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Xu MY, Song ZY, Liang CZ. Robot-assisted repair of ureteral stricture. J Robot Surg 2024; 18:354. [PMID: 39340614 PMCID: PMC11438720 DOI: 10.1007/s11701-024-01993-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/23/2024] [Indexed: 09/30/2024]
Abstract
As robot-assisted laparoscopic techniques continue to advance, becoming increasingly complex and refined, there has been significant progress in the minimally invasive treatment of ureteral strictures. This abstract aims to provide an overview and description of various surgical techniques that utilize robots for repairing ureteral strictures. We have summarized the progression of these surgical methods and highlighted the latest advancements in the procedures. When compared to open surgery, robot-assisted reconstruction techniques demonstrate superior functional outcomes, fewer postoperative complications, and a faster recovery in the treatment of ureteral strictures. This abstract aims to provide an overview and description of various surgical techniques utilizing robots to repair ureteral strictures. Robotic ureteral stricture correction has emerged as a valuable therapeutic option, particularly when endoscopic procedures are not feasible. Compared to traditional open surgery, robotic methods exhibit superior therapeutic effectiveness, fewer postoperative complications, and accelerated recovery. Reconstructive procedures such as reimplantation, psoas hitch, Boari flap, ureter-to-ureter anastomosis, appendix graft, buccal mucosa graft (BMG), ileal transplantation, or kidney autotransplantation can be performed depending on the extent and location of the stricture. Robotic surgical techniques also offer advantages, such as an expanded field of vision and the incorporation of supplementary technologies such as FireflyTM, indocyanine green (ICG), and near-infrared fluorescence (NIRF) imaging. However, further long-term, multicenter investigations are necessary to validate the positive findings reported in existing case series. Compared with open surgery, robot-assisted reconstruction techniques yield superior functional outcomes, fewer postoperative complications, and accelerated recovery for the treatment of ureteral strictures.
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Affiliation(s)
- Mu-Yang Xu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, People's Republic of China
- Institute of Urology, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Zheng-Yao Song
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, People's Republic of China
- Institute of Urology, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Chao-Zhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, People's Republic of China.
- Institute of Urology, Anhui Medical University, Hefei, Anhui, People's Republic of China.
- Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Hefei, Anhui, People's Republic of China.
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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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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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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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Wang X, Chen S, Li X, Fan S, Han G, Li Z, Yang K, Zhang K, Zhou L, Li X. Robotic-assisted Laparoscopic Bilateral Ileal Ureter Replacement With Extracorporeal Ileal Segment Preparation for Bilateral Extensive Ureteral Strictures: The Initial Experience. Urology 2023; 176:213-218. [PMID: 37003474 DOI: 10.1016/j.urology.2023.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE To present our initial experience and evaluate perioperative, and follow-up outcomes following the novel technique of robot-assisted laparoscopic bilateral ileal ureter replacement (IUR) with extracorporeal ileal segment preparation for bilateral extensive ureteral strictures (BEUS). METHODS We prospectively enrolled 4 consecutive patients with BEUS undergoing robot-assisted laparoscopic bilateral IUR with extracorporeal ileal segment preparation between June 2021 and October 2021. A 4-arm technique was used. The demographic characteristics, perioperative data, and follow-up outcomes as well as the description of surgical technique were reported. RESULTS All the patients had BEUS, and the length of strictures was over 10.ßcm in both sides. All procedures were performed effectively with a median operative time of 312.5.ßminutes (range 227-433) and a median estimated blood loss of 75.ßmL (range 50-200). In one patient, additional partial small bowel resection procedure was performed. No case was converted to open surgery. The median length of the ileal graft was 29.ßcm (range 15-32). The median postoperative hospitalization was 10 days (range 6-13). Two patients developed metabolic acidosis, and no major complications during the perioperative and follow-up period were reported. All patients presented symptom-free, with no signs of restenosis and improved/stabilized hydronephrosis, during the median follow-up of 12 months (range 12-15). CONCLUSION We present the details and initial experience of robot-assisted laparoscopic bilateral IUR with extracorporeal ileal segment preparation. According to the median follow-up of 12 months, this minimally invasive procedure is a safe, feasible, and effective approach in the management of BEUS.
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Affiliation(s)
- Xiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Silu Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China; Department of Nursing, Peking University First Hospital, Peking University, Xicheng District, Beijing 100034, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Kai Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Xicheng District, Beijing 100034, China.
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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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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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Fuller TW, Daily AM, Buckley JC. Robotic Ureteral Reconstruction. Urol Clin North Am 2022; 49:495-505. [DOI: 10.1016/j.ucl.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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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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Elbers JR, Rodríguez Socarrás M, Rivas JG, Autran AM, Esperto F, Tortolero L, Carrion DM, Sancha FG. Robotic Repair of Ureteral Strictures: Techniques and Review. Curr Urol Rep 2021; 22:39. [PMID: 34105032 DOI: 10.1007/s11934-021-01056-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW To provide an overview and description of the different surgical techniques for the robotic repair of ureteral strictures. RECENT FINDINGS The robotic repair of ureteral stenosis has emerged as a useful option for treating strictures unsuitable for endoscopic resolution with good results, lower morbidity, and faster recovery than open techniques. Depending on the stricture's length and location, the reconstructive options are reimplantation, psoas hitch, Boari flap, ureteroureterostomy, appendiceal onlay flap, buccal mucosa graft (BMG) ureteroplasty, ileal replacement, or renal autotransplantation. The robotic approach offers a magnified vision and the possibility of adding near-infrared fluorescence (NIRF) imaging, indocyanine green (ICG), and FireflyTM to facilitate the technique. Multicenter studies with extended follow-up still have to confirm the good results obtained in published case series. Robotic reconstructive techniques are useful for repairing ureteral strictures, obtaining good functional results with less morbidity and faster recovery than open procedures.
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Affiliation(s)
- Javier Reinoso Elbers
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| | - Moises Rodríguez Socarrás
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain.
| | - Juan Gómez Rivas
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| | - Ana Maria Autran
- Oficina de Investigacion CAU (Confederacion Americana de Urologia), Madrid, Argentina
| | | | | | - Diego M Carrion
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| | - Fernando Gómez Sancha
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
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11
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Zhu W, Xiong S, Fang D, Hao H, Zhang L, Xiong G, Yang K, Zhang P, Zhu H, Cai L, Li X, Zhou L. Minimally invasive ileal ureter replacement: Comparative analysis of robot-assisted laparoscopic versus conventional laparoscopic surgery. Int J Med Robot 2021; 17:e2230. [PMID: 33533169 DOI: 10.1002/rcs.2230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/22/2020] [Accepted: 01/15/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND This study is an initial comparative analysis of perioperative and intermediate-term functional outcomes between patients who underwent robot-assisted laparoscopic (RALS) or conventional laparoscopic surgery (LS). MATERIALS AND METHODS A total of 25 patients who underwent ileal ureter replacement (10 RALS and 15 LS) were followed by functional cine magnetic resonance urography (MRU) combined with a modified Whitaker test. Also, the characteristics, perioperative data and functional outcomes of the patients were compared. RESULTS The estimated blood loss, postoperative hospital stay and time to oral intake were significantly lower in the RALS group. At the median 14-month follow-up, all the patients showed improved renal function and were symptom-free, with no signs of leakage or stenosis observed by cine MRU combined with a modified Whitaker test. CONCLUSIONS RALS with an extracorporeal bowel resection is feasible and appears to be safe, with quick postoperative recovery and encouraging outcomes.
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Affiliation(s)
- Weijie Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Dong Fang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Gengyan Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Lin Cai
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
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12
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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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13
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Kapogiannis F, Spartalis E, Fasoulakis K, Tsourouflis G, Dimitroulis D, Nikiteas NI. Laparoscopic and Robotic Management of Ureteral Stricture in Adults. In Vivo 2021; 34:965-972. [PMID: 32354881 DOI: 10.21873/invivo.11864] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM The aim of this review was to provide an update on the status of minimal invasive treatment of ureteral stricture either with a laparoscopic or robotic surgery. MATERIALS AND METHODS Eligible studies, published until November 2019 were retrieved through Medline, Cochrane and Pubmed databases. Predetermined inclusion and exclusion criteria were used as selection method for data synthesis and acquisition. The study was performed in accordance with the PRISMA statement. RESULTS A total of 19 retrospective studies met the inclusion criteria. All of them demonstrated the safety, feasibility and success of both laparoscopic and robotic ureteral reconstruction. Individual case series or cumulative comparison analysis of the available studies showed at least equivalent success rates and a trend favoring laparoscopic and robotic groups in terms of estimated blood loss and length of hospital stay to the detriment of longer operative times and possibly higher cost. CONCLUSION Current evidence suggests the effectiveness, safety and increasing incorporation of minimally invasive techniques for complex stricture repair and reconstruction.
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Affiliation(s)
- Filippos Kapogiannis
- Department of Urology, Hippokrateion Hospital, Athens, Greece .,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gerasimos Tsourouflis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos I Nikiteas
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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14
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15
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Seetharam Bhat KR, Moschovas MC, Patel VR, Ko YH. The robot-assisted ureteral reconstruction in adult: A narrative review on the surgical techniques and contemporary outcomes. Asian J Urol 2020; 8:38-49. [PMID: 33569271 PMCID: PMC7859418 DOI: 10.1016/j.ajur.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/30/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022] Open
Abstract
Despite the rapid increase in the use of robotic surgery in urology, the majority of ureteric reconstruction procedures are still performed using laparoscopic or open approaches. This is primarily due to uncertainty regarding the advantages of robotic approaches over conventional ones, and the unique difficulty in identifying the specific area of interest due to the lack of tactile feedback from the current robotic systems. However, with the potential benefits of minimal invasiveness, several pioneering reports have been published on robotic surgery in urology. By reviewing the literature on this topic, we aimed to summarize the techniques, considerations, and consistent findings regarding robotic ureteral reconstruction in adults. Robotic applications for ureteral surgery have been primarily reported for pediatric urology, especially in the context of relieving a congenital obstruction in the ureteral pelvic junction. However, contemporary studies have also consistently demonstrated that robotic surgery could be a reliable option for malignant, iatrogenic, and traumatic conditions, which generally occur in adult patients. Nevertheless, the lack of comparative studies on heterogeneous hosts and disease conditions make it difficult to determine the benefit of the robotic approach over the conventional approach in the general population; thus, qualified prospective trials are needed for wider acceptance. However, contemporary reports have demonstrated that the robotic approach could be an alternative option for ureteral construction, even in the absence of haptic feedback, which can be compensated by various surgical techniques and enhanced three-dimensional visualization.
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Affiliation(s)
| | - Marcio Covas Moschovas
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
| | - Vipul R Patel
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
| | - Young Hwii Ko
- Department of Urology, Yeungnam University, Daegu, Republic of Korea
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16
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Lee Z, Lee M, Koster H, Lee R, Cheng N, Jun M, Slawin J, Zhao LC, Stifelman MD, Eun DD. A Multi-Institutional Experience With Robotic Ureteroplasty With Buccal Mucosa Graft: An Updated Analysis of Intermediate-Term Outcomes. Urology 2020; 147:306-310. [PMID: 32798516 DOI: 10.1016/j.urology.2020.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To update our prior multi-institutional experience with robotic ureteroplasty with buccal mucosa graft and analyze our intermediate-term outcomes. Although our previous multi-institutional report provided significant insight into the safety and efficacy associated with robotic ureteroplasty with buccal mucosa graft, it was limited by small patient numbers. METHODS We retrospectively reviewed our multi-institutional database to identify all patients who underwent robotic ureteroplasty with buccal mucosa graft between October 2013 and March 2019 with ≥12 months follow up. Indication for surgery was a complex proximal and/or middle ureteral stricture not amenable to primary excision and anastomosis secondary to stricture length or peri-ureteral fibrosis. Surgical success was defined as the absence of obstructive flank pain and ureteral obstruction on functional imaging. RESULTS Of 54 patients, 43 (79.6 %) patients underwent an onlay, and 11 (20.4%) patients underwent an augmented anastomotic robotic ureteroplasty with buccal mucosa graft. Eighteen of 54 (33.3%) patients previously failed a ureteral reconstruction. The median stricture length was 3.0 (IQR 2.0-4.0, range 1-8) centimeters. There were 3 of 54 (5.6%) major postoperative complications. The median length of stay was 1.0 (IQR 1.0-3.0) day. At a median follow-up of 27.5 (IQR 21.3-38.0) months, 47 of 54 (87.0%) cases were surgically successful. Stricture recurrences were diagnosed ≤2 months postoperatively in 3 of 7 (42.9%) patients, and ≥10 months postoperatively in 4 of 7 (57.1%) patients. CONCLUSION Robotic ureteroplasty with buccal mucosa graft is associated with low peri-operative morbidity and excellent intermediate-term outcomes.
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Affiliation(s)
- Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
| | - Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Helaine Koster
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Randall Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Nathan Cheng
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Min Jun
- Department of Urology, Grossman School of Medicine at New York University Langone Health, New York, NY
| | - Jeremy Slawin
- Department of Urology, Grossman School of Medicine at New York University Langone Health, New York, NY
| | - Lee C Zhao
- Department of Urology, Grossman School of Medicine at New York University Langone Health, New York, NY
| | - Michael D Stifelman
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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17
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Pacchetti A, Balzarini F, Mantica G, Valcalda M, Traverso P, Camerini G, Terrone C. Totally intracorporeal robotic ileal interposition for iatrogenic complete ureteral avulsion: Technical considerations and outcomes of two cases. UROLOGY VIDEO JOURNAL 2020. [DOI: 10.1016/j.urolvj.2020.100033] [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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18
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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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19
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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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20
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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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21
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Robotic Surgery as Applied to Functional and Reconstructive Urology. Eur Urol Focus 2019; 5:322-328. [DOI: 10.1016/j.euf.2019.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 11/19/2022]
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22
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Kumar S, Chandna A, Khanna A, Parmar KM, Narain TA, Sadasukhi N. Robot assisted intra-corporeal ileocalicostomy ureteral substitution for complex uretero-pelvic junction obstruction: a novel and feasible innovation. J Robot Surg 2018; 13:589-593. [DOI: 10.1007/s11701-018-0885-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
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