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The Clinical Study of Bladder Flap Ureteroplasty (Psoas Hitch) in the Treatment of Lower Ureteral Injuries and Strictures (19 Cases). EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4607735. [PMID: 35656474 PMCID: PMC9155903 DOI: 10.1155/2022/4607735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study was to investigate the efficacy and safety of bladder flap ureteroplasty (psoas hitch) in the treatment of lower ureteral injuries and strictures. Methods 19 patients with lower ureteral injuries and strictures scheduled for a bladder flap ureteroplasty (psoas hitch) in our hospital from January 2020 to January 2021 were recruited. The outcome measures included treatment efficacy and safety. Results The operative time, intraoperative bleeding, catheter extubation time, hospital stay, extubation time of ureteral stent, and follow-up time were (125.36 ± 15.38) min, (75.37 ± 11.09) ml, (7.25 ± 1.04) d, (8.76 ± 1.11) d, (46.34 ± 7.66) d, and(19.27 ± 1.27) months, respectively. No serious perioperative adverse reactions were observed, and all the symptoms of patients were relieved. Conclusion Bladder flap ureteroplasty (psoas hitch) is safe and effective for the treatment of lower ureteral injuries, with advantages such as less intraoperative bleeding and trauma and rapid recovery, so it is worthy of promotion. This was a retrospective study supervised by the Ethics Committee of Hebei Yanda Hospital.This trial is registered with no. hebYD076.
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O'Rourke TK, Gn M, Patel HV, Fakes C, Jones N, Cancian M, Elsamra SE. The Urologist and the Appendix: A Review of Appendiceal Use in Genitourinary Reconstructive Surgery. Urology 2021; 159:10-15. [PMID: 34695504 DOI: 10.1016/j.urology.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022]
Abstract
Recently, genitourinary reconstruction has experienced a renaissance. Over the past several years, there has been an expansion of the literature regarding the use of buccal mucosa for the repair of complex ureteral strictures and other pathologies. The appendix has been an available graft utilized for the repair of ureteral stricture disease and has been infrequently reported since the early 1900s. This review serves to highlight the use of the appendix for reconstruction in urology, particularly focusing on the anatomy and physiology of the appendix, historical use, and current applications, particularly in robotic upper tract reconstruction.
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Affiliation(s)
- Timothy K O'Rourke
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Martus Gn
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Hiren V Patel
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Christina Fakes
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nyasia Jones
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Madeline Cancian
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sammy E Elsamra
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Bole R, Nichols P, Gopalakrishna A, Dodge N, Manka M, Viers BR. The appendix is a valuable reconstructive tool for robotic surgical management of complex right ureteral stricture disease. UROLOGY VIDEO JOURNAL 2020. [DOI: 10.1016/j.urolvj.2020.100032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Jun MS, Stair S, Xu A, Lee Z, Asghar AM, Strauss D, Stifelman MD, Eun D, Zhao LC. A Multi-Institutional Experience With Robotic Appendiceal Ureteroplasty. Urology 2020; 145:287-291. [PMID: 32681918 DOI: 10.1016/j.urology.2020.06.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To report a multi-institutional experience with robotic appendiceal ureteroplasty. METHODS This is a retrospective review of 13 patients undergoing right appendiceal flap ureteroplasty at 2 institutions between April 2016 and October 2019. The primary endpoint was surgical success defined by the absence of flank pain and radiographic evidence of ureteral patency. RESULTS Eight of 13 (62%) underwent appendiceal onlay while 5/13 (38%) underwent appendiceal interposition. Mean length of stricture was 6.5 cm (range 1.5-15 cm) affecting anywhere along the right ureter. Mean operative time was 337 minutes (range 206-583), mean estimated blood loss was 116 mL (range 50-600), and median length of stay was 2.5 days (range 1-9). Balloon dilation was required in 1/12 (8%). One patient died on postoperative day 0 due to a sudden cardiovascular event. Otherwise, there were no complications (Clavien-Dindo > 2) within 30 days from surgery. At a mean follow up of 14.6 months, 11/12 (92%) were successful. CONCLUSION Robotic appendiceal ureteroplasty for right ureteral strictures is a versatile technique with high success rates across institutions.
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Affiliation(s)
- Min Suk Jun
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Sabrina Stair
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Alex Xu
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Aeen M Asghar
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - David Strauss
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Michael D Stifelman
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall, Hackensack, NJ
| | - Daniel Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Lee C Zhao
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY.
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Dal Moro F, Terrosu G, Lorenzin D, Cherchi V, Goffo F, Lissandrello G, Ferraioli G, Zaborra C, Risaliti A. Complete substitution of the left ureter with vermicular appendix during hemicolectomy for cancer in an adult patient. Prog Urol 2020; 30:547-549. [PMID: 32409238 DOI: 10.1016/j.purol.2020.03.010] [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: 01/25/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
We demonstrated that a complete left ureteral substitution with appendix is a feasible and safe technique. To our knowledge, this is the first case of a successful complete substitution of the left ureter with vermicular appendix in an adult patient reported in the literature.
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Affiliation(s)
- F Dal Moro
- Department of Medical Area, Urology - University of Udine, Via Pozzuolo 330, 33100 Udine, Italy; Department of Surgery, Oncology and Gastroenterology, Urology, University of Padova, Padova, Italy.
| | - G Terrosu
- Department of Medical Area, Surgery - University of Udine, Udine, Italy
| | - D Lorenzin
- Department of Medical Area, Surgery - University of Udine, Udine, Italy
| | - V Cherchi
- Department of Medical Area, Surgery - University of Udine, Udine, Italy
| | - F Goffo
- Department of Surgery, Oncology and Gastroenterology, Urology, University of Padova, Padova, Italy
| | - G Lissandrello
- Department of Imaging, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - G Ferraioli
- Department of Surgery, Oncology and Gastroenterology, Urology, University of Padova, Padova, Italy
| | - C Zaborra
- Department of Surgery, Oncology and Gastroenterology, Urology, University of Padova, Padova, Italy
| | - A Risaliti
- Department of Medical Area, Surgery - University of Udine, Udine, Italy
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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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Bilgutay AN, Kirsch AJ. Robotic Ureteral Reconstruction in the Pediatric Population. Front Pediatr 2019; 7:85. [PMID: 30968006 PMCID: PMC6439422 DOI: 10.3389/fped.2019.00085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/27/2019] [Indexed: 12/17/2022] Open
Abstract
Robot-assisted laparoscopic (RAL) surgery is a safe, minimally invasive technique that has become more widely used in pediatric urology over recent decades. With several advantages over standard laparoscopy, robotic surgery is particularly well-suited to reconstructive surgery involving delicate structures like the ureter. A robotic approach provides excellent access to and visualization of the ureter at all levels. Common applications include upper ureteral reconstruction (e.g., pyeloplasty, ureteropelvic junction polypectomy, ureterocalicostomy, and high uretero-ureterostomy in duplex systems), mid-ureteral reconstruction (e.g., mid uretero-ureterostomy for stricture or polyp), and lower ureteral reconstruction (e.g., ureteral reimplantation and lower ureter-ureterostomy in duplex systems). Herein, we describe each of these robotic procedures in detail.
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Affiliation(s)
- Aylin N Bilgutay
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Andrew J Kirsch
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
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