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Kochkin A, Kalfountzos C, Gallyamov E, Biktimirov R, Sanzharov A, Sergeev V, Popov S, Dal Moro F, Tokas T, Gözen AS. Laparoscopic intracorporeal ileal ureter replacement: multi-institutional data from 102 patients. MINIM INVASIV THER 2024; 33:140-146. [PMID: 38265869 DOI: 10.1080/13645706.2024.2302889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To present long-term results of our laparoscopic intracorporeal ileal ureter replacement (LIUR) cohort, including more complex cases of laparoscopic ileocalycostomy. MATERIAL AND METHODS We collected records of patients undergoing LIUR. Follow-up included a chemical profile and urine cultures. Imaging consisted of renal ultrasonography, excretory urography, cystography, and computer tomographic or magnetic resonance urography. RESULTS One hundred and two patients were included. Stricture location was left (46.1%), right (39.2%), or bilateral (14.7%). No open conversion was performed. Seventy-four patients (72.5%) underwent a total ureteral unit removal. The mean operative time was 289.4 (120 - 680) minutes. The estimated blood loss was 185.2 (10-400) mL. Three patients had intraoperative complications, and fifteen had early postoperative complications. The mean postoperative hospital stay was 12.2 (7-35) days. The mean follow-up duration period was 37.7 (12-162) months. Most patients' follow-up was uneventful (88%), and seven patients presented with Grade 2 late complications. CONCLUSIONS Intracorporeal laparoscopic ileal ureteral replacement in cases of extensive ureteral lesions offers optimal long-term outcomes and a low complication rate. Ileocalycostomy constitutes a viable option in the small group of patients with long proximal ureteral strictures and intrarenal pelvis.
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Affiliation(s)
- Alexey Kochkin
- Department of Urology, Urological Center of Russian Railways Hospital, Privolzhskiy Research Medical University, Nizhny Novgorod, Russia
| | - Christos Kalfountzos
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Viopolis, Larissa, Greece
| | - Eduard Gallyamov
- Department of Common Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Rafael Biktimirov
- Department of Urology, Federal Clinical Center of High Medical Technology of Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Andrey Sanzharov
- Department of Urology, Federal Scientific and Clinical Center for Specialized Methods of Medical Care and Medical Technologies of Federal Medical Biological Agency, Moscow, Russia
| | - Vladimir Sergeev
- Department of Urology, Russian State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Sergey Popov
- Department of Urology, I.I. Mechkikov North - Western State Medical University, St. Petersburg, Russia
| | - Fabrizio Dal Moro
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Theodoros Tokas
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
- Department of Urology, Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
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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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Yang K, Wang X, Xu C, Li Z, Han G, Fan S, Chen S, Li X, Zhu H, Zhou L, Li X. Totally Intracorporeal Robot-assisted Unilateral or Bilateral Ileal Ureter Replacement for the Treatment of Ureteral Strictures: Technique and Outcomes from a Single Center. Eur Urol 2023; 84:561-570. [PMID: 37225525 DOI: 10.1016/j.eururo.2023.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/27/2023] [Accepted: 04/23/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Few studies on totally intracorporeal robot-assisted ileal ureter replacement (RA-IUR) have been reported. OBJECTIVE To report our technique and the outcomes of totally intracorporeal RA-IUR for unilateral or bilateral ureteral reconstruction, involving performing cystoplasty simultaneously. DESIGN, SETTING, AND PARTICIPANTS Fifteen patients underwent totally intracorporeal RA-IUR from April 2021 to July 2022 at a single center. The perioperative variables were prospectively collected, and the outcomes were assessed. SURGICAL PROCEDURE The surgical procedure included dissection of the proximal end of the ureteral stricture or renal pelvis, harvesting of the ileal ureter, rebuilding of intestinal continuity, upper anastomosis of the ileum to the renal pelvis or the ureteral end, and lower anastomosis of the ileum to the bladder. All operations were performed intracorporeally. MEASUREMENTS Patient demographics and perioperative results were prospectively collected and analyzed for perioperative complications and success rates. A descriptive statistical analysis was performed. RESULTS AND LIMITATIONS All patients successfully underwent totally intracorporeal RA-IUR without open conversion. Seven patients received unilateral RA-IUR and eight received bilateral RA-IUR. The mean (range) length of the harvested ileal segment was 28.3 (15-40) cm, the operative duration was 261.8 (183-381) min, the estimated blood loss was 64.7 (30-100) ml, and the duration of postoperative hospitalization was 10.5 (7-17) d. At a median (range) follow-up of 14 (8-22) mo, the subjective and functional success rates were 100% and 86.7%, respectively. CONCLUSIONS Our results demonstrate that totally intracorporeal unilateral or bilateral RA-IUR (even with ileocystoplasty) can be performed safely and efficiently with acceptable minor complications and a high success rate. PATIENT SUMMARY Our study indicates that totally intracorporeal robotic ileal ureter replacement surgery is safe and feasible for ureteral reconstruction, even with ileocystoplasty. The postoperative complications are acceptable. At a median follow-up of 14 (8-22) mo, the subjective and functional success rates were 100% and 86.7%, respectively.
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Affiliation(s)
- Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Xiang Wang
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Chunru Xu
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Guanpen Han
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Silu Chen
- 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
| | | | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
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Singh J. Ileal Ureter Utilization in Patients with Previous Urinary Diversions. Urology 2023; 178:190. [PMID: 37263425 DOI: 10.1016/j.urology.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Jas Singh
- Division of Urology, McGill University, 3755 Chem. de la Côte-Sainte-Catherine, Montréal, QC H3T 1E2, Canada.
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Fan S, Han G, Li Z, Wang X, Li X, Xiong S, Li D, Zhang J, Meng C, Zhang P, Yang K, Li X, Zhou L. Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series. BMC Surg 2022; 22:435. [PMID: 36544120 PMCID: PMC9773509 DOI: 10.1186/s12893-022-01885-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Complete intracorporal robotic ileal ureteric replacement is challenging. We aimed to present the surgical technique of robotic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures. METHODS From March 2019 to March 2021, 18 patients underwent robotic ileal ureter replacement with extracorporeal ileal segment preparation by one experienced surgeon. The demographic, perioperative, and follow-up data were recorded. Success was defined as the resolution of the presenting symptom, a stable estimated glomerular filtration rate and unobstructive drainage on imaging examination. RESULTS All 18 surgeries were successfully completed without conversion. The median length of the intestinal tube used was 20 (12-30) cm. The median operative time was 248 (170-450) min, the median estimated blood loss was 50 (10-200) ml, and the median postoperative hospital stay was 7 (5-27) days. At a median follow-up of 16 (13-28) months, all patients were symptom-free. No or mild hydronephrosis was confirmed in 17 patients; 1 patient had moderate hydronephrosis without peristalsis of the ileal ureter. The renal function was stable in all patients. The overall success rate was 100%. Postoperative complications, including 4 cases of urinary infections (Grade I), 1 case of an incision hernia (Grade I), 4 cases of kidney stone formation (Grade I), 6 cases of metabolic acidosis (Grade I), 4 cases of incomplete ileus (Grade II), and 1 case of an incision infection (Grade IIIb). CONCLUSIONS Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation is safe, feasible, and effective for the treatment of long ureteral strictures, especially in high-volume tertiary referral centers with extensive robotic surgery experience capable of managing severe peri-operative complications.
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Affiliation(s)
- Shubo Fan
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - GuanPeng Han
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Zhihua Li
- grid.411472.50000 0004 1764 1621Nursing Department, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Xiang Wang
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Xinfei Li
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Shengwei Xiong
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Dan Li
- grid.411472.50000 0004 1764 1621Nursing Department, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Jun Zhang
- grid.411472.50000 0004 1764 1621Nursing Department, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Chang Meng
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Peng Zhang
- grid.414252.40000 0004 1761 8894Department of Urology, Emergency General Hospital, No. 29, Xibahenanli, Chaoyang District, Beijing, 100028 China
| | - Kunlin Yang
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Xuesong Li
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Liqun Zhou
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
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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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Zhang G, Zhao J, Zhao G, Niu Z, Liu P, Sun L. Laparoscopic ureteral reimplantation with a Boari flap for long-segment ureteric avulsion or ureteric strictures: our experience. Int Urol Nephrol 2022; 54:1865-1870. [PMID: 35594006 DOI: 10.1007/s11255-022-03224-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was designed to evaluate the feasibility of laparoscopic ureteral reimplantation with a Boari flap for long-segment ureteric avulsion or ureteric strictures of the middle and lower ureters. By observing its curative effect and prognosis, we can provide a safer and reliable treatment option for patients with middle and lower ureteral injury. METHODS In this study, of the eight cases under study, five were diagnosed with long-segment ureteric strictures, one had long-segment ureteric avulsion, one was diagnosed with ureteral rupture caused by surgical injury of appendicitis, and the remaining one underwent ureterostomy after ureteral injury. The location of ureteral injury was in the middle lower segment. All eight patients underwent laparoscopic ureteral reimplantation with a Boari flap from January 2018 to October 2021. In this study, two patients were treated with a Boari bladder flap with psoas hitching. All procedures were performed by the same surgeon with over 20 years of experience in urological surgery. RESULTS The mean length of ureteric avulsion or ureteric strictures was 7.94 cm (range, 4-15 cm). Laparoscopic ureteral reimplantation with a Boari flap was performed successfully between 120 and 240 min. The mean duration of postoperative hospital stay was 6 days, and no major complications related to the procedure in the perioperative period occurred. Postoperative follow-up showed no obvious hydronephrosis on computed tomography urography or urinary ultrasound in all eight patients. Postoperative reexamination did not reveal any significant hydronephrosis, urinary tract infection, or ureteral reflux, and none of the postoperative renal functions were abnormal. CONCLUSIONS Laparoscopic ureteral reimplantation with a Boari flap is safe and feasible for experienced physicians. In our case, the length/width ratio of bladder flap is more than 4:1, with good blood supply and no obvious complications, it provides a longer alternative length.
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Affiliation(s)
- Guanglei Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Jiming Zhao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Guiting Zhao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Zhihong Niu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Ping Liu
- Institute of Orthopaedic Basic and Clinical Transformation, University of Shanghai for Science and Technology, Shanghai, China.,The Base of Achievement Transformation, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Liang Sun
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
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Yang K, Fan S, Wang J, Yin L, Li Z, Xiong S, Han G, Meng C, Zhang P, Li X, Zhou L. Robotic-assisted Lingual Mucosal Graft Ureteroplasty for the Repair of Complex Ureteral Strictures: Technique Description and the Medium-term Outcome. Eur Urol 2022; 81:533-540. [PMID: 35101303 DOI: 10.1016/j.eururo.2022.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/07/2021] [Accepted: 01/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Robot-assisted autologous graft ureteroplasty provides another treatment option for complex ureteral strictures, circumventing ileal ureter or renal autotransplantation. OBJECTIVE To report the medium-term outcome of robotic ureteroplasty with a lingual mucosal graft (RU-LMG) for managing complex ureteral strictures. DESIGN, SETTING, AND PARTICIPANTS Between June 2019 and September 2020, 12 patients underwent RU-LMG. The perioperative variables were prospectively collected, and the outcomes were assessed. SURGICAL PROCEDURE After ureteral stricture dissection, the narrow segment was cut longitudinally, and a lingual mucosal graft (LMG) of the required length was harvested, followed by double-J stent placement and LMG ventral onlay anastomosis. If the diseased ureter required transection, posteriorly augmented ureteral anastomosis could be performed before LMG harvest. Finally, the anastomotic area was wrapped by the omental flap. MEASUREMENTS A descriptive statistical analysis was performed. The criteria for complete success included the absence of both clinical symptoms and obstruction on radiography. RESULTS AND LIMITATIONS Seven patients (58%) had a history of failed ureteral reconstruction. The mean (range) stricture length was 4.7 (3-6.5) cm, LMG length was 4.4 (3-7) cm, LMG width was 1.5 (1-2) cm, operative duration was 197.1 (130-346) min, estimated blood loss was 49.2 (10-200) ml, and the duration of postoperative hospitalization was 6 (4-14) d. No open conversions and intraoperative complications occurred. The median follow-up time was 15 mo (range: 13-27 mo). The overall success rate was 92% (11/12). CONCLUSIONS These medium-term follow-up results demonstrate that RU-LMG is a safe and feasible technique for repairing ureteral strictures. PATIENT SUMMARY Our study proves that robotic ureteroplasty with a lingual mucosal graft is a safe and feasible technique for ureteral reconstruction that can serve as another choice for managing long, complex ureteral strictures.
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Affiliation(s)
- Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Lu Yin
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Chang Meng
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
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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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Grosso AA, DI Maida F, Mari A, Campi R, Crisci A, Vignolini G, Masieri L, Carini M, Minervini A. Totally intracorporeal robotic ileal ureter replacement: focus on surgical technique and outcomes. Minerva Urol Nephrol 2021; 73:532-539. [PMID: 33439579 DOI: 10.23736/s2724-6051.20.04191-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of the present study was to describe our totally intracorporeal robotic ileal ureter replacement technique, reporting perioperative and mid-term results and compare it with previous similar experiences, specifically focusing on technical considerations. METHODS Three patients were submitted to robotic ileal ureter substitution for long ureteral defects in our institution during 2019. The procedures were carried out fully intracorporeally. Two patients received a complete replacement of the urinary tract using an ileal segment, while in one patient the lower ureteral stump was maintained, and an ileal-ureter anastomosis was performed distally. Patients' baseline characteristics, as well as perioperative and mid-term results were collected. A detailed description of the technique is reported and compared with prior similar experiences. RESULTS Median operative time was 270 (range 240-300) min. No Clavien-Dindo complication >2 was collected. All patients experienced a fast return to oral intake and canalization. Antegrade pyelography, performed a 1-month follow-up, revealed full passage of the medium contrast in those patients submitted to complete ileal ureter replacement while, in the third one, stenosis at the level of ileal-ureter anastomoses was found. CONCLUSIONS Robotic ileal ureter replacement can be performed completely intracorporeal with optimal results and limited complication rate, in selected cases. According to our considerations, specific surgical steps are needed to reduce the risks related to this procedure, including avoiding partial ileal substitution.
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Affiliation(s)
- Antonio A Grosso
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy -
| | - Fabrizio DI Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Alfonso Crisci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Masieri
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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11
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Liang C, Chai S, Gao X, Wang J, Ni D, Hou T, Xiao X, Yang Y, Li W, Li B. Laparoscopic "reverse 7" ileal ureteral replacement for bilateral extensive ureteral strictures performed completely intracorporeally: the initial experience. Int Urol Nephrol 2021; 53:919-924. [PMID: 33387228 DOI: 10.1007/s11255-020-02751-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To present our initial experience and evaluate the feasibility of the novel technique of completely intracorporeal laparoscopic "reverse 7" ileal ureteral replacement (IUR). MATERIALS AND METHODS Between December 2018 and September 2019, two patients underwent completely intracorporeal laparoscopic "reverse 7" IUR, which were female patients with bilateral extensive ureteral strictures (BEUS) secondary to radical hysterectomy and pelvic lymph node dissection for cervical cancer and postoperative radiotherapy. Antegrade pyelography and retrograde pyelography showed BEUS preoperatively. RESULTS The novel technique was performed successfully by the same surgeon without conversion to open surgery. The operating time of each patient was 420 min and 410 min, respectively. Meanwhile, the estimated blood loss of each patient was 120 ml and 100 ml, respectively. There were no major complications during the perioperative period. After ureteral stent was removed, antegrade pyelography postoperatively revealed excellent drainage with the resolution of hydronephrosis in both patients. After removing of ureteral stent and nephrostomy tube, no patients have a complaint about the donor site or the onset of flank pain. CONCLUSIONS To our knowledge, we present the initial experience with completely intracorporeal laparoscopic "reverse 7" IUR. With initial follow-up outcomes, this novel minimally invasive technique appears to be feasible and efficacious in treating BEUS in carefully selected patients.
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Affiliation(s)
- Chaoqi Liang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan, 430022, China
| | - Shuaishuai Chai
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan, 430022, China
| | - Xincheng Gao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan, 430022, China
| | - Jianli Wang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan, 430022, China
| | - Dong Ni
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan, 430022, China
| | - Teng Hou
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan, 430022, China
| | - Xingyuan Xiao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan, 430022, China
| | - You Yang
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Wencheng Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan, 430022, China
| | - Bing Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan, 430022, China.
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Ding G, Cheng S, Li X, Fang D, Yang K, Tang Q, Zhang P, Hao H, Li X, Zhou L. Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures. Transl Androl Urol 2021; 10:56-65. [PMID: 33532296 PMCID: PMC7844529 DOI: 10.21037/tau-20-789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background To summarize our experience with the Boari flap-psoas hitch and compare the indications, perioperative data and outcomes between open and laparoscopic procedures. Methods This study retrospectively reviewed 35 patients with complex distal ureteral stricture between January 2015 and April 2019. All patients were treated with Boari flap-psoas hitch by either an open or a laparoscopic procedure. Selection criteria were based on the etiology, comorbidities, medical history, and patient preference. Results All surgeries were performed successfully. The median operation time was 201 min (range, 120 to 300 min), and the median estimated blood loss was 50 mL (range, 20 to 400 mL). The median postoperative hospitalization was 9 days (range, 3 to 46 days). Nineteen patients were treated by the open procedure, and 16 were treated by the transperitoneal laparoscopic procedure. The surgical indication of open surgery was broader than that for laparoscopic surgery. For patients experiencing iatrogenic injury and ureterovesical reimplantation failure, no significant differences in sex, laterality, operative time, ASA score or postoperative hospitalization stay were observed between the two groups. The median estimated blood loss was lower in the laparoscopic group than in the open group (P=0.047). Patients in the open group had more surgical complications than patients in the laparoscopic group (P=0.049). The postoperative follow-up showed the radiological resolution of hydronephrosis in 33 patients. Conclusions With the appropriate surgical considerations, Boari flap-psoas hitch is a valid method to bridge distal ureteral defects. For select patients, laparoscopic surgery had advantages being a minimal invasive surgery with less estimated blood loss and fewer surgical complications.
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Affiliation(s)
- Guangpu Ding
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Sida Cheng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- 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
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Qi Tang
- 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
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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[Application of indocyanine green in complex upper urinary tract repair surgery]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52. [PMID: 32773795 PMCID: PMC7433627 DOI: 10.19723/j.issn.1671-167x.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the clinical application of indocyanine green (ICG) visualization by near infrared fluorescence laparoscopy (NIFL) in complex upper urinary tract reconstructions surgery. METHODS This was a retrospective study of 7 patients who underwent complex surgeries of ureteral reconstruction between May 2019 and October 2019. There were 6 males and 1 female with the age ranging from 24 to 57 years (median age was 47 years). There were 5 cases of right ureteral strictures, of which 3 were proximal ureteral strictures and 2 were multiple and long ureteral strictures caused by radiotherapy. There were 2 cases of left ureteral strictures, of which 1 was ureteropelvic junction stricture and 1 was proximal ureteral stricture. There were 4 cases of secondary repair operations and 3 cases of primary operations. All the patients underwent laparoscopic surgery via the abdominal approach. ICG was injected into the ureter via nephrostomy tube during the operations, and the diseased ureter was identified by NIFL. Among the patients, 2 cases underwent IUPU (Institute of Urology, Peking University) modified ileal ureter replacement, 2 cases underwent ureteroureterostomy, 2 cases underwent appendiceal onlay flap ureteroplasty, and 1 case underwent lingual mucosa onlay flap ureteroplasty. RESULTS All the operations were successfully completed without open conversion. The localization and separation of ureteral lesions were completed under NIFL. The mean operative time was 187 (135-300) min. The duration of ureteral separation was 15-27 min, and the mean time was 18 min. The estimated blood loss was 15-200 mL, the mean estimated blood loss was 50 mL. There was one patient with ileal ureter replacement who had fever after surgery and responded well to antibiotics. The mean (range) length of postoperative hospital stay was 7 (6-10) days and no postoperative complications of a high grade (Clavien-Dindo Ⅲ and Ⅳ) occurred. Up to now, the mean follow-up duration was 9 (6-11) months, and no indocyanine green toxicity occurred. All D-J stents and nephrostomy were removed successfully 2 months after the operation. Ultrasound showed no obvious hydronephrosis, and CTU (computed tomography urography) showed that the urinary tract was unobstructed and the kidney function was normal. CONCLUSION The application of ICG in the complex upper urinary tract reconstructive surgery is a safe and easy method to help surgeon to identify the ureter which may reduce the risk of iatrogenic damage and protect the ureteral blood supply.
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Wang J, Xiong S, Fan S, Yang K, Huang B, Zhang D, Zhu H, Ji M, Chen J, Sun J, Zhang P, Li X. Appendiceal Onlay Flap Ureteroplasty for the Treatment of Complex Ureteral Strictures: Initial Experience of Nine Patients. J Endourol 2020; 34:874-881. [PMID: 32323579 DOI: 10.1089/end.2020.0176] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the onlay technique using the appendix for ureteral reconstruction and describe the initial experience of nine operations performed by one surgeon. Methods: Nine patients with complex ureteral strictures who underwent appendiceal onlay flap ureteroplasty since May 2019 were recruited from our RECUTTER database. There were seven men and two women, with a mean age of 38.9 years; four patients underwent robot-assisted laparoscopic surgery, and five patients underwent traditional laparoscopic surgery. All patients had iatrogenic injuries of the ureter after treatment of stone disease. Seven patients had proximal ureteral strictures, and two had midureteral strictures. The mean stricture length of the nine patients was 3.9 (range 3-4.5) cm. Nephrostomy was performed in seven patients before they presented to our center, and the other two patients had indwelling Double-J ureteral stents. Results: All nine operations were effectively completed without open conversion. The mean operation time was 182 (range 135-220) minutes, the mean estimated blood loss was 71 (range 20-100) mL, and the mean length of postoperative hospital stay was 9 (range 6-12) days. No postoperative complications of high grade (Clavien-Dindo III and IV) occurred within 30 days of surgery. All the patients had their Double-J ureteral stents and nephrostomy tubes removed after complete ureteroscopy and upper urinary tract urodynamic examination or CTU, which showed that the anastomosis healed well and that the urinary tract was unobstructed, respectively. The objective success rate was 100% (all the patients had endoscopic and radiographic resolution of their ureteral strictures). The subjective success rate was 88.9% (one patient developed recurrent back discomfort and a 0.5 cm calculus was found in her renal pelvis). Conclusions: Appendiceal onlay flap ureteroplasty is a viable and effective technique for treating complex proximal and middle ureteral strictures at the right side.
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Affiliation(s)
- Jie Wang
- Department of Urology, National Urological Cancer Center, Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Shengwei Xiong
- Department of Urology, National Urological Cancer Center, Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Shubo Fan
- Department of Urology, National Urological Cancer Center, Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Kunlin Yang
- Department of Urology, National Urological Cancer Center, Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Bingwei Huang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Dengxiang Zhang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Mingfei Ji
- Department of Urology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Jie Chen
- Department of Urology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Jiantao Sun
- Department of Urology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, National Urological Cancer Center, Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
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15
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Kochkin A, Tokas T, Gallyamov E, Biktimirov R, Sanzharov A, Sergeev V, Popov S, Gözen AS. Laparoscopic totally intracorporeal ileal ureter replacement: a multi-institutional study. MINIM INVASIV THER 2020; 31:119-126. [DOI: 10.1080/13645706.2020.1762094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Alexey Kochkin
- Urological Center of Russian Railways Hospital, Privolzhskiy Research Medical University, Nizhny Novgorod, Russia
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Eduard Gallyamov
- Department of common surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Rafael Biktimirov
- Department of Urology, Federal Clinical Center of High Medical Technology of Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Andrey Sanzharov
- Department of Urology, Federal Scientific and Clinical Center for Specialized Methods of Medical Care and Medical Technologies of Federal Medical Biological Agency, Moscow, Russia
| | - Vladimir Sergeev
- Department of Urology, Russian State Research Center − Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Sergey Popov
- Department of Urology, I.I. Mechkikov North – Western State Medical University, St. Petersburg, Russia
| | - Ali Serdar Gözen
- Department of Urology SLK-Kliniken Heilbronn, University of Heidelberg, Heilbronn, Germany
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16
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Porpiglia F, Checcucci E, Piramide F, Amparore D, Fiori C, Hemal A. Subtotal ureteral substitution with ileum for patients with multiple ureteral stenosis. Transl Androl Urol 2020; 9:971-976. [PMID: 32420213 PMCID: PMC7215022 DOI: 10.21037/tau.2019.12.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The use of small bowel for ureteral substitution in patients with ureteral stenosis can, nowadays, be safely performed with a laparoscopic or robotic mini-invasive approach. To date, this technique required a complete substitution of the ureter with ileum. In this work we present our robotic intracorporeal sub-total ureteral substitution preserving the distal part of the ureter with the aim to reduce the risk of vescico-ureteral reflux. We report the case of a 65-years old male with a “functional” right single kidney and multiple recurrent stenosis. Our technique seems to be feasible and safe, no intra or postoperative complication were recorded. At 3 months of follow-up the trans-nephrostomic enhanced CT showed a completely opacification of ileal ureter, thus the nephrostomic tube was removed. At 6 and 12 months the patient was asymptomatic and with a level of serum creatinine 1.9 and 1.6 mg/dL, respectively. In conclusion the sub-total ureteral substitution with ileum can be a safety and effective procedure for patients who require a mandatory preservation of homolateral renal function.
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Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Ashok Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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17
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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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18
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Xiong SW, Yang KL, Ding GP, Hao H, Li XS, Zhou LQ, Guo YL. [Advances in surgical repair of ureteral injury]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:783-789. [PMID: 31420641 DOI: 10.19723/j.issn.1671-167x.2019.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ureteral injury can be classified as iatrogenic or traumatic, which represents a rare but challenging field of reconstructive urology. Due to their close proximity to vital abdominal and pelvic organs, the ureters are highly susceptible to iatrogenic injury, while ureteral injury caused by external trauma is relatively rare. The signs of ureteric injury are difficult to identify initially and often present after a delay. The treatment of ureteral injury, which is depended on the type, location, and degree of injury, the time of diagnosis and the patient's overall clinical condition, ranges from simple endoscopic management to complex surgical reconstruction. And long defect of the ureter presents much greater challenges to urologists. Ureterotomy under endoscopy using laser or cold-knife is available for the treatment of 2-3 cm benign ureteral injuries or strictures. Pyeloplasty is an effective treatment for ureteropelvic junction obstruction and some improved methods showed the possibility of repairing long-segment (10-15 cm) stenosis. Proximal and mid-ureteral injuries or strictures of 2-3 cm long can often be managed by primary ureteroureterostomy. When not feasible due to ureteral defects of longer segment, mobilization of the kidney should be considered, and transureteroureterostomy is alternative if the proximal ureter is of sufficient length. And autotransplantation or nephrectomy is regarded as the last resorts. Most of the injuries or strictures are observed in the distal ureter, below the pelvic brim, and are usually treated with ureteroneocystostomy. A non-refluxing technique together with a ureteral nipple or submucosal tunnel method, is preferable as it minimizes vesico-ureteral reflux and the risk of infection. In order to cover a longer distance, ureteroneocystostomy in combination with a psoas hitch (covering 6-10 cm of defect) or a Boari flap (covering 12-15 cm) is often adopted. Among various ureteral replacement procedures, only intestinal ureteral substitution, which includes ileal ureter, appendiceal interposition and reconfigured colon substitution, has gained wide acceptance when urothelial tissue is insufficient. Ileal ureter can be used to replace the ureter of >15 cm defect and even to replace the entire unbilateral ureter or bilateral ureter. Laparoscopic and robotic-assisted techniques are increasingly being employed for ureteral reconstruction and adopted with encouraging results.
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Affiliation(s)
- S W Xiong
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - K L Yang
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - G P Ding
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - H Hao
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - X S Li
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - L Q Zhou
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - Y L Guo
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
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丁 光, 程 嗣, 方 冬, 杨 昆, 李 学, 周 辉, 张 骞, 叶 雄, 周 利. [Review of upper urinary modified minimal invasive surgical technology]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:610-614. [PMID: 31420609 PMCID: PMC7433496 DOI: 10.19723/j.issn.1671-167x.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 11/20/2022]
Abstract
Upper urinary surgery is an important area of urology surgery. Open surgery used to be the gold standard of upper urinary surgery. With the development of medical techniques, minimal invasive surgeries including laparoscopic and robot assisted-laparoscopic surgery have gradually replaced the open surgery. Because of the complexity and diversity of upper urinary diseases, surgeries sometimes are difficult, and minimal invasive surgeries require higher surgical abilities of urologists than open surgeries. In recent years, depending on our surgical experience and international reports, our team from three Chinese medical centers summarizes techniques of upper urinary minimal invasive surgeries. For malignant diseases, such as renal and ureteral carcinomas, it's important to totally remove the tumor first, and then to avoid the surgical injuries. We summarize surgical experience of retroperitoneal laparoscopic partial nephrectomy for moderately complex renal hilar tumors. Our team modified minimal invasive techniques for some complex tumors, including ring suture technique for renal hilar tumors, internal suspension technique for renal ventral tumors, and combination retroperitoneal laparoscopic surgery with mini-flank incision for complex renal tumors. While for begin diseases, urologists should focus on the resections and surgical injuries at the same time. We have reported the novel technique of laparoscopic aspiration for central renal angiomyolipoma, making the surgery simple and available. For reconstruction surgeries, operations should be based on several principals. We generalize it as "4TB principals", which include "tension-free", "water-tight", "thin suture", "no touch of the key area" and "protecting the blood supply". Depending on the localization, length, and etiology of the strictures, different techniques are required. Our team summarize the pyeloplasty, ureteral reimplantation and ileal ureter replacement based on our surgical experience. For infant upper urinary surgeries, our team has made invasive surgeries that can be used in complex diseases, such as duplex kidney. Based on years of surgical techniques, our modified surgeries achieve a better subjective cosmetic result than the traditional surgeries. In the future, the standardized, practical, simple and individual minimal invasive surgical technique will become the main direction in the future researches.
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Affiliation(s)
- 光璞 丁
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 嗣达 程
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 冬 方
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 昆霖 杨
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 学松 李
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 辉霞 周
- 中国人民解放军总医院第七医学中心八一儿童医院泌尿外科, 北京 100700Department of Pediatric Urology, Bayi Children’s Hospital Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, No 5 Nanmencang, Beijing, 100700, China
| | - 骞 张
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 雄俊 叶
- 北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
| | - 利群 周
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
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Konheim JA, Khaled DT, Canter DJ. Ileocalicostomy Ureteral Substitution for Complex Ureteropelvic Junction Stricture: Technique and Initial Experience. Urology 2018; 122:174-178. [PMID: 30171917 DOI: 10.1016/j.urology.2018.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To present our novel surgical technique, ileocalicostomy ureteral substitution, for the management of long upper ureteral strictures in patients without a dilated extra-renal pelvis. MATERIALS AND METHODS Two patients were identified with long, complex proximal ureteral strictures who were treated with our novel surgical technique by a single surgeon at a single institution. Perioperative data for these two patients are presented along with a detailed description of the surgical technique. RESULTS Ileocalicostomy ureteral substitution was successfully performed in two cases. The total operative time for these cases was 436 minutes and 246 minutes, with estimated blood loss of 300 mL and 200 mL. Length of stay for the two patients was 8 days and 6 days, respectively. There were no major (Clavien-Dindo Classification ≥ grade 3) complications. Both patients are entirely free of urinary tubes with unobstructed kidneys since reconstruction. CONCLUSION Ileocalicostomy ureteral substitution is a feasible reconstructive option for select patients. To our knowledge this report is the initial experience in the literature presented.
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Affiliation(s)
- Jeremy A Konheim
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA
| | - Dunia T Khaled
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA
| | - Daniel J Canter
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA.
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Ubrig B, Janusonis J, Paulics L, Boy A, Heiland M, Roosen A. Functional Outcome of Completely Intracorporeal Robotic Ileal Ureteric Replacement. Urology 2017; 114:193-197. [PMID: 29180072 DOI: 10.1016/j.urology.2017.11.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/11/2017] [Accepted: 11/14/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess perioperative, clinical, and functional outcomes following completely robotic ileal ureter. METHODS We retrospectively reviewed 7 consecutive patients undergoing completely intracorporeal ileal ureteric replacement between November 2015 and May 2017. One patient had a solitary kidney. A 4-arm technique was used. In 5 patients, additional psoas hitch procedure was performed. Patients had retrograde filling and removal of the ileal stent and transurethral catheter at an average of 14 days postoperatively. Renal ultrasonography, serum analysis, and diuretic renography were performed at follow-up 3 months postoperatively. RESULTS Mean operative time was 328 ± 66.3 minutes and median estimated blood loss was 100 mL (range 50-200); mean length of the ileal substitute was 20.4 cm (range 18-24). No case was converted to open surgery. In 1 patient, there was a prolonged insufficiency of the pyeloileal anastomosis, requiring prolonged stenting. Apart from that, there were no major complications and no open surgical or endoscopic reinterventions. On 3-month follow-up, all patients presented symptom-free, with no signs of obstruction on ultrasound and significantly improved glomerular filtration rate, creatinine levels, and differential renal function (P = .02, 0.03, and 0.046, respectively). Five patients had a diuretic halftime <10 minutes, 2 had a halftime between 10 and 20 minutes. CONCLUSION Completely intracorporeal robotic ileal ureteric replacement results in full functional restoration of the upper tract in cases of long defects of the mid and upper ureter.
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Affiliation(s)
- B Ubrig
- Department of Urology, Augusta-Kliniken, Witten/Herdecke University, Bochum, Germany
| | - J Janusonis
- Department of Urology, Augusta-Kliniken, Witten/Herdecke University, Bochum, Germany
| | - L Paulics
- Department of Urology, Augusta-Kliniken, Witten/Herdecke University, Bochum, Germany
| | - A Boy
- Department of Urology, Augusta-Kliniken, Witten/Herdecke University, Bochum, Germany
| | - M Heiland
- Department of Urology, Augusta-Kliniken, Witten/Herdecke University, Bochum, Germany
| | - A Roosen
- Department of Urology, Augusta-Kliniken, Witten/Herdecke University, Bochum, Germany; Ludwig-Maximilians-University, Munich, Germany.
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