstruction. Only a few papers have examined the results of the ileal ureter and renal function outcomes. Furthermore, there are even fewer papers showing patients with the intestinal ureter, which is used to drain urine from a solitary kidney in early childhood. AN OBJECTIVE To perform a systematic review and analyze available cases of the long-term function of the "neoureter" and differences in the surgical approach. To present the case of a 29-year-old female with a history of ileal replacement of the ureter in a solitary kidney which was performed in this patient at the age of 14 months. STUDY DESIGN PubMed and Scopus were used to search for eligible articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were strictly followed. Based on the titles, abstracts, and full-text reviews, 77 articles were analyzed, of which only 23 were directly related to pediatric cases of our interest. Medical records of the female patient, who has been treated in our center since 1991, were retrospectively described and reviewed. RESULTS Of 23 papers, we identified 75 cases of children who underwent ureteral substitution. The outcomes of the procedure are satisfactory and acceptable. The presented case of the female patient shows a good therapeutic option. CONCLUSION Ileal ureteral reconstruction is a safe and effective therapeutic option (even in a long-term follow-up). Despite many problems and complications, it allows preservation of renal and bladder function and social dryness.
Collapse
Affiliation(s)
- T Koszutski
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| | - D Smyczek Krakowczyk
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland.
| | - A Pastuszka
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| | - Sz Tobor
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| | - G Kudela
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| | - L Hyla-Klekot
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| |
Collapse
|
8
|
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
|
9
|
George DP, Venkatachalapathy VSS, Abraham GP. Laparoscopic appendicular interposition ureteroplasty for mid-ureteral defect. Indian J Urol 2021; 37:189-190. [PMID: 34103807 PMCID: PMC8173952 DOI: 10.4103/iju.iju_117_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/14/2020] [Accepted: 10/11/2020] [Indexed: 11/04/2022] Open
Abstract
Patients with ureteral defects and salvageable renal units present a challenge in reconstructive urology. Vermiform appendix interposition is an option in the management of mid-ureteral defects that can not be managed by primary ureteroureterostomy. Laparoscopic appendicular interposition ureteroplasty is a technically demanding and an infrequently attempted procedure. We present a video demonstration of laparoscopic appendicular interposition for a 4-cm long right mid-ureteral defect in an elderly male. Laparoscopic appendicular interposition ureteroplasty for mid-ureteral defects can provide good long-term functional outcomes with results comparable to an open approach and has the advantage of reduced morbidity.
Collapse
|
10
|
Reconstruction of full-length ureter defects by laparoscopic bladder flap forming. Sci Rep 2021; 11:3970. [PMID: 33597578 PMCID: PMC7890060 DOI: 10.1038/s41598-021-83518-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022] Open
Abstract
To evaluate the safety and efficacy of laparoscopic bladder muscle flap reconstruction in the treatment of extensive ureteral avulsion.
Patients with full-length (re length > 20 cm) and upper ureteral (avulsion length > 10 cm) defects were eligible. All patients were treated with laparoscopic bladder muscle flap reconstruction. Peri-operative information and post-operative complications were recorded. The kidney function, urinary ultrasound or computed tomography (CT), sun-renal function tests emission computed tomography (ECT) and cystography after operation were recorded. Ten patients were included (7 with full-length and 3 with upper ureteral defects). Median age was 56 years and 70% of them were female. The average operation time and blood loss was 124 min and 92.2 ml. There was no treatment-related adverse effects including urinary leakage, renal colic, fever, etc. The median follow-up was 18.5 months (3–39 months). The surgery did not significantly alter the renal function and separation degree of the renal pelvis during long-term follow-up. Double J stents were removed in nine patients (90%) within six months after operation. Only one case was diagnosed with post-operative anastomotic stricture, and subsequently received laparoscopic ipsilateral nephrectomy one year after the reconstruction operation. All cases had normal voiding and pear-shaped cystography. Laparoscopic bladder flap repair is a safe and effective treatment approach together with several advantages for patients with full-length or upper ureteral avulsion.
Collapse
|
11
|
Sert İÜ, Aydın A. Case report series: management of complete ureteral avulsion with review of the relevant literature. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00047-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Endoscopic operations and ureteroscopy have become the first choice for ureteral calculi and ureter-related operations. The ratios of the complications, which are mostly iatrogenic, range between 9 and 11%. Total ureteral avulsion during URS is quite rare with a prevalence of 0–0.3%. We present three total ureteral avulsions we experienced in our clinic during the last 2 years and their treatment.
Case presentation
During the last 2 years, we experienced three total ureteral avulsions: one of these occurred in our clinic and the other two occurred in an external center and were referred to us. In two cases, the omental flap was rotated after ureteral reimplantation and the ureter was completely wrapped inside the omental flap. In the third case, boari flap was formed from the bladder. Due to the presence of extrarenal wide renal pelvis, anastomosis was made with boari flap after a y–v flap was rotated on the renal pelvis. D-J stents of the patients were removed at the end of 3 months. Although there was mild hydronephrosis, parenchymal thinning and a significant decrease in functions were not observed. Ureteral avulsion of the patients was successfully managed without the need for nephrectomy.
Conclusion
Ureteral avulsion management is an extremely difficult condition for both the surgeon and the patient. So, the most important thing is to prevent ureteral avulsion. Ureteroplasty and omental flap treatment are applicable methods with quite successful results for complete ureteral avulsions.
Collapse
|
12
|
Ureteral Avulsion during Semirigid Ureteroscopy: A Single-Centre Experience. Surg Res Pract 2020; 2020:3198689. [PMID: 33134480 PMCID: PMC7593724 DOI: 10.1155/2020/3198689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/02/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022] Open
Abstract
Aims The aim of the study is to present our experience with the management of ureteral avulsions following semirigid ureteroscopy for ureteral stones. This is one of the largest series reported so far. Methods and Materials It is a retrospective and observational study done at Sri Ramachandra Institute of Higher Education and Research over the last 18 years. Results There were seven cases of ureteral avulsion following semirigid ureteroscopy. All patients were males with a mean age of 35.7 years. All had impacted stones, with proximal ureteric location in 6 patients and distal ureteric location in 1 patient. Five cases had two-point avulsions with loss of entire ureter. Two cases had one-point avulsion: one distal ureteric and the other mid-ureteric. Of the five cases with whole length ureteral avulsion, four were managed by classical ileal replacement of ureter and the the fifth case was managed by ileal replacement of ureter by the Yang–Monti technique. Of the two cases with one-point avulsion, one was managed by uretero-neocystostomy and the other by uretero-ureterostomy. All the patients had successful outcome. Conclusions Even though rare, ureteral avulsion can potentially happen especially when dealing with impacted ureteric stones. Being conscious of the possible occurrence of this serious complication during any difficult ureteroscopy and exercising utmost care during the procedure are important preventive measures. However, this catastrophe can be successfully managed by either immediate definitive repair or in a staged manner.
Collapse
|
13
|
Burns ZR, Sawyer KN, Selph JP. Appendiceal Interposition for Ureteral Stricture Disease: Technique and Surgical Outcomes. Urology 2020; 146:248-252. [PMID: 32961223 DOI: 10.1016/j.urology.2020.07.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To report our initial experience with ureteral appendiceal interposition (UAI) in a series of adult patients undergoing ureteral reconstruction for ureteral stricture. METHODS We retrospectively collected data of patients who underwent UAI for ureteral stricture disease from December 2015 to March of 2020. Success of surgery was defined as one that required no subsequent procedural intervention for recurrent ureteral stricture disease, or loss of kidney function. RESULTS Eleven patients underwent UAI for ureteral stricture. Etiologies for stricture disease included radiation exposure, nephrolithiasis, and iatrogenic injury. Median follow-up was 363 days. Three patients had Clavien-Dindo class III complications during their hospitalization. No patient required repeat intervention due to recurrent ureteral stricture disease. On imaging, 9 patients had no obstruction on Lasix renal scan postoperatively, or improvement in hydronephrosis on CT scan. Two patients with poor renal function preop continued to show poor function after surgery. CONCLUSION The use of the appendix is a safe and feasible option for ureteral reconstruction in appropriately selected adult patients when primary ureteral repair is not possible.
Collapse
Affiliation(s)
| | | | - John Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
14
|
Wang J, Xiong S, Fan S, Yang K, Huang B, Zhang D, Zhu H, Ji M, Chen J, Sun J, Zhang P, Li X. Appendiceal Onlay Flap Ureteroplasty for the Treatment of Complex Ureteral Strictures: Initial Experience of Nine Patients. J Endourol 2020; 34:874-881. [PMID: 32323579 DOI: 10.1089/end.2020.0176] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the onlay technique using the appendix for ureteral reconstruction and describe the initial experience of nine operations performed by one surgeon. Methods: Nine patients with complex ureteral strictures who underwent appendiceal onlay flap ureteroplasty since May 2019 were recruited from our RECUTTER database. There were seven men and two women, with a mean age of 38.9 years; four patients underwent robot-assisted laparoscopic surgery, and five patients underwent traditional laparoscopic surgery. All patients had iatrogenic injuries of the ureter after treatment of stone disease. Seven patients had proximal ureteral strictures, and two had midureteral strictures. The mean stricture length of the nine patients was 3.9 (range 3-4.5) cm. Nephrostomy was performed in seven patients before they presented to our center, and the other two patients had indwelling Double-J ureteral stents. Results: All nine operations were effectively completed without open conversion. The mean operation time was 182 (range 135-220) minutes, the mean estimated blood loss was 71 (range 20-100) mL, and the mean length of postoperative hospital stay was 9 (range 6-12) days. No postoperative complications of high grade (Clavien-Dindo III and IV) occurred within 30 days of surgery. All the patients had their Double-J ureteral stents and nephrostomy tubes removed after complete ureteroscopy and upper urinary tract urodynamic examination or CTU, which showed that the anastomosis healed well and that the urinary tract was unobstructed, respectively. The objective success rate was 100% (all the patients had endoscopic and radiographic resolution of their ureteral strictures). The subjective success rate was 88.9% (one patient developed recurrent back discomfort and a 0.5 cm calculus was found in her renal pelvis). Conclusions: Appendiceal onlay flap ureteroplasty is a viable and effective technique for treating complex proximal and middle ureteral strictures at the right side.
Collapse
Affiliation(s)
- Jie Wang
- Department of Urology, National Urological Cancer Center, Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Shengwei Xiong
- Department of Urology, National Urological Cancer Center, Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Shubo Fan
- Department of Urology, National Urological Cancer Center, Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Kunlin Yang
- Department of Urology, National Urological Cancer Center, Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Bingwei Huang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Dengxiang Zhang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Mingfei Ji
- Department of Urology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Jie Chen
- Department of Urology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Jiantao Sun
- Department of Urology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, National Urological Cancer Center, Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| |
Collapse
|
15
|
Xiong S, Zhu W, Li X, Zhang P, Wang H, Li X. Intestinal interposition for complex ureteral reconstruction: A comprehensive review. Int J Urol 2020; 27:377-386. [PMID: 32189401 DOI: 10.1111/iju.14222] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/11/2020] [Indexed: 12/21/2022]
Abstract
Long ureteral defects have remained a challenge to urologists for a long time. Bowel interposition, including ileal ureter, appendiceal interposition and reconfigured colon substitution, has gained wide acceptance, even though it is a complicated procedure and associated with some potential complications. Mucus obstruction and metabolic disorders are common complications of intestinal substitution. To circumvent these troubles, modified techniques, such as tapering the bowel graft, intestinal onlay flap and the Yang-Monti procedure, are used. In particular, Yang-Monti ileal ureter replacement is a highly effective option for ureteral reconstruction, and the incidence of complications would be significantly reduced in select patients. After being combined with the Boari flap or psoas hitch technique, the length of intestinal segment used can also be significantly reduced. Most recent long-term results suggest that ileal ureter replacement with antireflux anastomosis seems to be remarkably free of complications, and we highly praise the distal nipple valve technique. Appendiceal interposition is available for patients with normal appendix, and usually this procedure is limited to reconstructing the right ureter. Appendiceal onlay ureteroplasty has emerged as a feasible and effective option to manage patients with complex proximal and mid-ureteral strictures of the right side. The colon is rarely used for ureteral reconstruction because of its large caliber and mucous surface area. However, a reconfigured colon segment is a good substitute to reconstruct long-segment ureteral defects, and long-term follow up confirmed minimal complications and improved renal function. This review provides a comprehensive perspective on complex ureteral reconstruction and replacement using intestinal segments, in particular, ileal ureter replacement.
Collapse
Affiliation(s)
- Shengwei Xiong
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Weijie Zhu
- 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
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - He Wang
- Department of Medical Imaging, Peking University First 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
| |
Collapse
|
16
|
Swift K, Borzi P. Resection of Symptomatic ureteric paraganglioma with appendiceal interposition. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
17
|
Stein R, Zahn K, Huck N. Current Indications and Techniques for the Use of Bowel Segments in Pediatric Urinary Tract Reconstruction. Front Pediatr 2019; 7:236. [PMID: 31245339 PMCID: PMC6581750 DOI: 10.3389/fped.2019.00236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/24/2019] [Indexed: 01/28/2023] Open
Abstract
Today, there are few indications for the use of bowel in pediatric urology. This is in large extent due to the successful conservative therapy in patients with neurogenic bladder and the improved success of primary reconstruction in patients with the bladder exstrophy-epispadias complex. Only after the failure of the maximum of conservative therapy or after failure of primary reconstruction, bladder augmentation, or urinary diversion should be considered. Malignant tumors of the lower urinary tract (e.g., rhabdomyosarcomas of the bladder/prostate) are other rare indications for urinary diversion. Replacement or reconstruction of the ureter with a bowel segment is also a quite rarely performed procedure. In this review, the advantages and disadvantages of the different options for the use of bowel segments for bladder augmentation, bladder substitution, urinary diversion, or ureter replacement during childhood and adolescence are discussed.
Collapse
Affiliation(s)
- Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | | | | |
Collapse
|
18
|
Divya PV, Ranade RR, Kulkarni P, Chandrashekhar V, DCruz ALJ. Urological Reconstructions in Gynecological Oncology. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-018-0244-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
19
|
Bilgutay AN, Kirsch AJ. Robotic Ureteral Reconstruction in the Pediatric Population. Front Pediatr 2019; 7:85. [PMID: 30968006 PMCID: PMC6439422 DOI: 10.3389/fped.2019.00085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/27/2019] [Indexed: 12/17/2022] Open
Abstract
Robot-assisted laparoscopic (RAL) surgery is a safe, minimally invasive technique that has become more widely used in pediatric urology over recent decades. With several advantages over standard laparoscopy, robotic surgery is particularly well-suited to reconstructive surgery involving delicate structures like the ureter. A robotic approach provides excellent access to and visualization of the ureter at all levels. Common applications include upper ureteral reconstruction (e.g., pyeloplasty, ureteropelvic junction polypectomy, ureterocalicostomy, and high uretero-ureterostomy in duplex systems), mid-ureteral reconstruction (e.g., mid uretero-ureterostomy for stricture or polyp), and lower ureteral reconstruction (e.g., ureteral reimplantation and lower ureter-ureterostomy in duplex systems). Herein, we describe each of these robotic procedures in detail.
Collapse
Affiliation(s)
- Aylin N Bilgutay
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Andrew J Kirsch
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| |
Collapse
|
20
|
Laparoscopic appendiceal interposition pyeloplasty for long ureteric strictures in children. J Pediatr Urol 2018; 14:551.e1-551.e5. [PMID: 30082131 DOI: 10.1016/j.jpurol.2018.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 06/19/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The management of long ureteric strictures is very challenging, and ureteral substitution is necessary when end-to-end anastomosis can not be accomplished. OBJECTIVE To evaluate the mid-term results of laparoscopic appendiceal interposition pyeloplasty in children with long ureteric strictures. METHODS Between March 2010 and September 2016 four patients (median age 24 months, male/female 3/1) underwent laparoscopic appendiceal interposition pyeloplasty at the current hospital. Two patients had previously failed pyeloplasty, one had a traffic injury, and one had iatrogenic ureteral injury (Summary Table). The intraoperative, postoperative and follow-up results were analyzed. Success was defined as clinical (subjective) and radiologic (objective) resolution of the stricture. RESULTS All surgeries were successfully completed without conversion. The mean stricture length was 4.5 cm. Two cases were right-sided strictures, and two were left-sided. The mean operative time and estimated blood loss were 238.5 min and 25.0 ml, respectively. No intraoperative complication was encountered. No Grade 3 or Grade 4 complication was observed after surgery. One was anastomosed in the antiperistaltic manner and three were in the isoperistaltic fashion. The mean postoperative hospital stay was 7.3 days. The success rate was 100% at a mean follow-up duration of 33.8 months. DISCUSSION There is no consensus on the best surgical approach for long ureteric strictures. Ureteric replacement with intestinal segments or kidney autotransplantation is a viable alternative treatment to long ureteric strictures. However, both methods are technically challenging with significant complications. Appendiceal interposition to restore ureteral continuity has been described in adult patients. The current results demonstrated that laparoscopic appendiceal interposition pyeloplasty is a safe and feasible minimally invasive approach for the treatment of long ureteral strictures in children. CONCLUSIONS Laparoscopic appendiceal interposition pyeloplasty was a viable minimally invasive alternative for children with long ureteric strictures on both left and right sides. Both isoperistaltic or antiperistaltic anastomosis were feasible.
Collapse
|
21
|
Staged ureteral reconstruction using the appendix in a complex pediatric patient. Urol Case Rep 2018; 21:98-100. [PMID: 30263890 PMCID: PMC6157467 DOI: 10.1016/j.eucr.2018.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/11/2018] [Accepted: 08/22/2018] [Indexed: 11/22/2022] Open
|
22
|
Dias Filho AC, Martinez CAT, Côrte MB, Maroccolo MVO. Left ureteral appendiceal interposition: exercise caution and do not be mislead by postoperative radiological obstruction. Int Braz J Urol 2017; 44:400-402. [PMID: 29211395 PMCID: PMC6050558 DOI: 10.1590/s1677-5538.ibju.2017.0295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/20/2017] [Indexed: 11/21/2022] Open
Abstract
Postoperative imaging after appendiceal ureteral interposition may be difficult to interpret, misguiding the urologist towards intervention. We present a case in which radiological obstruction was not endorsed by a 99TcDTPA nephrogram, with favorable outcome after conservative treatment.
Collapse
Affiliation(s)
| | | | - Maria Bianca Côrte
- Unidade de Proctologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil
| | | |
Collapse
|
23
|
Yarlagadda VK, Nix JW, Benson DG, Selph JP. Feasibility of Intracorporeal Robotic-Assisted Laparoscopic Appendiceal Interposition for Ureteral Stricture Disease: A Case Report. Urology 2017; 109:201-205. [DOI: 10.1016/j.urology.2017.08.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/25/2017] [Accepted: 08/15/2017] [Indexed: 02/08/2023]
|
24
|
Kumar P, Sarin YK. Use Of Appendix As Neoureter- A Ray Of Hope. J Neonatal Surg 2017; 6:64. [PMID: 28920024 PMCID: PMC5593483 DOI: 10.21699/jns.v6i3.576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/23/2017] [Indexed: 11/21/2022] Open
Abstract
A case of antenatally diagnosed hydronephrosis (later known to be PUJO complicated with urinoma and associated with hypoplasia of entire ureter) was treated using vermiform appendix as replacement.
Collapse
|
25
|
Gupta S, Kumar B, Basu S, Pal DK. Reconstruction of urethra using appendix in a patient with cloacal malformation. BMJ Case Rep 2017; 2017:bcr-2017-221198. [PMID: 28739627 DOI: 10.1136/bcr-2017-221198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of 21-year-old young woman with congenital cloacal malformation. She was operated at the age of 1.5 years separating the rectum from common opening as a two-stage repair. She was incontinent in the earlier part of her life but she became continent to some extent later in early adulthood. She presented with urinary stress incontinence following delivery of dead fetus of 6 months. She underwent multiple investigations revealing common opening of bladder neck and vagina. A multidisciplinary evaluation was done and she underwent closure of common channel and neourethra reconstruction using pedicled appendix. Patient was continent and voiding by herself on discharge.
Collapse
Affiliation(s)
- Sandeep Gupta
- Department of Urology, Institute of Post Graduate Medical Education and Research Kolkata, Kolkata, India
| | - Barun Kumar
- Department of Urology, Institute of Post Graduate Medical Education and Research Kolkata, Kolkata, India
| | - Sandip Basu
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research Kolkata, Kolkata, India
| |
Collapse
|
26
|
Yakupoglu YK, Aki FT, Kordan Y, Ozden E, Tonyali S, Bostanci Y, Vuruskan H, Bilen CY, Sarikaya S. Renal Autotransplantation at Three Academic Institutions in Turkey. Urol Int 2016; 97:466-472. [PMID: 27505010 DOI: 10.1159/000448482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/18/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The objective of this study is to present the experience of 3 institutions performing renal autotransplantation (RAT) and to discuss surgical techniques employed and the results in the light of the medical literature. MATERIALS AND METHODS A total of 14 patients (11 male and 3 female) with a mean age of 47 ± 8 years (35-61 years), who underwent RAT procedure at 3 different institutions between October 2006 and November 2014, in Turkey, were evaluated retrospectively. Indications for RAT procedure are ureteral avulsion, renal artery aneurysm and intimal dissection caused by percutaneous transluminal renal artery angioplasty (PTRA). Twelve patients with ureteral avulsion, 1 patient with renal artery aneurysm and 1 patient with intimal dissection caused by PTRA were followed-up for 103 months. Seven (50%) open and 7 (50%) laparoscopic nephrectomies were performed. Nine patients (64.3%) were right-sided and 5 patients (35.7%) were left-sided. Complications of grade III and above as per Clavien-Dindo classification were assessed. RESULTS Mean time from injury to RAT was 21.2 ± 40.1 days. However, 5 (35.7%) patients were treated on the same day of the injury. As per Clavien-Dindo classification, 2 (14.2%) grade IVa and 1 (7.1%) grade IIIa complications were reported. However, no significant correlation was observed between the complications and graft loss regarding type and side of the nephrectomy performed (p = 0.462 and p = 0.505, respectively) and timing of the intervention (p = 0.692). CONCLUSION RAT is a safe procedure in combination with minimally invasive laparoscopic technique in carefully selected patients; however, it requires expertise and proficiency in laparoscopy, reconstructive urology and transplantation. Nevertheless RAT should be considered as the last resort, when other modalities fail.
Collapse
|
27
|
Adani GL, Pravisani R, Baccarani U, Bolgeri M, Lorenzin D, Terrosu G, Girometti R, Cherchi V, Risaliti A. Extended Ureteral Stricture Corrected With Appendiceal Replacement in a Kidney Transplant Recipient. Urology 2015; 86:840-3. [PMID: 26141140 DOI: 10.1016/j.urology.2015.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 06/03/2015] [Accepted: 06/11/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To present our technique of ureteral replacement with an appendicovesicostomy for the treatment of extended ureteral stricture after kidney transplantation. Ureteral stricture represents a urologic complication that may cause progressive function impairment and graft loss. Symptomatic ureteral stenosis is generally treated with a percutaneous nephrostomy and ureteral stenting. This approach may be initially effective, but often does not offer a long-term solution. METHODS A 48-year-old Caucasian man underwent kidney transplantation from a heart-beating deceased donor. The graft was transplanted to the right iliac fossa. Ureterovesical anastomosis was performed following the Lich-Gregoir technique. The postoperative period and follow-up were uneventful. Six months later the patient experienced an episode of acute pyelonephritis with hydronephrosis. A percutaneous nephrostomy was inserted, and an anterograde pyelography confirmed proximal dilatation with severe distal stenosis involving the entire ureter including the ureterovesical anastomosis. A 9 French Double-J stent was inserted antegradely and the patient was prepared for surgery. RESULTS We decided therefore to use the appendix as a conduit between the proximal transplant ureter and the bladder It was interposed with an isoperistaltic orientation and anastomosed to the ureter proximally and to the bladder distally (Lich-Gregoir reimplantation) using interrupted absorbable 5/0 sutures over a 10-Fr Double-J stent. The urethral catheter was removed on day 9 postoperatively and the patient was discharged with normal parameters. At 1 year follow-up the patient remains well. CONCLUSION The positive outcome confirms how the use of appendix as ureteral replacement is feasible and effective, allowing the salvage of the renal allograft.
Collapse
Affiliation(s)
- Gian Luigi Adani
- Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy.
| | - Riccardo Pravisani
- Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy
| | - Umberto Baccarani
- Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy
| | - Marco Bolgeri
- Department of Urology, Darent Valley Hospital, Dartford, Kent, UK
| | - Dario Lorenzin
- Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy
| | - Giovanni Terrosu
- Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy
| | - Rossano Girometti
- Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy
| | - Vittorio Cherchi
- Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy
| | - Andrea Risaliti
- Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy
| |
Collapse
|
28
|
Duty BD, Kreshover JE, Richstone L, Kavoussi LR. Review of appendiceal onlay flap in the management of complex ureteric strictures in six patients. BJU Int 2015; 115:282-7. [PMID: 24471943 DOI: 10.1111/bju.12651] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate appendiceal onlay flap ureteroplasty for repairing complex right proximal and mid-ureteric strictures. PATIENTS AND METHODS Between August 2006 and August 2012 four women and two men (mean age 34.2 years) underwent right laparoscopic appendiceal onlay flap ureteroplasty. The mean stricture length was 2.5 cm. Stricture formation was secondary to impacted ureteric stones in three patients and failed pyeloplasty for congenital pelvi-ureteric junction obstruction in the remaining three. Each patient had ipsilateral flank pain before surgery. RESULTS The mean operating time, estimated blood loss and hospital stay were 244 min, 175 mL and 3.2 days, respectively. No intra- or peri-operative complications were noted. The objective success rate was 100% (all patients had radiographic and/or endoscopic resolution of their ureteric strictures). The subjective success rate was 66%, (two patients developed recurrent discomfort, which upon exploration was found to be attributable to fibrosis away from the appendiceal onlay graft, where the gonadal vessels crossed the ureter). Both patients with recurrent pain underwent laparoscopic ureterolysis and bladder advancement flap proximal to the appendiceal onlay, which markedly improved one patient's pain but the other patient continued to have discomfort, ultimately resulting in a laparoscopic nephroureterectomy. CONCLUSIONS Appendiceal onlay ureteroplasty is a viable treatment option for patients with complex right proximal and mid-ureteric strictures, while minimising the potential morbidity of appendiceal and ileal interposition.
Collapse
Affiliation(s)
- Brian D Duty
- Oregon Health and Science University, Portland, OR, USA
| | | | | | | |
Collapse
|
29
|
Vincent MV, Doyle A, Bernstein S, Jackman S. Absence of the appendix discovered during childhood. SPRINGERPLUS 2014; 3:522. [PMID: 25279313 PMCID: PMC4166596 DOI: 10.1186/2193-1801-3-522] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 09/06/2014] [Indexed: 02/10/2023]
Abstract
Absence of the appendix is rare. Isolated cases are usually discovered in adult patients or cadavers. We report the case of a 14 year old boy who was found to have no appendix on laparotomy for assumed acute appendicitis and use this opportunity to highlight the growing surgical uses of this vestigial structure.
Collapse
Affiliation(s)
- Michelle V Vincent
- Department of Surgery, Queen Elizabeth Hospital, Martindales Road, St Michael, BB1115 Barbados
| | - Alex Doyle
- Department of Surgery, Queen Elizabeth Hospital, Martindales Road, St Michael, BB1115 Barbados
| | - Sean Bernstein
- Department of Surgery, Queen Elizabeth Hospital, Martindales Road, St Michael, BB1115 Barbados
| | - Selma Jackman
- Department of Surgery, Queen Elizabeth Hospital, Martindales Road, St Michael, BB1115 Barbados
| |
Collapse
|
30
|
Lazica DA, Brandt AS, Roth S. [Avoidance and management of complications in open surgical ureter reconstruction]. Urologe A 2014; 53:968-75. [PMID: 24934377 DOI: 10.1007/s00120-014-3499-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Open surgical reconstruction of the ureter is a urological procedure with a potentially high risk of complications. The correct selection of patients and time of operation are important aspects regarding the treatment strategy. Position and length of the affected ureter segment to be reconstructed determine the surgical intervention possibilities. The psoas hitch procedure is a well-established technique for distal reconstruction of the ureter where most iatrogenic injuries occur. In more proximal or complex defects, several procedures are available. Partial or complete replacement of the ureter with bowel is still considered the standard for bridging long ureteral defects but is accompanied with higher intra- and postoperative complication rates. In specific patients and situations, autotransplantation of the kidney and subcutaneous pyelovesical bypasses are clinical options. Using mucosal grafts or tissue engineering may be new therapeutic prospects to cover ureteral defects but the clinical impact still needs to be clarified. All therapeutic strategies share the fact that great surgical expertise and experience are necessary as the operative technique must be mastered to avoid severe complications.
Collapse
Affiliation(s)
- D A Lazica
- Klinik für Urologie und Kinderurologie, HELIOS Klinikum Wuppertal, Lehrstuhl der Universität Witten/Herdecke, Heusnerstraße 40, 42283, Wuppertal, Deutschland,
| | | | | |
Collapse
|
31
|
Ordorica R, Wiegand LR, Webster JC, Lockhart JL. Ureteral Replacement and Onlay Repair with Reconfigured Intestinal Segments. J Urol 2014; 191:1301-6. [DOI: 10.1016/j.juro.2013.11.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2013] [Indexed: 11/15/2022]
|
32
|
How to manage total avulsion of the ureter from both ends: our experience and literature review. Int Urol Nephrol 2013; 45:1553-60. [PMID: 23884730 DOI: 10.1007/s11255-013-0505-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the treatment alternatives of total avulsion of the ureter from both ends including ureteropelvic junction (UPJ) and ureterovesical junction (UVJ). METHODS Total ureteral avulsion on both ends of the ureter was examined in 4 cases performing ureteroscopy. In two male patients of the four cases, avulsion was noticed intraoperatively and ureteral re-anastomosis at UPJ and re-implantation at UVJ were performed immediately. Boari flap was performed for one female patient immediately and for the other female patient who was referred from another hospital after the ureteroscopy, 4 days later. RESULTS One patient who had ureteral re-implantation was followed with 3-month intervals by ultrasonography and abdominal X-ray. At the end of 1 year, it was determined that kidney parenchyma was normal and the patient had kidney and upper ureteral stones. Percutaneous nephrolithotomy was performed, and the patient was stone-free at the end of the operation. Two years after the surgery, both kidneys were normal. This is the only case who had a successful ureteral re-implantation in literature. The other patient turned up a year later for routine checks after the ureteral stent was removed. Then, hydronephrosis and renal atrophy were detected. The patient did not accept nephrectomy or any other intervention and he was lost to follow-up. Boari flap procedure was performed after UPJ repair for the other two female patients. Their kidneys were both normal 3 months after the operation. CONCLUSIONS In case of ureteral avulsion from both ends of the ureter in the male patients, as bladder capacity is not enough for a Boari flap, proximal anastomosis and distal re-implantation could be a good choice for the management of this untoward event. This new approach also saves time for reconstructive treatments if necessary. If bladder capacity is enough to reach UPJ, Boari flap could be a good choice in female patients.
Collapse
|
33
|
|
34
|
|
35
|
Corbetta JP, Weller S, Bortagaray JI, Durán V, Burek C, Sager C, Lopez JC. Ureteral replacement with appendix in pediatric renal transplantation. Pediatr Transplant 2012; 16:235-8. [PMID: 22151119 DOI: 10.1111/j.1399-3046.2011.01608.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ureteral necrosis is an uncommon complication following RT which can adversely affect outcome. Even though authors agree that the native ureter ought to be preserved, there are cases in which graft function can only be salvaged by ureteral substitution. The scant references in the literature on the use of the appendix for left ureteral replacement in children prompted us to report the following two cases in whom the technique was employed and to assess the evolution of graft function in these patients.
Collapse
Affiliation(s)
- Juan P Corbetta
- Department of Urology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
| | | | | | | | | | | | | |
Collapse
|
36
|
Handu AT, Garge S, Peters NJ, Kanojia RP, Rao KLN. Undiagnosed ureteroinguinal hernia with solitary kidney in a child with ureteric injury during herniotomy. J Pediatr Surg 2012; 47:799-802. [PMID: 22498400 DOI: 10.1016/j.jpedsurg.2012.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/04/2012] [Accepted: 01/04/2012] [Indexed: 11/28/2022]
Abstract
Iatrogenic ureteric injuries are an uncommon but difficult problem to manage. Although ureteric injury has been reported during hernia surgery in adults, it has not been reported in children during herniotomy. An 18-month-old male child underwent repair of an inguinal hernia and developed postoperative anuria. Investigations revealed that the patient had a solitary kidney and had injury to the solitary ureter. We successfully managed this patient using the vermiform appendix to replace a segment of the injured ureter. The possible mechanism of injury and the relevant literature are discussed.
Collapse
Affiliation(s)
- Abahilasha Tej Handu
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | | | | | | | | |
Collapse
|
37
|
Abstract
Ureteral injuries are caused by iatrogenic reasons in about 75% of cases. Among urological procedures ureterorenoscopy (URS) is mainly described as the reason for ureteral injury, although complication rates of URS are generally low. Injuries of the ureter are divided into five grades by the AAST. Grades I-II are referred to as partial and grades III-V as complex ureteral injuries. To avoid higher complication rates there should be no delay in confirmation of diagnosis and initiation of therapy. Correct therapy depends on grade of injury. Partial ureteral injuries are treated by endoscopic inlay of a ureteral stent for approximately 14-21 days. In complex injuries endoscopic ureteroureterostomy could be attempted but leads to rather poor long-term results depending on the length of devascularization of the injured ureter.Procedures with and without use of bowel for ureteral reconstruction and replacement have been described. The type of operative procedure should be selected based on location and degree of ureteral injury. Besides ureteral reconstruction, autotransplantation of the affected kidney can be required in individual cases.
Collapse
|
38
|
Obaidah A, Mane SB, Dhende NP, Acharya H, Goel N, Thakur AA, Arlikar J. Our Experience of Ureteral Substitution in Pediatric Age Group. Urology 2010; 75:1476-80. [DOI: 10.1016/j.urology.2009.07.1327] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 07/20/2009] [Accepted: 07/31/2009] [Indexed: 10/20/2022]
|
39
|
Pereira BMT, Ogilvie MP, Gomez-Rodriguez JC, Ryan ML, Peña D, Marttos AC, Pizano LR, McKenney MG. A review of ureteral injuries after external trauma. Scand J Trauma Resusc Emerg Med 2010; 18:6. [PMID: 20128905 PMCID: PMC2830948 DOI: 10.1186/1757-7241-18-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 02/03/2010] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma. Several anatomic and physiologic considerations are paramount regarding ureteral injuries management. LITERATURE REVIEW Eighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU) failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%). Complications occurred in 36.2% of cases. The mortality rate was 17%. CONCLUSION The mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis.
Collapse
Affiliation(s)
- Bruno MT Pereira
- DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami/Jackson Memorial Hospital, Ryder Trauma Center, Miami, FL, USA
| | - Michael P Ogilvie
- DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami/Jackson Memorial Hospital, Ryder Trauma Center, Miami, FL, USA
| | - Juan Carlos Gomez-Rodriguez
- DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami/Jackson Memorial Hospital, Ryder Trauma Center, Miami, FL, USA
- Universidad Militar Nueva Granada, Hospital Militar Central, Servicio de Cirurgia General, Bogotá, DC, Colombia
| | - Mark L Ryan
- DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami/Jackson Memorial Hospital, Ryder Trauma Center, Miami, FL, USA
| | - Diego Peña
- Universidad Militar Nueva Granada, Hospital Militar Central, Servicio de Cirurgia General, Bogotá, DC, Colombia
| | - Antonio C Marttos
- DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami/Jackson Memorial Hospital, Ryder Trauma Center, Miami, FL, USA
| | - Louis R Pizano
- DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami/Jackson Memorial Hospital, Ryder Trauma Center, Miami, FL, USA
| | - Mark G McKenney
- DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami/Jackson Memorial Hospital, Ryder Trauma Center, Miami, FL, USA
| |
Collapse
|
40
|
Kannaiyan L, Karl S, Mathai J, Chacko J, Sen S. Congenital ureteric stenosis: a study of 17 children. Pediatr Surg Int 2009; 25:513-7. [PMID: 19437024 DOI: 10.1007/s00383-009-2368-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2009] [Indexed: 11/29/2022]
Abstract
AIM To review cases of congenital ureteric stenosis treated in the period between 1999 and 2007. We propose to analyze the type of presentation, management and results. MATERIAL AND METHODS We report 17 children aged 20 days to 8 years with obstructive uropathy due to congenital stenosis of the ureter at one or more levels. This condition could be mistaken for the more common pelviureteric junction obstruction (PUJO) or primary megaureter, but it is a distinct and more serious anomaly. 13 of the 17 children had one or more associated anomalies, the most significant of which was a contralateral multicystic dysplastic kidney. Other associated anomalies included PUJO, megacalyx, vesicoureteric reflux, urogenital sinus, duplicate vagina, anorectal malformation and agenesis of the bladder. 16 children were symptomatic at presentation, with uremia (serum creatinine >1 mg/dl) in 5, while 1 was diagnosed antenatally. The correct preoperative diagnosis was made in only three children. Reconstruction included ureteroureteral anastomosis, ureteric reimplantation or ureteral substitution. RESULTS There is follow up for 15 of the 17 patients. Length of follow up ranges from 1 to 7 years (average 2.7 years). There was satisfactory urinary drainage established in all 17 cases and uremia has resolved 3 of the 5 children. The children with solitary functioning kidney are at risk of uremia in later life. CONCLUSION Congenital ureteric stenosis is a rare condition, but distinct anomaly with possible grave consequence and has been distinguished from other causes of congenital ureteric obstruction.
Collapse
|
41
|
Deyl RT, Averbeck MA, Almeida GL, Pioner GT, Souto CAV. Appendix interposition for total left ureteral reconstruction. J Pediatr Urol 2009; 5:237-9. [PMID: 19109072 DOI: 10.1016/j.jpurol.2008.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2008] [Accepted: 11/23/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Appendix interposition has been described as an option for surgical reconstruction of partial and total ureteral defects both in children and adults. However, to our knowledge, appendix interposition for a total left ureteral reconstruction has never been described. CASE REPORT We report the first case of total left ureteral reconstruction with cecal appendix to connect the renal pelvis of a native kidney to the urinary bladder in a 3-month-old child with ureteral necrosis following pyeloplasty. RESULTS Postoperative recovery was uneventful. Postoperative intravenous pyelogram showed good flow of dye from the pelvis past the appendicular graft into the bladder. After 6 months, the child was asymptomatic, within the normal growth curve for height and weight. CONCLUSION Total ureteral reconstruction with cecal appendix is a feasible technique in young children. Surveillance for late operative complications is required, since this is the first case of total left ureteral reconstruction with appendix to connect the renal pelvis of a native kidney to the urinary bladder.
Collapse
Affiliation(s)
- Rafael Trindade Deyl
- Urology Department, Santa Casa Hospital Complex, Santo Antonio Children's Hospital, Prof. Annes Dias Street, 285, Porto Alegre, Rio Grande do Sul 90020-090, Brazil
| | | | | | | | | |
Collapse
|