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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.
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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
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Singh J, Wang L, Smith TG, Graber W, Matin S, Pisters L, Lenaine Westney O. Ileal Interposition for Ureteral Reconstruction Following Treatment for Abdominopelvic Malignancy: Complications and Outcomes From a Comprehensive Cancer Center. Urology 2024; 183:215-220. [PMID: 37802194 DOI: 10.1016/j.urology.2023.09.026] [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: 07/19/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To characterize the outcomes of ileal interposition for the management of ureteral obstruction from tumor and ureteral stricture following treatment for abdominopelvic malignancy. MATERIALS AND METHODS A retrospective database analysis was performed for all cases of ileal interposition performed by 5 surgeons from January 2013 to December 2020. Patients were ≥18 years of age and included if undergoing ileal interposition in either the primary setting of a surgical procedure for tumor extirpation or in the delayed setting. RESULTS In total, 23 patients who underwent repair of 27 ureteral units were included. The mean age was 60.2 years. Median follow-up was 21.6 months. The most common primary diagnoses were urothelial (35%), colorectal (31%), and cervical (22%) cancer. The etiologies of ureteral obstruction were malignant in 48% and ureteral stricture in 52%. Types of repairs included unilateral interposition in 13 patients, bilateral interposition in 1 patient, interposition to an ileal conduit in 3 patients, and interposition with cystoplasty in 6 patients. There was a statistically significant difference between the mean preoperative (Creatinine 1.05 mg/dL, Estimated Glomerular Filtration Rate 77 ml/min/1.73 m2) renal function and postoperative (Creatinine 1.26 mg/dL, Estimated Glomerular Filtration Rate 67 mL/min/1.73 m2) renal function at the most recent follow-up (P = .024). Eight minor (grade 1-2) and 6 major (grade ≥3) complications developed for a minor and major complication rate of 35% and 26%, respectively. CONCLUSION Ileal interposition is successfully utilized as a reconstructive technique at the time of enbloc resection involving the ureter and to address ureteral stricture in the delayed setting.
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Affiliation(s)
- Jas Singh
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Lin Wang
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas G Smith
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William Graber
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Surena Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Louis Pisters
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - O Lenaine Westney
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
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3
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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.
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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
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Zaghbib S, Saadi A, Boussaffa H, Ayed H, Slama MRB. Management strategies and root causes of missed iatrogenic intraoperative ureteral injuries with delayed diagnosis: a retrospective cohort study of 40 cases. Patient Saf Surg 2023; 17:21. [PMID: 37496033 PMCID: PMC10373270 DOI: 10.1186/s13037-023-00372-x] [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: 05/30/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Intraoperative iatrogenic ureteral injuries represent rare technical surgical complications with the potential for adverse patient outcomes, particularly when the diagnosis is delayed. Ideally, these technical complications are recognized and repaired intraoperatively. This study was designed to investigate the root causes and outcomes of missed intraoperative ureteral injuries at a tertiary urology referral centre in Tunisia. METHODS This is a retrospective cohort study in a tertiary urology referral centre in Tunis from January 1st, 2015, to December 31st, 2020, including all patients with iatrogenic ureteral injury, not diagnosed intraoperatively. The factors associated with the success of endoscopic treatment and those associated with the unfavourable evolution were investigated. RESULTS A total of 40 iatrogenic ureteral injuries were included. Gynaecological surgery was responsible for 85% of ureteral injuries, mainly during hysterectomies (55%). The symptoms were dominated by low back pain (37.5%) and pyelonephritis (25%). Endoscopic treatment was attempted in 22 cases, it was sufficient in 12 cases. Ureteral injury required surgical treatment in 24 cases, and ureteroneocystostomy was performed in 16 cases. Nephrectomy was performed in eight cases, representing 20% of injuries, including three cases as the first treatment for late-diagnosed cases with a destroyed kidney. In the analytical study, endoscopic treatment was sufficient in 50% in case of ureteral fistula versus 27% in case of ureteral stenosis (p = 0.04). Nephrectomy was performed in 10% of cases when ureteral injury was diagnosed within the first month postoperatively compared to 60% of cases when this delay exceeded one month (p = 0.004). CONCLUSION Iatrogenic ureteral injuries discovered postoperatively are mostly secondary to gynaecologic surgery. Although endoscopic treatment is usually performed as a first treatment, a more aggressive surgical is often necessary, with a nephrectomy rate of 20%.
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Affiliation(s)
- Selim Zaghbib
- Urology department, Charles Nicolle Hospital, 1001 Boulevard du 09 Avril, Tunis, Tunisia.
| | - Ahmed Saadi
- Urology department, Charles Nicolle Hospital, 1001 Boulevard du 09 Avril, Tunis, Tunisia
| | - Hamza Boussaffa
- Urology department, Charles Nicolle Hospital, 1001 Boulevard du 09 Avril, Tunis, Tunisia
| | - Haroun Ayed
- Urology department, Charles Nicolle Hospital, 1001 Boulevard du 09 Avril, Tunis, Tunisia
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Soyster ME, Arnold PJ, Burns RT, Zappia JL, Roth JD, Francesca Monn M, Bihrle R, Mellon MJ. Ileal Ureter Utilization in Patients With Previous Urinary Diversions. Urology 2023; 177:184-188. [PMID: 37076019 DOI: 10.1016/j.urology.2023.04.001] [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: 02/06/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To evaluate a subset of patients who develop strictures requiring Ileal Ureter (IU) in the setting of prior urinary diversion or augmentation (ileal conduits, neobladders, continent urinary diversions). To our knowledge, there are no prior studies on patients with IU substitution into established lower urinary tract reconstructions. METHODS A retrospective review of patients (18 years) undergoing IU creation from 1989 to 2021 was performed. A total of 160 patients were identified. In total, 19 (12%) patients had IUs into diversions. We examined demographics, stricture cause, diversion type, renal function, and postoperative complications. RESULTS Nineteen patients were identified. Sixteen were male. Mean age was 57.7(SD 17.0) years. Diversions included continent urinary reservoirs (4), neobladders (5), ileal conduits (7), and bladder augmentations with Monti channels (3). Fifteen had unilateral surgery, and 4 had bilateral "reverse 7" IU creation. Average length of stay was 7.6 days (SD 2.9). Average follow-up was 32.9 months (SD 27). Mean preoperative creatinine was 1.5 (SD 0.4); mean postoperative creatinine at most recent follow-up was 1.6 (SD 0.7). There was no significant difference between pre- and postoperative creatinine (P = .18). One patient had a ventriculoperitoneal Shunt infection resulting ventriculoperitoneal shunt externalization, 1 had Clostridium difficile infection potentially causing an entero-neobladder fistula, 2 with ileus, 1 urine leak, and 1 wound infection. None required renal replacement therapy. CONCLUSION Patients with urinary diversions and prior bowel reconstructive surgeries with subsequent ureteral strictures are a challenging cohort of patients. In properly selected patients, ureteral reconstruction with ileum is feasible and preserves renal function with minimal long-term complications.
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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
| | - Jason L Zappia
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Joshua D Roth
- 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
| | - Richard Bihrle
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Matthew J Mellon
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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The suspended ileal loop for difficult Hartmann's reversal. Tech Coloproctol 2023; 27:243-246. [PMID: 36316535 DOI: 10.1007/s10151-022-02715-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hartmann's reversal can be complicated by the presence of dense adhesions in the upper part of the abdominal cavity, difficulties in freeing the splenic flexure with the risk of splenic tears, a lack of sufficient colonic length, the risk of ureteral lesion, or the risk of lesions of the vascular arcade. METHODS We propose a technique which consists of interposing an adapted segment of ileal loop between the end of the proximal colon and the rectum to restore intestinal continuity. RESULTS Two patients had Hartmann procedure, the first for a Hinchey stage 4 perforated diverticulitis and the second for a colorectal fistula due to ischemia of the proximal colonic segment. Hartmann's reversal was expected to be difficult, so a suspended ileal loop was used. The outcomes were uneventful, and functional results were satisfactory. CONCLUSIONS A suspended ileal loop could be used as a salvage procedure in some cases of potentially difficult Hartmann's reversal.
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7
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Han DS, Johnson JP, Schulster ML, Shah O. Indications for and results of renal autotransplantation. Curr Opin Nephrol Hypertens 2023; 32:183-192. [PMID: 36683544 DOI: 10.1097/mnh.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW To understand the indications and outcomes of renal autotransplantation, and when to consider this unique procedure for patients. RECENT FINDINGS Renal autotransplantation confers acceptably low rates of graft failure and prevents need for long-term dialysis. Renal autotransplantation remains an important management strategy in very select patients for complex renovascular disease, ureteral stricture disease, ureteral trauma, upper urinary tract urothelial carcinoma, renal cell carcinoma, and Loin-Pain Hematuria Syndrome. With advancements in minimally invasive procedures, the application of renal autotransplantation for refractory stone disease is rare but exists. Robot-assisted laparoscopic renal autotransplantation demonstrates reproducible graft success and complication rates with improved perioperative outcomes (ex. hospital length of stay) - though comparative studies are lacking. Patients would benefit from a multidisciplinary approach from renal transplant surgeons, vascular surgeons, urologists, nephrologists, dieticians, pain management providers, social workers, and psychiatrists. SUMMARY In experienced hands, renal autotransplantation is a reasonable treatment approach for complex and refractory renal vascular disease, Loin-Pain Hematuria Syndrome, ureteral strictures and trauma, upper urinary tract malignancy, and stone disease in highly select patients.
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Affiliation(s)
- David S Han
- Columbia University Irving Medical Center, Department of Urology
| | - Jeffrey P Johnson
- Weill Cornell Medical College, Department of Urology, New York, New York, USA
| | | | - Ojas Shah
- Columbia University Irving Medical Center, Department of Urology
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8
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Joosten JJ, Sharabiany S, Musters GD, Beerlage HP, Tanis PJ, Bemelman WA, Hompes R. Iatrogenic injury of the urinary tract during salvage procedures for pelvic sepsis: Experience of a national referral centre. Colorectal Dis 2022; 24:1397-1404. [PMID: 35698898 PMCID: PMC9796761 DOI: 10.1111/codi.16221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/21/2022] [Accepted: 06/06/2022] [Indexed: 01/07/2023]
Abstract
AIM This study aimed to determine the incidence, consequences and outcomes of iatrogenic urinary tract injury (IUI) during salvage surgery for pelvic sepsis. METHOD Patients who underwent salvage surgery for pelvic sepsis after prior low anterior resection or Hartmann's procedure for rectal cancer were prospectively maintained in a database between 2010 and 2020 and reviewed retrospectively. The primary endpoint was the incidence of IUI. Secondary endpoints were timing of diagnosis (intra- vs. postoperative), reinterventions related to the IUI and healing of IUI. RESULTS In total 126 consecutive patients were included, and IUI occurred in 13 patients (10%). A ureteric injury occurred in eight patients, bladder injury in four patients and a urethral injury in one patient. All patients with an IUI had radiotherapy as neoadjuvant treatment. The IUI was diagnosed postoperatively in 63% (n = 8/13) with a median duration between surgery and diagnosis of the IUI of 10 days (IQR: 6-15). The median number of reinterventions was five (range 1-31) in the group with a postoperative diagnosis and one (range 0-1) in the group with an intraoperative diagnosis. Four patients required a surgical reintervention, all concerning injuries diagnosed postoperatively. At the end of follow-up, 85% of patients (n = 11/13) had a healed IUI. CONCLUSION Iatrogenic urinary tract injury is not uncommon in salvage procedures for pelvic sepsis, even in an experienced tertiary referral centre. Most injuries were diagnosed postoperatively which affects the severity of these complications, emphasising the need to improve intraoperative diagnostic modalities.
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Affiliation(s)
- Johanna J. Joosten
- Department of Surgery, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Sarah Sharabiany
- Department of Surgery, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Gijsbert D. Musters
- Department of Surgery, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Harrie P. Beerlage
- Department of Urology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Pieter J. Tanis
- Department of Surgery, Amsterdam UMC, Cancer Centre AmsterdamUniversity of AmsterdamAmsterdamThe Netherlands,Department of Surgical Oncology and Gastrointestinal SurgeryRotterdamThe Netherlands
| | | | - Roel Hompes
- Department of Surgery, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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Takagi K, Matsumoto K, Taniguchi D, Machino R, Uchida F, Hara R, Oishi K, Yamane Y, Iwatake M, Eguchi M, Mochizuki Y, Nakayama K, Nagayasu T. Regeneration of the ureter using a scaffold-free live-cell structure created with the bio-three-dimensional printing technique. Acta Biomater 2022:S1742-7061(22)00662-6. [DOI: 10.1016/j.actbio.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022]
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韩 冠, 许 洋, 李 志, 孟 畅, 朱 宏, 杨 昆, 周 利, 李 学. [Ureteral stenosis following hematopoietic stem cell transplantation: A case report]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:762-765. [PMID: 35950405 PMCID: PMC9385521 DOI: 10.19723/j.issn.1671-167x.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Indexed: 06/15/2023]
Abstract
Ureteral stenosis is a comparatively rare complication following hematopoietic stem cell transplantation (HSCT). The etiology is still unclear and most believe that this may be due to the reactivation of BK virus in a state of immunodeficiency. In the later stages of ureteral stenosis with scarring, invasive interventions must be taken to relieve the hydronephrosis. Common treatments, such as D-J stent placement and permanent nephrostomy may not only entail the risk of infection, but also seriously affect the quality of life. Few cases of surgical intervention have been reported. In this article, a 25-year-old female was admitted to Peking University First Hospital suffering from recurrent flank pain. Seven years before, she developed hemorrhagic cystitis and bilateral urethritis 40 days after allogeneic HSCT. After continuous bladder irrigation and antiviral therapy, the left-sided hydronephrosis gradually alleviated while the right-sided one did not improve. D-J stents were used for urine drainage for 7 years before percuta-neous nephrostomy. Preoperative antegrade pyelography revealed significant hydronephrosis in the right kidney with long stricture of proximal-middle ureter. After comprehensive decision, she underwent ileal ureter replacement. The operation was successful. The segmental lesion was dissected and the scar tissue was removed. A 25 cm intestinal tube was isolated to connect the pelvis and bladder. An anti-reflux nipple was created at the distal end of ileal ureter to prevent the potential infection. The blood loss was minimal. After surgery, the drainage tube was removed in 2 weeks, the nephrostomy tube and the D-J stent was removed in 3 months. Follow-up mainly included clinical assessment, serologic testing, renal ultrasonography, blood gas analysis and radiological examination. During the follow-up of 6 years, she was symptom-free and no postoperative complications occurred. The serum creatinine level was stable. No hydronephrosis was observed under ultrasonography. Obvious peristaltic waves and ureteral jets of the ileal ureter was confirmed on cine magnetic resonance urography. To sum up, ureteral stenosis after HSCT is relatively rare. Obstruction caused by scarring is usually irreversible and surgical intervention should be designed according to the location and length of the lesion. Ileal ureter replacement can be a safe, feasible and effective method to solve this kind of complex stricture.
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Affiliation(s)
- 冠鹏 韩
- 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - 洋洋 许
- 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - 志华 李
- 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - 畅 孟
- 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - 宏建 朱
- 北京市健宫医院泌尿外科,北京 100054Department of Urology, Beijing Jiangong Hospital, Beijing 100054, China
| | - 昆霖 杨
- 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - 利群 周
- 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - 学松 李
- 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
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11
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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.
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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
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12
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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
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Li X, Wang X, Li T, Zhu W, Ma M, Yang K, Li Z, Wu J, Wang H, Liao L, Li X, Zhou L. Cine magnetic resonance urography and Whitaker test: dynamic visualized and quantified tools in ileal ureter replacement. Transl Androl Urol 2022; 10:4110-4119. [PMID: 34984177 PMCID: PMC8661268 DOI: 10.21037/tau-21-507] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background To assess the feasibility and usefulness of cine magnetic resonance urography (MRU) and Whitaker test as postoperative evaluation tools of ileal ureter replacement. Methods We retrospectively collected the medical records of 42 patients who underwent ileal ureter replacement between August 2015 and August 2020. The morphology, luminal diameter, amplitude, contraction ratio, peristaltic frequency, ureteral jets and peristalsis efficiency were recorded in cine MRU. Under different perfusion loads, image and pressure changes of the reconstructed upper urinary tract were recorded in the Whitaker test. Patients were categorized into normal pressure and elevated pressure groups. Results A total of 42 patients underwent cine MRU, and 20 of them finished the Whitaker test successfully. The mean amplitude was 9.29±3.51 mm, and the contraction ratio was 0.607 (0.247–0.790). The median peristaltic efficiency was 0.75 (0.29–1). Three patients presented an unusual rise in renal pelvis pressure, which was 54, 26, 57 cmH2O respectively. The amplitude of the ileal graft in the elevated pressure group was larger (13.80±5.73 vs. 8.09±3.38 mm, P=0.024), the contraction ratio was higher [0.68 (0.59–0.79) vs. 0.59 (0.25–0.79), P=0.028], the peristaltic frequency was more active [7 (6–8) vs. 4 (3–8), P=0.025], but the peristaltic efficiency was lower [0.50 (0.29–0.50) vs. 0.75 (0.33–1), P=0.029] compared to the normal pressure group. There were no significant differences in the ureteral jets [3 (2–4) vs. 3 (1–7), P=0.840), creatinine (97.3±7.3 vs. 103.2±30.7 µmol/L, P=0.753), and estimated glomerular filtration rate (eGFR) (76.4±14.1 vs. 68.5±28.7 mL/min·1.73 m2, P=0.663). Conclusions Cine MRU provides morphological and peristaltic motility of the ileal graft, cine MRU after ileal ureter replacement was recommended as a routine examination. The Whitaker test represents a complementary investigation to evaluate pressure changes to reveal the ability to transport urine, and it can be used as a supplementary examination to clarify equivocal cases.
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Affiliation(s)
- Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Teng Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Weijie Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Mingming Ma
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Kunlin Yang
- 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
| | - Juan Wu
- China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - He Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Limin Liao
- China Rehabilitation Research Center, Beijing Boai Hospital, 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
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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.
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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
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15
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Li X, Zhu W, Zeng Z, Wang Q, Fang D, Li Z, Guan H, Huang Y, Zhang P, Zhu H, Li X, Zhou L. Bilateral ileal ureter substitution for patients with ureteral strictures secondary to gynecological tumors radiotherapy: a multi-center retrospective study. Transl Androl Urol 2021; 10:3226-3238. [PMID: 34532248 PMCID: PMC8421837 DOI: 10.21037/tau-21-255] [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: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background The selection of treatment for bilateral ureteral strictures caused by radiotherapy in patients with gynecological tumors often brings great challenges to urologists. This study was designed to analyze the characteristics of radiation-induced ureteral strictures and summarize the surgical experience of bilateral ileal ureter substitution. Methods We retrospectively collected the medical records of 18 patients between June 2010 and June 2019 who had a radiation-induced bilateral ureteral strictures. Time interval from radiotherapy to the discovery of ureteral stricture was categorized into short-term (less than 12 months) and long-term (over 12 months) groups. All patients received reverse “7” bilateral ileal ureteral substitution. Surgical success was defined as no restenosis, relief of symptoms, and improved/stabilized hydronephrosis. Results The patients had been suffered from ureteral stricture for a median of 12 [2–106] months. The mean length of the left and right ureteral stricture was 9.6±2.6 and 8.8±3.2 cm, respectively. The mean length of the ileal graft was 29.1±7.4 cm. The mean operative time was 308.4±70.2 min, and the mean estimated blood loss was 254.7±166.2 mL. The postoperative hospital stays in the short-term group was significantly shorter than that in the long-term group (14.0 vs. 20.6 days, P=0.049). During a median follow-up time of 24.1 (4.5–71.9) months, the success rate was 94.4%. Eight minor complications and two major complications occurred in 7 patients. Conclusions Bilateral ileal ureter substitution can be an effective strategy for radiation-induced ureteral stricture in patients with gynecological tumors.
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Affiliation(s)
- Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Weijie Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhen Zeng
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qian Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Dong Fang
- 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
| | - Yanbo Huang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, 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
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16
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Launer BM, Redger KD, Koslov DS, Sax-Bolder AN, Higuchi TT, Windsperger AP, Flynn BJ. Long-term Follow Up of Ileal Ureteral Replacement for Complex Ureteral Strictures: Single Institution Study. Urology 2021; 157:257-262. [PMID: 34310914 DOI: 10.1016/j.urology.2021.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report our 16-year experience with ileal ureter interposition for complex ureteral stricture. Ureteral reconstruction continues to evolve to include less invasive techniques to successfully manage ureteral stricture. However, long, complex, obliterative and especially radiated ureteral strictures are not amenable to less invasive techniques and may require Ileal ureter interposition. MATERIALS AND METHODS Retrospective review of a single institution's ureteral reconstruction database was performed. Demographics, operative details, success rate, complication rate, and length of follow-up were noted. Unilateral replacements utilized ileal ureteral interposition. Success rate was defined as no need for further open intervention. RESULTS Between 2003 and 2019, 188 ureteral reconstructions were performed, of which 46 required ileal ureter interposition. Of these 46 patients, 10 required bilateral reconstruction. Average age was 53 years, 26 (57%) were female. The average stricture length was 9.1 cm (2-20 cm). Stricture etiology included iatrogenic causes (n = 24, 52%), radiation causes (n = 12; 26%), vascular disease (n = 3; 7%), and idiopathic retroperitoneal fibrosis (n = 3; 7%). Forty-three surgeries were performed by open abdominal approach; 3 were performed robotically. The average length of operation was 412 minutes, blood loss 417 mL and LOS was 10 days. At mean follow up of 4.4 years (1-16 years), overall success rate was 83%, with 17% (n = 8) patients requiring subsequent major surgery (5 successful ureteral revision, 3 nephrectomy) and 11 (24%) patients experiencing a major complication. CONCLUSION In our long-term follow up of over 4 years, ileal ureteral interposition remains a successful option for complex ureteral strictures in properly selected patients.
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Affiliation(s)
- Bryn M Launer
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO
| | - Kirk D Redger
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO
| | - David S Koslov
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO
| | - Anessa N Sax-Bolder
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO
| | - Ty T Higuchi
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO
| | - Andrew P Windsperger
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO
| | - Brian J Flynn
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO.
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Kidney Autotransplantation for Treatment of Ureteric Obstruction: A Case Report and Brief Review of the Literature. Case Rep Surg 2021; 2021:6646958. [PMID: 34336349 PMCID: PMC8321762 DOI: 10.1155/2021/6646958] [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: 10/09/2020] [Accepted: 07/11/2021] [Indexed: 12/19/2022] Open
Abstract
Autologous kidney transplantation is a relatively rare procedure that has been used as an alternative treatment for a variety of complex genitourinary problems, in particular for the treatment of complex proximal ureteral strictures. In this case report, a 47-year-old male, who had undergone a living donor nephrectomy 14 years earlier, presented with episodes of acute kidney injury on chronic kidney disease. He was found to have a complex proximal ureter stricture of his solitary right kidney. He underwent nephrectomy with subsequent autotransplantation of the kidney into the right iliac fossa. His renal function improved significantly after surgery. Renal autotransplantation may be considered for the management of proximal ureteral obstruction when alternative options are contraindicated.
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Roux S, Pettenati C, Dariane C, Sbizzera M, Dominique I, Matillon X, Toinet T, Neuzillet Y, Bessède T, Champy C, Timsit MO, Méjean A. Management of long ureteral stenosis: Alternatives to indwelling ureteral stents. Prog Urol 2021; 31:598-604. [PMID: 33941454 DOI: 10.1016/j.purol.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIF Evaluate kidney autotransplantation (KAT) and ileal ureter substitution (IUS) practice and outcome as alternatives to indwelling ureteral stents for the management of long ureteral stenosis (US). MATERIAL We included all patients treated for US with KAT or IUS in 5 French university urology centers between 2010 and 2018. We excluded US due to urothelial carcinoma. Primary endpoint was the preservation of ipsilateral kidney and renal function without any urinary diversion. RESULTS 22 patients were treated with KAT (n=8, 36.4%) and IUS (n=14, 63.6%). Mean US length was 4.6cm and 6cm (P=0.52) in KAT and IUS groups respectively. US etiologies were lithiasis, iatrogenic, retroperitoneal fibrosis or extrinsic compression. US level was varied. The surgery was described as difficult because of peritoneal adhesions or major peri-ureteral fibrosis. Mean operating time and hospital stay were 336 and 346minutes (P=0.87) and 8 and 15 days respectively (P=0.001). Postoperative complications were mostly Clavien ≤2 (n=17, 77.3%). Revision surgery was required in the KAT group in 3 cases (37.5%), for textiles, renal vein thrombosis and anastomotic leak, none in the IUS group. The mean follow-up was 15.7 months. All but one (in the KAT group) ipsilateral kidneys were preserved, without renal function impairment (Δcreat +2.1 vs. +2.4μmol/l respectively, P=0.67), nor urinary diversion. CONCLUSION KAT and IUS are safe alternatives whose indication depends on surgeons expertise. Our study pointed out the scarcity of this practice suggesting the need to refer patients to expert centers. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- S Roux
- Department of Urology and Transplant surgery, Hôpital Européen Georges-Pompidou, AP-HP, University of Paris Descartes, Paris, France.
| | - C Pettenati
- Department of Urology and Transplant surgery, Hôpital Européen Georges-Pompidou, AP-HP, University of Paris Descartes, Paris, France
| | - C Dariane
- Department of Urology and Transplant surgery, Hôpital Européen Georges-Pompidou, AP-HP, University of Paris Descartes, Paris, France
| | - M Sbizzera
- Hospices Civils de Lyon, HCL, University of Lyon 1, Department of Urology, Lyon, France
| | - I Dominique
- Hospices Civils de Lyon, HCL, University of Lyon 1, Department of Urology, Lyon, France
| | - X Matillon
- Hospices Civils de Lyon, HCL, University of Lyon 1, Department of Urology, Lyon, France
| | - T Toinet
- Hôpital Foch, University of Versailles-Saint-Quentin-En-Yvelynes, Department Of Urology, Suresnes, France
| | - Y Neuzillet
- Hôpital Foch, University of Versailles-Saint-Quentin-En-Yvelynes, Department Of Urology, Suresnes, France
| | - T Bessède
- Hôpital Kremlin-Bicêtre, AP-HP, University of Paris Sud, Department of Urology, Le Kremlin-Bicêtre, France
| | - C Champy
- Hôpital Henri Mondor, AP-HP, University of Paris-Est Créteil, Department Of Urology, Créteil, France
| | - M O Timsit
- Department of Urology and Transplant surgery, Hôpital Européen Georges-Pompidou, AP-HP, University of Paris Descartes, Paris, France
| | - A Méjean
- Department of Urology and Transplant surgery, Hôpital Européen Georges-Pompidou, AP-HP, University of Paris Descartes, Paris, France
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Huned D, Kumaran A, Lee LS, Tiwari RV. Case of flank pain from ureteral injury after lumbar laminectomy. BMJ Case Rep 2021; 14:14/4/e241170. [PMID: 33910802 PMCID: PMC8094358 DOI: 10.1136/bcr-2020-241170] [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: 11/04/2022] Open
Abstract
We present a case of an iatrogenic complete left proximal ureteric injury after a lumbar 1 laminectomy and intradural tumour excision and lumbar 4/5 transforaminal lumbar interbody fusion. Initial management included a percutaneous nephrostomy for urinary diversion followed by definitive urinary reconstruction with an ileal ureter.
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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.
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21
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Ali-El-Dein B, El-Hefnawy AS, D' Elia G, El-Mekresh MM, Shokeir AA, Gad H, Bazeed MA. Long-term Outcome of Yang-Monti Ileal Replacement of the Ureter: A Technique Suitable for Mild, Moderate Loss of Kidney Function and Solitary Kidney. Urology 2021; 152:153-159. [PMID: 33359492 DOI: 10.1016/j.urology.2020.09.061] [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] [Received: 08/20/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To present long-term outcome of Yang-Monti ileal ureter, with a focus on patients with mild/moderate loss of kidney function and solitary kidney. PATIENTS AND METHODS Between March 2001 and December 2019, Yang-Monti ileal ureter was performed on 36 patients with ureteric defects and median age 46.5 years. Of these, 4, 14, 15 and 3 patients had stage 1, stage 2, stage 3a and stage 4a chronic kidney disease, respectively; 6 had solitary kidney. Patients were regularly followed for complications, morphological, and functional outcome. RESULTS Ureteric stricture etiology was iatrogenic (16), Bilharzial (7), tuberculous (4), retroperitoneal fibrosis (5), malignancy (3), and gunshot injury (1). The median (range) ureteric defect length was 11 (8-16) cm. Four grade 1/2 postoperative Clavien-Dindo complications were noted. Median follow-up was 68 months (range 12-215). Intestinal obstruction developed in 1 patient and urinary tract infection in 10. At last follow-up, serum creatinine, split renographic clearance, and estimated glomerular filtration rate showed significant improvement compared to preoperative values, in the whole series, in cases with chronic kidney disease (stages 2, 3a and 3b) and solitary kidney. Four cases with chronic kidney disease (stage 3) showed deterioration of the kidney function parameters. Magnetic resonance urography showed improvement of hydronephrosis in most patients. No metabolic complications were noted. CONCLUSION Yang-Monti Ileal ureter is durable and effective in improving kidney function with few complications. It can be safely used in cases of mild/moderate kidney function loss and solitary kidney. A threshold eGFR <40 mL/min/1.73 m2 is considered relative contraindication.
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Affiliation(s)
- Bedeir Ali-El-Dein
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Ahmed S El-Hefnawy
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Gianluca D' Elia
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohsen M El-Mekresh
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed A Shokeir
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hosam Gad
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mahmoud A Bazeed
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Poujade L, Branchereau J, Rigaud J, Perrouin-Verbe MA. Ileal ureter replacement: Early morbidity and long-term results. Prog Urol 2020; 31:357-367. [PMID: 33189554 DOI: 10.1016/j.purol.2020.10.002] [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: 04/20/2020] [Revised: 09/25/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Ileal ureter is a technique that consists of replacing the ureter by a segment of ileum to treat a long ureteric lesion or a lesion involving the lumbar ureter. The primary objective of our study was to assess the early perioperative morbidity of ileal ureter according to the Clavien-Dindo classification. The secondary objectives were to assess the morbidity and the medium- and long-term outcome of renal function. MATERIALS AND METHODS Single-centre retrospective study, collecting data from patients operated between February 2005 and October 2019. All patients who underwent ileal ureter replacement surgery in our unit were included in this analysis. The ureteric defect was longer than five centimetres and involved the pelvic and/or iliac and/or lumbar ureter. All ileal ureter replacements were performed by open surgery using isoperistaltic ileal grafts. RESULTS Twenty-one patients (11 women and 10 men) underwent total or subtotal, unilateral or bilateral ileal ureter replacement, corresponding to 25 kidneys. The grade III early postoperative complication rate was 9.5% (two cases) mainly consisting of bleeding. No grade IV or V complications were observed. With a mean follow-up of 85 months, long-term morbidity essentially consisted of infectious complications. No patients developed anastomotic strictures. Mean serum creatinine was 116.3μmol/L preoperatively, 105.6μmol/L one month postoperatively and 112.2μmol/L at last follow-up. Renal function was generally preserved or even improved, except for patients with preoperative renal failure. CONCLUSION Ileal ureter replacement is a surgical alternative associated with low morbidity and satisfactory long-term functional results. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- L Poujade
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - J Branchereau
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - J Rigaud
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - M-A Perrouin-Verbe
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
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Bansal A, Kumar A, Maheshwari R, Desai P, Chaturvedi S, Dassi V. Renal autotransplant for major ureteric loss: Results from median 11 years of follow-up. Turk J Urol 2020; 47:151-157. [PMID: 33085605 DOI: 10.5152/tud.2020.20371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Renal autotransplant (RA) is an underutilized procedure to treat major ureteric loss. Studies on long-term outcomes and follow-up after RA are scarce. This study aimed to report the long-term outcomes and follow-up after RA. MATERIAL AND METHODS We identified 9 patients, from 2007 to 2019, who underwent RA after major ureteric loss (where direct restoration of continuity was not possible). We collected data regarding the etiology of ureteric loss, preoperative differential renal function, method of nephrectomy (laparoscopic or open), method of anastomosing the residual ureter/pelvis to the bladder, postoperative complications, duration of hospital stay, and renal function and drainage postoperatively and until the last follow-up. Changes in renal function and/or any obstruction to urinary drainage of the ipsilateral kidney postoperatively or during follow-up were measured. The Wilcoxon matched-pairs signed-rank test was used to compare the mean creatinine values preoperatively, postoperatively, and at last follow-up (p<0.05 was considered statistically significant). RESULTS All the patients had uneventful intraoperative and postoperative periods. The mean hospital stay was 6.4 (5-8) days. The median follow-up was 132 (46-156) months. The mean preoperative serum creatinine level was 1.0 (0.7-1.7) mg/dL. The mean creatinine value postoperatively and at last follow-up had no significant difference with preoperative value (p=0.96 and 0.75, respectively). The postoperative diethylene triamine pentaacetic acid scan demonstrated good perfusion and drainage. There was no deterioration of renal function or drainage during the follow-up. CONCLUSION RA is an excellent modality to treat major ureteric loss. It preserves renal function and avoids the problems related to bowel interposition and the need for long-term follow-up.
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Affiliation(s)
- Amit Bansal
- Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India
| | - Anant Kumar
- Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India
| | - Ruchir Maheshwari
- Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India
| | - Pragnesh Desai
- Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India
| | - Samit Chaturvedi
- Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India
| | - Vimal Dassi
- Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India
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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.
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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
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Zhu WJ, Ma MM, Zheng MM, Hao H, Yang KL, Zhou LQ, Zhang JS, Wang H, Li XS. Cine magnetic resonance urography for postoperative evaluation of reconstructive urinary tract after ileal ureter substitution: initial experience. Clin Radiol 2020; 75:480.e1-480.e9. [PMID: 32106934 DOI: 10.1016/j.crad.2020.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/23/2020] [Indexed: 11/25/2022]
Abstract
AIM To report the initial experiences with functional cine magnetic resonance urography (cine MRU) and assess its usefulness as a novel postoperative evaluation method of ileal ureter substitution. MATERIALS AND METHODS The medical records of 17 patients from who underwent cine MRU during June 2010 to December 2019 during their follow-up after ileal ureter substitution were collected. The cine MRU videos of reconstructive urinary tract were observed, and the luminal diameter, contraction ratio, peristaltic waves, and ureteral jets were measured. RESULTS Seventeen patients underwent cine MRU after ileal ureter substitution during their follow-up. Based on their cine MRU videos assessing the morphology and the peristaltic motility of the reconstructive urinary tract, there was resolution of preoperative hydronephrosis, which matched their ameliorative renal function. Clearly, peristaltic motility of the ileal graft was observed in 14 patients with obvious peristaltic waves and ureteral jets. CONCLUSION This study is the first to assess the clinical utility of functional cine MRU during the patient follow-up after ileal ureter substitution. Cine MRU is a radiation-free, non-invasive imaging method that can clearly show the morphology and the peristaltic motility of the ileal graft. Therefore, cine MRU, as a novel technique, will be extremely useful in the postoperative evaluation of patients after ileal ureter substitution.
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Affiliation(s)
- W J Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China
| | - M M Ma
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing 100034, China
| | - M M Zheng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China; Department of Urology, Fu Xing Hospital, Capital Medical University, No.20 Fuxingmenwai St, Xicheng District, Beijing 100038, China
| | - H Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China
| | - K L Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China
| | - L Q Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China
| | - J S Zhang
- Department of Urology, Fu Xing Hospital, Capital Medical University, No.20 Fuxingmenwai St, Xicheng District, Beijing 100038, China
| | - H Wang
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing 100034, China.
| | - X S Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China.
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Ignatiev RO, Miloserdov IA, Korsunsky AA, Bataev SM, Saydulaev DA, Ivanov DY. [Initial experience of renal autotransplantation in a child with ureteric rupture secondary to abdominal blunt trauma]. Khirurgiia (Mosk) 2020:74-79. [PMID: 31994503 DOI: 10.17116/hirurgia202001174] [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: 11/18/2022]
Abstract
A 8-year-old child with multiple skeletal injuries after car accident is presented in the article. Extensive right-sided urohematoma with impaired kidney function was diagnosed after 15 days. External drainage of urohematoma, ureteroscopy and examination of the right kidney were consecutively performed within 1.5 months. A complete rupture of the right ureter at the level of pyeloureterostomy was diagnosed. Right kidney autotransplantation with ureteral resection and pyeloureteral anastomosis were performed in 2 months after injury. Duration of surgery was 7.5 hours, cold ischemia - 55 min. Postoperative examination confirmed satisfactory function of the right kidney. This observation is relatively rare and the first in Russia.
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Affiliation(s)
- R O Ignatiev
- Pirogov Russian National Research Medical University Research Institute of Clinical Surgery, Moscow, Russia; Speransky Clinical Children's Hospital No. 9, Moscow, Russia
| | - I A Miloserdov
- Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia
| | - A A Korsunsky
- Speransky Clinical Children's Hospital No. 9, Moscow, Russia
| | - S M Bataev
- Pirogov Russian National Research Medical University Research Institute of Clinical Surgery, Moscow, Russia; Speransky Clinical Children's Hospital No. 9, Moscow, Russia
| | - D A Saydulaev
- Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia
| | - D Yu Ivanov
- Speransky Clinical Children's Hospital No. 9, Moscow, Russia
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Small Bowel Adenocarcinoma of Ileal Ureter 40 Years After Ureteral Reconstructive Surgery. Urology 2019; 129:e2-e3. [PMID: 31009745 DOI: 10.1016/j.urology.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/20/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
Malignant neoplasm arising from ileal ureter used for ureteral reconstructive surgery is an exceedingly rare event. Ureteroileoplasty was being performed since the beginning of the last century, but it was described more extensively in literature during the 1950s.1,2 Recurrent urinary infections, chronic renal failure, urolithiasis, anastomotic stricture, metabolic acidosis, and chronic dilation of the graft had been described as late complications of ureteroileoplasty.3,4 Herein, we describe history, imaging and pathologic findings of a small bowel adenocarcinoma arising from ileal ureter in a woman of 78-year-old, subjected to ureteroileoplasty about 40 years earlier.
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Zhong W, Hong P, Ding G, Yang K, Li X, Bao J, Bao G, Cui L, Men C, Li Z, Zhang P, Chu N, Zhou L. Technical considerations and outcomes for ileal ureter replacement: a retrospective study in China. BMC Surg 2019; 19:9. [PMID: 30658620 PMCID: PMC6339271 DOI: 10.1186/s12893-019-0472-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/04/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Ileal ureter replacement is an alternative treatment for various length ureter defects. We present our experience and outcome of ileal ureter replacement in China. METHODS We retrospectively collected data of patients who underwent ileal ureter replacement between January 2010 and January 2015. We reviewed the medical history, indications for surgery, operative data, perioperative data, and outcomes. Besides, follow-up data included symptom, urine routine test, serum creatinine, serum electrolyte status, and radiographic test. RESULTS There were 23 patients who underwent ileal ureter replacement by the same surgeon. Twenty patients were performed unilateral ileal ureter replacement, two patients underwent a combination of ileal ureter replacement and Boari flap-psoas hitch, and one received bilateral ileal ureter replacement. Among these patients, the main cause leading to surgical treatment was iatrogenic injuries (n = 15), especially urinary surgery procedure (n = 11). The median follow-up time was 45 months. There were 6 early complications and 6 late complications after operation. Only one patient suffered from small bowel-related complication and was cured by conservative treatment. Only the patient who underwent bilateral ileal ureter replacement had metabolic acidosis. And 22 patients (95.7%) had a good renal function. CONCLUSIONS Ileal ureter replacement is an efficacious and safe procedure for the therapy of long ureteral defects. With appropriate technical considerations, the complication rate may decrease.
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Affiliation(s)
- Wenlong Zhong
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Peng Hong
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Guangpu Ding
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Junsheng Bao
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Guochang Bao
- Department of Urology, Affiliated Hospital of Chifeng University, Chifeng, Inner Mongolia, China
| | - Liang Cui
- Department of Urology, The General Hospital of Civil Aviation Administration of China, Beijing, China
| | - Changping Men
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Zhe Li
- Department of Urology, China Meitan General Hospital, Beijing, China
| | - Peng Zhang
- Department of Urology, China Meitan General Hospital, Beijing, China
| | - Ning Chu
- Department of Urology, Heilongjiang provincial hospital, Harbin, Heilongjiang, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China.
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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.
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Affiliation(s)
- Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Katrin Zahn
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Nina Huck
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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Ou YC, Hu CY, Cheng HL, Yang WH. Long-term outcomes of total ureterectomy with ileal-ureteral substitution treatment for ureteral cancer: a single-center experience. BMC Urol 2018; 18:73. [PMID: 30170590 PMCID: PMC6119331 DOI: 10.1186/s12894-018-0389-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background To explore the feasibility and long-term outcomes of renal preservation in a retrospective cohort of patients with ureteral urothelial carcinoma undergoing total ureterectomy with ileal-ureteral substitution. Methods A retrospective review of the data from patients treated with total ureterectomy with ileal-ureteral substitution from 1988 to 2016 was performed. The pre-operative oncological status, long-term oncological outcome, long-term renal functional outcome, early and late complications were analyzed. Results A total of eight patients with a median age of 70 years were included. The median follow-up time was 109 months. Six patients had multi-focal tumor involvement over the target ureter, and six patients had bilateral upper tract involvement. Only one patient encountered the upper-tract recurrence. The 2 and 5-year cancer-specific survival rates were 87.5 and 75.0%, respectively. The renal function was well-preserved in most patients, with only one patient needed life-long postoperative hemodialysis. Five patients experienced early complications and four patients experienced late complications. No perioperative mortality happened. Conclusions A total ureterectomy with an ileal-ureteral substitution is feasible for treating ureteral urothelial carcinoma when a renal-sparing procedure is indicated. It provides good long-term oncological outcomes over the upper tract, and it also preserves the renal function.
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Affiliation(s)
- Yin-Chien Ou
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China
| | - Che-Yuan Hu
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China
| | - Hong-Lin Cheng
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China
| | - Wen-Horng Yang
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China.
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Liu D, Zhou H, Hao X, Cao H, Ma L, Zhou X, Tao T, Cheng W, Feng Z. Laparoscopic Yang-Monti Ureteral Reconstruction in Children. Urology 2018; 118:177-182. [PMID: 29751025 DOI: 10.1016/j.urology.2018.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/24/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the clinical outcome of surgical treatment for long ureteral defect in children, we evaluated our experience of managing 6 children with the long defect utilizing laparoscopic ureteral reconstruction technique using Yang-Monti technique. MATERIALS AND METHODS Six children with long ureteral defect who underwent laparoscopic Yang-Monti ureteral reconstruction between January 2013 and March 2016 were reviewed. The diagnosis and outcomes of long ureteral defects were reviewed based on clinical and imaging data. We assessed preoperative clinical data and outcomes, and analyzed the experience of laparoscopic Yang-Monti ureteral reconstruction. RESULTS The mean age of the patients was 8.5 years. The etiology of the ureteral defect was failed pyeloplasty in 4 patients, failed pyeloplasty and ureteral reimplantation in 1, and trauma in 1. The mean defect length was 5.83 cm. All operations were performed successfully with no serious intraoperative complications and no conversion. The average operative time was 314 minutes, the average intraoperative blood loss was 25 mL, the average drain removal was 3.83 days, the average start of oral feeding was 5.17 days, and the average postoperative hospital stay was 7.17 days. Six patients suffered Clavien I and II complications postoperatively and were managed conservatively. Two patients suffered Clavien III complications postoperatively and were managed by replacing stent. A diuretic T1/2 showed the improvement of differential renal function without urinary obstruction in all patients. CONCLUSION Laparoscopic Yang-Monti ureteral reconstruction is safe and feasible in children with an excellent outcome.
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Affiliation(s)
- Dehong Liu
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Huixia Zhou
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China.
| | - Xuemei Hao
- Department of Anesthesiology, PLA Army General Hospital, Beijing, China
| | - Hualin Cao
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Lifei Ma
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Xiaoguang Zhou
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Tian Tao
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Wei Cheng
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China; Department of Pediatric Surgery, Beijing United Family Hospital, Beijing, China
| | - Zhichun Feng
- Department of Pediatrics, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
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Robot-assisted Kidney Autotransplantation: A Minimally Invasive Way to Salvage Kidneys. Eur Urol Focus 2018; 4:198-205. [DOI: 10.1016/j.euf.2018.07.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/30/2018] [Accepted: 07/13/2018] [Indexed: 02/06/2023]
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Soria J, Guandalino M, Vedrine N, Pereira B, Guy L. [Results of conservative surgical management of ureteral injuries]. Prog Urol 2017; 28:120-127. [PMID: 29162380 DOI: 10.1016/j.purol.2017.10.011] [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] [Received: 04/07/2017] [Revised: 10/13/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The ureter is a retroperitoneal organ. Ureteral injuries are rare, with a prevalence of 0.083% of surgical interventions over 10 years. The objective of this study was to evaluate the surgical management of ureteric injuries according to the time of discovery, their size and their location. We also evaluated the results of this management on the renal repercussion as well as the predictive factors of the severity of the ureteric injuries. MATERIAL AND METHODS This was a monocentric retrospective study carried out on the basis of a systematic review of the CHU surgery files. RESULTS The average follow-up was 30 months. The average hospital stay was 8 days. Thirty-four patients (73.9%) underwent initial endoscopic management by attempting a double J probe. Only 20 patients received this double J probe and only 11 patients (55%) did not recidivate the ureteral injury with a median duration of maintenance of the double J probe of 90 days (28-240). Thirty-five patients received open surgical management (76.1%). We found 57% ureterovesical reimplantations (n=20), corresponding to pelvic ureteral injuries (n=32). We also found 20% of nephrectomies. No patient had recurrence of the ureteral injury. Eight patients had secondary dilatation of the pyelocalicious cavities (28.57%). The success of surgical treatment was therefore 57%. CONCLUSION The management of surgically treated ureter injuries provides good results but remains relatively diversified due to the different lesion levels. It was effective in 57% of cases including nephrectomies as failure of treatment. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- J Soria
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - M Guandalino
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - N Vedrine
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - B Pereira
- Service de biostatistique, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - L Guy
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
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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]
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Ruiz M, Hevia V, Fabuel JJ, Fernández AA, Gómez V, Burgos FJ. Kidney autotransplantation: long-term outcomes and complications. Experience in a tertiary hospital and literature review. Int Urol Nephrol 2017; 49:1929-1935. [PMID: 28828690 DOI: 10.1007/s11255-017-1680-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To analyze indications, surgical technique, complications and long-term outcomes of kidney autotransplantation (KAT) after 26-year experience at a single institution. MATERIALS AND METHODS A retrospective observational study of patients who underwent KAT at our institution (January 1990-December 2016) was carried out. Data collected included indications, surgical technique, complications (Clavien-Dindo), hospital stay and long-term outcomes. Literature review was performed through MEDLINE and ClinicalKey databases including "kidney," "renal," "autotransplantation" and "autograft." RESULTS Fifteen patients underwent a KAT, with a mean age of 41 years (range 34-59). Indications were vascular abnormalities in 8 cases and ureteral injury in 7. Nephrectomy was performed through laparoscopy in 2 cases (13.3%) and open in 13 (86.7%). Vascular grafts to reperfuse the kidney were used in 8 patients, and ureteral reimplantation was performed in 11 cases. Mean hospital stay was 9.1 days (range 3-20). Seven patients (46.7%) developed postoperative complications: 6 minor (Clavien I-II) and 1 major (Clavien III). After a mean follow-up of 73.1 months (range 7-312), 80% of the patients have a functioning graft. Most common indication reported in the literature is ureteral stricture, especially in the most recent years. Graft survival is variable, and complications are frequent, but usually minor. CONCLUSIONS KAT is an effective treatment for complex ureteral lesions and kidney vascular abnormalities, with good results in the long term. Surgical complications are frequent, but usually minor. As a challenging surgery, it should be performed by experienced kidney transplant surgeons. Complex and proximal ureteral injuries are nowadays the main indication of this procedure.
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Affiliation(s)
- Mercedes Ruiz
- Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain
| | - Vital Hevia
- Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain.
| | - Jose-Javier Fabuel
- Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain
| | - Alvaro-Amancio Fernández
- Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain
| | - Victoria Gómez
- Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain
| | - Francisco-Javier Burgos
- Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain
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Waldorf B, Lee Z, Kidd L, Kaplan J, Harris A, Metro M, Liu J, Eun D. Robotic Buccal Ureteroplasty: a Review of the Current Literature. Curr Urol Rep 2017; 18:40. [PMID: 28401476 DOI: 10.1007/s11934-017-0683-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW This study aimed to provide an overview of the literature on buccal mucosal ureteroplasty for ureteral stricture disease, with a specific focus on the application of the robotic platform to buccal ureteroplasty. RECENT FINDINGS In our review, we highlight the results of Zhao et al. from the New York University School of Medicine Department of Urology, as well as our own results from Temple University Hospital. Zhao et al. published the first series of four patients who underwent robotic buccal ureteroplasty. Mean stricture length was 3.0 cm, and at a mean follow-up of 15 months, all repairs remained patent. We also describe our results in 10 patients who underwent robotic buccal ureteroplasty at Temple University Hospital. Median stricture length was 3.0 cm, and at a median follow-up of 5 months, all repairs remain patent. Robotic buccal ureteroplasty offers a promising option for repair of complex ureteral strictures.
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Affiliation(s)
- Benjamin Waldorf
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA.
| | - Ziho Lee
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Laura Kidd
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Joshua Kaplan
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Andrew Harris
- Paul B. Hall Regional Medical Center, Paintsville, KY, USA
| | - Michael Metro
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Jeffrey Liu
- Temple Head and Neck Institute, Temple University School of Medicine, Philadelphia, PA, USA
| | - Daniel Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
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Ureteral Reconstruction With Ileum: Long-term Follow-up of Renal Function. Urology 2017; 104:225-229. [PMID: 28237532 DOI: 10.1016/j.urology.2017.02.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess long-term renal preservation and surgical outcomes in patients undergoing ureteric substitution with ileum. This has been a mainstay of reconstruction options for lengthy ureteral defects. METHODS Consecutive patients aged 18 or older undergoing ileal ureters at our institution were retrospectively reviewed (from 1989 to June 2013). Patients with <6 months of follow-up were excluded. Demographic, surgical, and renal functional outcomes were reviewed. Renal function was assessed by the Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease Study equations. RESULTS Of the 108 patients meeting the inclusion criteria, 86 (79.6%) had single-renal unit reconstruction and 22 had bilateral reconstruction. Eighty-four (77.8%) had radiation-induced stricture and 24 had iatrogenic or trauma-induced strictures. The median follow-up was 51 months (interquartile range: 22-112). Short-term complications included Clavien grade I (16 [14.8%]), Clavien grade II (3 [2.8%]), Clavien grade III (9 [8.3%]), and Clavien grade IV (3 [2.8%]). Long-term complications included fistula in 6 patients (5.6%), renal failure requiring dialysis in 2 patients (1.9%), hyperchloremic metabolic acidosis in 4 patients (3.7%), and incisional hernia in 11 patients (10.2%). Nine patients (8.3%) had small-bowel obstructions; 3 (2.8%) required adhesiolysis. Four patients (3.7%) had an anastamotic stricture. Nineteen patients (17.6%) had worsening renal function. Cox proportional hazards regression found that those with bilateral repair were at 3.7 times increased risk of worsening renal function (P = .02). CONCLUSION Ureteral substitution with ileum provides an effective and versatile long-term reconstructive option with minimal renal function compromise in properly selected patients. Bilateral reconstruction may contribute to worse long-term renal function.
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Koenig JF, Rensing A, Austin PF, Vricella G. First-ever Reported Obstructing Ureteral Nephrogenic Adenoma in a Child and Subsequent Robotic-assisted Laparoscopic Ileal Ureter. Urology 2016; 94:221-3. [DOI: 10.1016/j.urology.2016.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/03/2016] [Accepted: 03/08/2016] [Indexed: 11/24/2022]
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Althumairi AA, Efron JE. Genitourinary Considerations in Reoperative and Complex Colorectal Surgery. Clin Colon Rectal Surg 2016; 29:145-51. [PMID: 27247540 PMCID: PMC4882184 DOI: 10.1055/s-0036-1580629] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Genitourinary structures are at risk of injury during colorectal surgery. The incidence of injury is low; however, the risk is higher in cases involving severe inflammatory or infectious processes, locally advanced or recurrent cancer, previous radiation, and reoperation. Consideration of the anatomical relationship between the genitourinary system, and the colon and rectum is crucial to avoid injuries. Intraoperative diagnostic techniques such as intravenous pyelogram (IVP), fluoroscopic cystogram, or retrograde urethrogram can aid in identifying suspected injuries. Early recognition and repair of injuries decrease the morbidity of an injury. Repair of injuries depends on the location and extent of the injury. Simple injuries may be repaired primarily, while complex injuries may require more advanced repairs such as a flap reconstruction.
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Affiliation(s)
- Azah A. Althumairi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan E. Efron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hofer MD, Aguilar-Cruz HJ, Singla N, Cordon BH, Scott JM, Morey AF. Expanding Applications of Renal Mobilization and Downward Nephropexy in Ureteral Reconstruction. Urology 2016; 94:232-6. [PMID: 27112510 DOI: 10.1016/j.urology.2016.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate renal mobilization with downward nephropexy as an adjunct maneuver to facilitate various methods of reconstruction of the upper urinary tract with limited ureteral length. MATERIALS AND METHODS We retrospectively reviewed all upper urinary tract reconstructive procedures performed from 2007 to 2015 to identify those requiring downward renal mobilization with nephropexy. Data including concomitant maneuvers, stricture location, prior surgeries, and intraoperative details were analyzed. Success rates, defined by resolution of symptoms and avoidance of further intervention, and complications were evaluated. RESULTS Of 92 patients undergoing ureteral reconstruction during the study period, 18 (19.6%) involved renal mobilization with downward nephropexy to gain additional ureteral length (5/7 [71.4%] of ureterocalycostomies, 8/26 [30.1%] of Boari flap bladder reconfigurations, 4/12 [33.3%] of ureteroureterostomies, and 1/12 [8.3%] of ileal ureters). Two-thirds of patients (12/18, 66.7%) had undergone unsuccessful prior open, laparoscopic, or endoscopic reconstruction attempts. Renal mobilization was performed open in 15/18 (83.3%) cases and laparoscopically in 3/18 (16.7%). After renal mobilization, the average distance of downward movement achieved was 3.3 cm (range 3-5 cm). With a mean follow-up of 50.4 months (range 3-87 months), overall success rate defined as ureteral patency was 88.9%, with 2/18 patients (11.1%) requiring a subsequent nephrectomy for failed upper tract reconstruction and persistent symptomatic hydronephrosis. CONCLUSION Downward renal mobilization and nephropexy is a safe and versatile technique that can be effectively combined with many other reconstructive maneuvers.
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Dixon A, Tretiakova M, Gore J, Voelzke BB. Metastatic Renal Cell Carcinoma to the Contralateral Ureter: A Rare Phenomenon. Urol Case Rep 2015; 4:36-7. [PMID: 26793575 PMCID: PMC4719895 DOI: 10.1016/j.eucr.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/14/2015] [Indexed: 12/03/2022] Open
Abstract
Metastatic renal cell carcinoma (RCC) to the contralateral ureter is a rare phenomenon. We report a metastatic RCC to the contralateral ureter 5 months after right radical nephrectomy for Fuhrman grade 3/4 clear cell adenocarcinoma with pathologic T3 staging. The distal ureter was excised followed by partial ileal ureteral substitution. Pathology confirmed metastatic clear cell RCC Fuhrman grade 2/4. Ileal ureteral substitution has been shown to provide good long-term functional outcomes and should be considered as a possible option for surgical treatment of ureteral metastasis.
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Affiliation(s)
| | | | - John Gore
- Department of Urology, University of Washington, USA
| | - Bryan B Voelzke
- Department of Urology, Harborview Medical Center, 325 9th Avenue, Box 359868, Seattle, WA 98101, USA
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Gomez-Gomez E, Malde S, Spilotros M, Shah PJ, J. Greenwell T, Ockrim JL. A tertiary experience of ileal–ureter substitution: Contemporary indications and outcomes. Scand J Urol 2015; 50:192-9. [DOI: 10.3109/21681805.2015.1106579] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Koch H, Hammer N, Ossmann S, Schierle K, Sack U, Hofmann J, Wecks M, Boldt A. Tissue Engineering of Ureteral Grafts: Preparation of Biocompatible Crosslinked Ureteral Scaffolds of Porcine Origin. Front Bioeng Biotechnol 2015; 3:89. [PMID: 26157796 PMCID: PMC4477215 DOI: 10.3389/fbioe.2015.00089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/08/2015] [Indexed: 12/20/2022] Open
Abstract
The surgical reconstruction of ureteric defects is often associated with post-operative complications and requires additional medical care. Decellularized ureters originating from porcine donors could represent an alternative therapy. Our aim was to investigate the possibility of manufacturing decellularized ureters, the characteristics of the extracellular matrix (ECM) and the biocompatibility of these grafts in vitro/in vivo after treatment with different crosslinking agents. To achieve these goals, native ureters were obtained from pigs and were decellularized. The success of decellularization and the ECM composition were characterized by (immuno)histological staining methods and a DNA-assay. In vitro: scaffolds were crosslinked either with carbodiimide (CDI), genipin (GP), glutaraldehyde, left chemically untreated or were lyophilized. Scaffolds in each group were reseeded with Caco2, LS48, 3T3 cells, or native rat smooth muscle cells (SMC). After 2 weeks, the number of ingrown cells was quantified. In vivo: crosslinked scaffolds were implanted subcutaneously into rats and the type of infiltrating cells were determined after 1, 9, and 30 days. After decellularization, scaffold morphology and composition of ECM were maintained, all cellular components were removed, DNA destroyed and strongly reduced. In vitro: GP and CDI scaffolds revealed a higher number of ingrown 3T3 and SMC cells as compared to untreated scaffolds. In vivo: at day 30, implants were predominantly infiltrated by fibroblasts and M2 anti-inflammatory macrophages. A maximum of MMP3 was observed in the CDI group at day 30. TIMP1 was below the detection limit. In this study, we demonstrated the potential of decellularization to create biocompatible porcine ureteric grafts, whereas a CDI-crosslink may facilitate the remodeling process. The use of decellularized ureteric grafts may represent a novel therapeutic method in reconstruction of ureteric defects.
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Affiliation(s)
- Holger Koch
- Translational Centre for Regenerative Medicine (TRM), University of Leipzig , Leipzig , Germany
| | - Niels Hammer
- Institute of Anatomy, Faculty of Medicine, University of Leipzig , Leipzig , Germany
| | - Susann Ossmann
- Heart Center, Clinic for Cardiac Surgery, University of Leipzig , Leipzig , Germany
| | - Katrin Schierle
- Institute of Pathology, University of Leipzig , Leipzig , Germany
| | - Ulrich Sack
- Translational Centre for Regenerative Medicine (TRM), University of Leipzig , Leipzig , Germany ; Institute for Clinical Immunology, Faculty of Medicine, University of Leipzig , Leipzig , Germany
| | - Jörg Hofmann
- Institut für Nichtklassische Chemie e. V. , Leipzig , Germany
| | - Mike Wecks
- Institut für Nichtklassische Chemie e. V. , Leipzig , Germany
| | - Andreas Boldt
- Translational Centre for Regenerative Medicine (TRM), University of Leipzig , Leipzig , Germany ; Institute for Clinical Immunology, Faculty of Medicine, University of Leipzig , Leipzig , Germany
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Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability. J Urol 2015; 194:738-743. [PMID: 25801764 DOI: 10.1016/j.juro.2015.03.089] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Laparoscopic nephrectomy with autotransplantation is a viable option when renal preservation is required or ureteral reconstruction is impossible. In this study we report on our long-term experience with laparoscopic nephrectomy with autotransplantation. MATERIALS AND METHODS A retrospective review of data from all patients who underwent laparoscopic nephrectomy with autotransplantation since 2000 revealed data for 52 of 59 patients after study exclusions. Indications for laparoscopic nephrectomy with autotransplantation included ureteral stricture disease (41), renal malignancy (7), ptotic kidney (1), chronic flank pain (1), renal artery aneurysm (1) and renovascular hypertension (1). Followup included ultrasonography, nuclear renography and computerized tomography. Complications analyzed were Clavien-Dindo grade III or higher. RESULTS A total of 52 patients (30 women, 57.6%) underwent laparoscopic nephrectomy with autotransplantation at a median age of 48 years (range 12 to 76). At a median followup of 73.5 months 47 patients (90.3%) had long-term function of the autotransplanted renal unit including 3 of 4 (75%) solitary kidneys. There were 5 patients (9.7%) who experienced renal unit failure at a median of 15 months. Of these patients 3 required nephrectomy of autotransplant unit secondary to renal vein thrombosis (1 day), pseudoaneurysm (15 months) and chronic pain (48 months). Overall 4 patients had early complications and 8 had late complications. In the tumor group 4 patients had disease progression and all are alive. CONCLUSIONS Laparoscopic nephrectomy with autotransplantation is an excellent long-term surgical option (greater than 90% success rate with longer than 6-year median followup) for complex ureteral and renal conditions that necessitate preservation of renal parenchyma. However, tumor progression is possible after ex vivo tumor excision. Therefore, careful patient selection and followup are mandatory. This report supports the safety, efficacy and durability of laparoscopic nephrectomy with autotransplantation in experienced hands.
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Takeuchi M, Masumori N, Tsukamoto T. Ureteral reconstruction with bowel segments: experience with eight patients in a single institute. Korean J Urol 2014; 55:742-9. [PMID: 25405017 PMCID: PMC4231152 DOI: 10.4111/kju.2014.55.11.742] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose Although replacement of the ureter with a bowel segment is indicated for large ureteral defects, it is still a challenging technique for urologists. We present our experience and outcome of ureteral reconstruction using bowel segments. Materials and Methods Ureteral reconstruction with bowel segments was performed in eight patients in our institute between 1969 and 2009. We investigated the position and length of the ureteral defect and methods of reconstruction as well as the patients' backgrounds, postoperative complications, and clinical outcomes. Results Five patients underwent ureteral replacement with isolated ileal segments alone. In one patient, the ureter was reconstructed by using the Yang-Monti procedure with the ileum. A colon segment was used in two patients who required bladder augmentation for tuberculous contracted bladder at the same time. Metabolic acidosis occurred in three patients having a solitary kidney and the ureter had to be replaced by a relatively long intestinal segment. Two patients who received preoperative radiation therapy were required to undergo additional operations. Long-term cancer-free survival was achieved in one patient who underwent ileal substitution for low-grade renal pelvic cancer. Conclusions Although ureteral replacement with a bowel segment is a challenging and useful procedure, attention must be paid to the possibility of metabolic acidosis, which is likely to occur in patients having a solitary kidney with renal insufficiency or in patients requiring a long intestinal segment for reconstruction. In addition, preoperative radiation therapy for the pelvic organs may cause postoperative complications.
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Affiliation(s)
- Motoi Takeuchi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Taiji Tsukamoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Li Y, Li C, Yang S, Song C, Liao W, Xiong Y. Reconstructing full-length ureteral defects using a spiral bladder muscle flap with vascular pedicles. Urology 2014; 83:1199-204. [PMID: 24767531 DOI: 10.1016/j.urology.2014.01.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 12/31/2013] [Accepted: 01/27/2014] [Indexed: 12/18/2022]
Abstract
INTRODUCTION This study investigates the efficacy of ureteral reconstruction using a spiral bladder muscle flap with vascular pedicles (ie, the superior vesical arteries) to repair full-length ureteral defects and explores a surgical approach for repairing long ureteral defects (>20 cm) using a bladder muscle flap. TECHNICAL CONSIDERATIONS The characteristics of the ureteral reconstruction surgery include the following: (1) Surgeons fully expose the bladder in the retroperitoneal space. (2) While dissecting the superior vesical arteries, the integrities of the blood vessel trunk and the primary branches are maintained as much as possible. (3) While preparing the bladder muscle flap, the surgeons make an S-shaped cut along the route of the superior vesical arteries along the bladder. In general, the basal width of the muscle flap is approximately 2-3 cm in length, and the total length is approximately 1-2 cm longer than the defective ureter. (4) During the surgery, kidney descent and fixation and psoas hitch are performed to reduce end-to-end anastomotic tension. (5) The addition of a submucosal tunnel to prevent postoperative ureteral reflux is unnecessary. (6) A pedicled greater omentum graft is transferred to cover the reconstructed ureter to enhance blood supply when necessary. CONCLUSION Ureteroplasty using a spiral bladder muscle flap with vascular pedicles (ie, the superior vesical arteries) is an ideal treatment to repair full-length ureteral defects. Moreover, this technique is particularly useful for ureteral defects longer than 20 cm. This procedure should be strongly promoted.
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Affiliation(s)
- Yongwei Li
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chenglong Li
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Sixing Yang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Chao Song
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenbiao Liao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yunhe Xiong
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
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Janitzky A, Borski J, Porsch M, Wendler JJ, Baumunk D, Liehr UB, Schostak M. [Long-term results for subcutaneous Detour® prosthesis for ureteral obstruction: experiences of implantation, aftercare and management of complications]. Urologe A 2013; 51:1714-21. [PMID: 23095948 DOI: 10.1007/s00120-012-3039-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND We present the long-term results of implementation of the Detour® prosthesis as an alternative to established methods of surgical, percutaneous or internal urinary diversion. PATIENTS AND METHODS Between 2004 and 2012 a total of 40 prostheses were implanted in 31 patients (mean age 65 years) with ureteral strictures of various origins. In the follow-up the patients underwent examinations and completed questionnaires. RESULTS The average follow-up was 23 months (range 1-92 months). Sonographic examinations showed no urinary retention in 38 out of 40 implanted systems. The retention values were stable in 19 patients, improved in 7 and worse in 3. The quality of life (QoL) was high (EORTC QLQ-C30 90%). Intraoperative complications were 2 intestinal lesions and 3 bleeding of the renal-pelvic system. Postoperative urinary tract infections and wound complications were encountered. In the long-term course three infected hydronephroses occurred which were treated and cured with antibiotics and temporary nephrostomy and 4 systems were explanted, including 2 exchanges. CONCLUSIONS The system may be considered for patients with ureteral strictures with palliative and curative intent. There were no significant disadvantages in comparison with established methods. There were fewer risks in implantation and complications were manageable. The quality of life was significantly improved.
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Affiliation(s)
- A Janitzky
- Universitätsklinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Straße 44, 39120 Magdeburg, Deutschland.
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Klap J, Phé V, Chartier-Kastler E, Mozer P, Bitker MO, Rouprêt M. [Aetiology and management of iatrogenic injury of the ureter: a review]. Prog Urol 2012; 22:913-9. [PMID: 23102013 DOI: 10.1016/j.purol.2012.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/16/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Ureteric injuries (IU) are common complications occurring during abdomino-pelvic surgical procedures. Our aim was to review risk factors, treatment and methods of prevention of these iatrogenic UI. MATERIAL AND METHODS A literature review in English and French by Medline(®) was performed using the keywords: ureter; iatrogenic; injury; ureteroscopy; morbidity and endoscopy. RESULTS The analysis of the epidemiology of IU shows that the first two causes are gynecological and urological surgery. In 80% of cases, the pelvic ureter was concerned. Mechanisms of injury were essentially ligation, section and ischemia by altering the ureteral vasculature. The main risk factors found were pelvic inflammation (endometriosis, radiation…) and the occurrence of bleeding during surgery. In the presence of risk factors, placing a double J stent or a CT may be useful preoperatively. The choice of reparation technique depended on the location of the PU, the circumstances of the occurrence and experience of the surgical team. CONCLUSION Pelvic surgery is a provider of iatrogenic PU. Knowledge of the management of PU once occurred must be mastered before carrying out any risk surgery.
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Affiliation(s)
- J Klap
- Service d'urologie, université Paris VI, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
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