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Chen S, Fan S, Yang K, Li Z, Gao W, Wang X, Li Z, Wang B, Huang C, Zhu H, Gu Y, Li X. Robotic appendiceal ureteric interposition or replacement: the surgical technique. BJU Int 2024. [PMID: 39225148 DOI: 10.1111/bju.16523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- Silu Chen
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Shubo Fan
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Kunlin Yang
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Zhihua Li
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Wenzhi Gao
- Department of Urology, Peking University First Hospital - Miyun Hospital, Beijing, China
| | - Xiang Wang
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Zhenyu Li
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Bing Wang
- Department of Urology, Peking University First Hospital - Miyun Hospital, Beijing, China
| | - Chen Huang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Yaming Gu
- Department of Urology, Peking University First Hospital - Miyun Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
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O'Rourke TK, Gn M, Patel HV, Fakes C, Jones N, Cancian M, Elsamra SE. The Urologist and the Appendix: A Review of Appendiceal Use in Genitourinary Reconstructive Surgery. Urology 2021; 159:10-15. [PMID: 34695504 DOI: 10.1016/j.urology.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022]
Abstract
Recently, genitourinary reconstruction has experienced a renaissance. Over the past several years, there has been an expansion of the literature regarding the use of buccal mucosa for the repair of complex ureteral strictures and other pathologies. The appendix has been an available graft utilized for the repair of ureteral stricture disease and has been infrequently reported since the early 1900s. This review serves to highlight the use of the appendix for reconstruction in urology, particularly focusing on the anatomy and physiology of the appendix, historical use, and current applications, particularly in robotic upper tract reconstruction.
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Affiliation(s)
- Timothy K O'Rourke
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Martus Gn
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Hiren V Patel
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Christina Fakes
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nyasia Jones
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Madeline Cancian
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sammy E Elsamra
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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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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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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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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Swift K, Borzi P. Resection of Symptomatic ureteric paraganglioma with appendiceal interposition. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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7
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Stein R, Zahn K, Huck N. Current Indications and Techniques for the Use of Bowel Segments in Pediatric Urinary Tract Reconstruction. Front Pediatr 2019; 7:236. [PMID: 31245339 PMCID: PMC6581750 DOI: 10.3389/fped.2019.00236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/24/2019] [Indexed: 01/28/2023] Open
Abstract
Today, there are few indications for the use of bowel in pediatric urology. This is in large extent due to the successful conservative therapy in patients with neurogenic bladder and the improved success of primary reconstruction in patients with the bladder exstrophy-epispadias complex. Only after the failure of the maximum of conservative therapy or after failure of primary reconstruction, bladder augmentation, or urinary diversion should be considered. Malignant tumors of the lower urinary tract (e.g., rhabdomyosarcomas of the bladder/prostate) are other rare indications for urinary diversion. Replacement or reconstruction of the ureter with a bowel segment is also a quite rarely performed procedure. In this review, the advantages and disadvantages of the different options for the use of bowel segments for bladder augmentation, bladder substitution, urinary diversion, or ureter replacement during childhood and adolescence are discussed.
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Affiliation(s)
- Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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Laparoscopic appendiceal interposition pyeloplasty for long ureteric strictures in children. J Pediatr Urol 2018; 14:551.e1-551.e5. [PMID: 30082131 DOI: 10.1016/j.jpurol.2018.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 06/19/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The management of long ureteric strictures is very challenging, and ureteral substitution is necessary when end-to-end anastomosis can not be accomplished. OBJECTIVE To evaluate the mid-term results of laparoscopic appendiceal interposition pyeloplasty in children with long ureteric strictures. METHODS Between March 2010 and September 2016 four patients (median age 24 months, male/female 3/1) underwent laparoscopic appendiceal interposition pyeloplasty at the current hospital. Two patients had previously failed pyeloplasty, one had a traffic injury, and one had iatrogenic ureteral injury (Summary Table). The intraoperative, postoperative and follow-up results were analyzed. Success was defined as clinical (subjective) and radiologic (objective) resolution of the stricture. RESULTS All surgeries were successfully completed without conversion. The mean stricture length was 4.5 cm. Two cases were right-sided strictures, and two were left-sided. The mean operative time and estimated blood loss were 238.5 min and 25.0 ml, respectively. No intraoperative complication was encountered. No Grade 3 or Grade 4 complication was observed after surgery. One was anastomosed in the antiperistaltic manner and three were in the isoperistaltic fashion. The mean postoperative hospital stay was 7.3 days. The success rate was 100% at a mean follow-up duration of 33.8 months. DISCUSSION There is no consensus on the best surgical approach for long ureteric strictures. Ureteric replacement with intestinal segments or kidney autotransplantation is a viable alternative treatment to long ureteric strictures. However, both methods are technically challenging with significant complications. Appendiceal interposition to restore ureteral continuity has been described in adult patients. The current results demonstrated that laparoscopic appendiceal interposition pyeloplasty is a safe and feasible minimally invasive approach for the treatment of long ureteral strictures in children. CONCLUSIONS Laparoscopic appendiceal interposition pyeloplasty was a viable minimally invasive alternative for children with long ureteric strictures on both left and right sides. Both isoperistaltic or antiperistaltic anastomosis were feasible.
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Staged ureteral reconstruction using the appendix in a complex pediatric patient. Urol Case Rep 2018; 21:98-100. [PMID: 30263890 PMCID: PMC6157467 DOI: 10.1016/j.eucr.2018.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/11/2018] [Accepted: 08/22/2018] [Indexed: 11/22/2022] Open
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10
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Mogorovich A, Selli C, De Maria M, Manassero F, Durante J, Urbani L. Clinical reappraisal and state of the art of nephropexy. Urologia 2018; 85:135-144. [PMID: 29637838 DOI: 10.1177/0391560317749191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diffusion of minimally invasive techniques for renal surgery has prompted a renewed interest in nephropexy which is indicated to prevent nephroptosis in symptomatic patients and to mobilize the upper ureter downward in order to bridge a ureteral defect. Recent publications have been reviewed to present the state of the art of the diagnosis and management of these two challenging conditions and to try to foresee the next steps. The evaluation of patients with mobile kidney can be made relying on diagnostic criteria such as ultrasound with color Doppler and measurement of resistive index, conventional upright X-ray frames after a supine uro-computerized tomography scan and both static and dynamic nuclear medicine scans, always with evaluation in the sitting or erect position. Laparoscopic nephropexy emerges as the current treatment option combining both objectively controlled repositioning of the kidney and resolution of symptoms with minimal invasiveness, low morbidity, and short hospital stay. The use of robotics is presently limited by its higher cost, but may increase in the future. Downward renal mobilization and nephropexy is a safe and versatile technique which has been adopted as a unique strategy or more often in combination with other surgical maneuvers in order to cope with complex ureteral reconstruction.
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Affiliation(s)
- Andrea Mogorovich
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Cesare Selli
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Maurizio De Maria
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Francesca Manassero
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Jacopo Durante
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Lucio Urbani
- 2 Department of Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Yarlagadda VK, Nix JW, Benson DG, Selph JP. Feasibility of Intracorporeal Robotic-Assisted Laparoscopic Appendiceal Interposition for Ureteral Stricture Disease: A Case Report. Urology 2017; 109:201-205. [DOI: 10.1016/j.urology.2017.08.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/25/2017] [Accepted: 08/15/2017] [Indexed: 02/08/2023]
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Kranz J, Brandt AS, Anheuser P, Reisch B, Steffens J, Roth S. [Ureteral stricture as a late complication of radiotherapy : Possible treatment options]. Urologe A 2016; 56:322-328. [PMID: 28004123 DOI: 10.1007/s00120-016-0294-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ureteral strictures are uncommon complications of radiotherapy which are often recognized late. Their consequences range from harmless dilatation of the ureter to loss of renal function and potential life-threatening urosepsis.Therapy of radiogenic ureteral stricture is a challenging task for every urologist. Several surgical strategies including minimally invasive procedures, reconstruction and partial or complete replacement of the ureter are available.This article provides an overview of the various options in the treatment of radiogenic stricture of the ureter, focusing on the use of ileum and colon segments for ureteral substitution.
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Affiliation(s)
- J Kranz
- Klinik für Urologie und Kinderurologie, St. Antonius-Hospital Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland.
| | - A S Brandt
- Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Wuppertal, Deutschland
| | - P Anheuser
- Klinik für Urologie, Albertinen-Krankenhaus Hamburg, Hamburg, Deutschland
| | - B Reisch
- Klinik für Urologie und Kinderurologie, St. Antonius-Hospital Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
| | - J Steffens
- Klinik für Urologie und Kinderurologie, St. Antonius-Hospital Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
| | - S Roth
- Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Wuppertal, Deutschland
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Yakupoglu YK, Aki FT, Kordan Y, Ozden E, Tonyali S, Bostanci Y, Vuruskan H, Bilen CY, Sarikaya S. Renal Autotransplantation at Three Academic Institutions in Turkey. Urol Int 2016; 97:466-472. [PMID: 27505010 DOI: 10.1159/000448482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/18/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The objective of this study is to present the experience of 3 institutions performing renal autotransplantation (RAT) and to discuss surgical techniques employed and the results in the light of the medical literature. MATERIALS AND METHODS A total of 14 patients (11 male and 3 female) with a mean age of 47 ± 8 years (35-61 years), who underwent RAT procedure at 3 different institutions between October 2006 and November 2014, in Turkey, were evaluated retrospectively. Indications for RAT procedure are ureteral avulsion, renal artery aneurysm and intimal dissection caused by percutaneous transluminal renal artery angioplasty (PTRA). Twelve patients with ureteral avulsion, 1 patient with renal artery aneurysm and 1 patient with intimal dissection caused by PTRA were followed-up for 103 months. Seven (50%) open and 7 (50%) laparoscopic nephrectomies were performed. Nine patients (64.3%) were right-sided and 5 patients (35.7%) were left-sided. Complications of grade III and above as per Clavien-Dindo classification were assessed. RESULTS Mean time from injury to RAT was 21.2 ± 40.1 days. However, 5 (35.7%) patients were treated on the same day of the injury. As per Clavien-Dindo classification, 2 (14.2%) grade IVa and 1 (7.1%) grade IIIa complications were reported. However, no significant correlation was observed between the complications and graft loss regarding type and side of the nephrectomy performed (p = 0.462 and p = 0.505, respectively) and timing of the intervention (p = 0.692). CONCLUSION RAT is a safe procedure in combination with minimally invasive laparoscopic technique in carefully selected patients; however, it requires expertise and proficiency in laparoscopy, reconstructive urology and transplantation. Nevertheless RAT should be considered as the last resort, when other modalities fail.
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Duty BD, Kreshover JE, Richstone L, Kavoussi LR. Review of appendiceal onlay flap in the management of complex ureteric strictures in six patients. BJU Int 2015; 115:282-7. [PMID: 24471943 DOI: 10.1111/bju.12651] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate appendiceal onlay flap ureteroplasty for repairing complex right proximal and mid-ureteric strictures. PATIENTS AND METHODS Between August 2006 and August 2012 four women and two men (mean age 34.2 years) underwent right laparoscopic appendiceal onlay flap ureteroplasty. The mean stricture length was 2.5 cm. Stricture formation was secondary to impacted ureteric stones in three patients and failed pyeloplasty for congenital pelvi-ureteric junction obstruction in the remaining three. Each patient had ipsilateral flank pain before surgery. RESULTS The mean operating time, estimated blood loss and hospital stay were 244 min, 175 mL and 3.2 days, respectively. No intra- or peri-operative complications were noted. The objective success rate was 100% (all patients had radiographic and/or endoscopic resolution of their ureteric strictures). The subjective success rate was 66%, (two patients developed recurrent discomfort, which upon exploration was found to be attributable to fibrosis away from the appendiceal onlay graft, where the gonadal vessels crossed the ureter). Both patients with recurrent pain underwent laparoscopic ureterolysis and bladder advancement flap proximal to the appendiceal onlay, which markedly improved one patient's pain but the other patient continued to have discomfort, ultimately resulting in a laparoscopic nephroureterectomy. CONCLUSIONS Appendiceal onlay ureteroplasty is a viable treatment option for patients with complex right proximal and mid-ureteric strictures, while minimising the potential morbidity of appendiceal and ileal interposition.
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Affiliation(s)
- Brian D Duty
- Oregon Health and Science University, Portland, OR, USA
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Yoon BI, Hong CG, Kim S, Ha US, Chung JH, Kim SW, Cho YH, Sohn DW. Ureteral substitution using appendix for a ureteral defect caused by a retroperitoneal rhabdomyosarcoma in a child. Korean J Urol 2014; 55:77-9. [PMID: 24466403 PMCID: PMC3897636 DOI: 10.4111/kju.2014.55.1.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/15/2012] [Indexed: 11/18/2022] Open
Abstract
A 7-year-old boy was diagnosed with a recurrent embryonal rhabdomyosarcoma in the retroperitoneum. After resection of the mass, direct end-to-end anastomosis of the ureter was not possible owing to the length of the resected segment. Accordingly, we performed ureteral substitution by using the appendix to repair the ureteral defect.
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Affiliation(s)
- Byung Il Yoon
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chan Gyu Hong
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seol Kim
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - U-Syn Ha
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae Hee Chung
- Department Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong-Hyun Cho
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dong Wan Sohn
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
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[Repair of right ureteral stenosis by traumatic injury with appendiceal interposition: a case report]. Nihon Hinyokika Gakkai Zasshi 2013; 104:667-70. [PMID: 24187855 DOI: 10.5980/jpnjurol.104.667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report a repair of a right ureteral stenosis with the appendix as a ureteral substitute. A 20-year-old male suffered a traumatic injury in a motorcycle accident. He underwent an emergency operation for right hemothorax, intraabdominal hemorrhage, and bone fracture of right leg. Three weeks later, right hydronephrosis and urinoma were identified. Combined retrograde and antegrade pyelography demonstrated a severe 7 cm long stenosis in the right upper ureter. After an indwelling right nephrostomy catheter was placed, he returned to the hospital for a ureteral reconstruction. We planned to substitute the appendix to bridge the stenotic ureter. After transecting the appendix from the cecum, the mesoappendix was spatulated from mesoileum. Ureteral tissue was resected and appendix was interposed. Three weeks later, ureteral stent was removed. DTPA diuretic renogram scintigraphy demonstrated no evidence of obstruction five weeks later. Two years postoperatively, the patient was asymptomatic and his renal function was normal. Although only few cases of ureteral repair with appendix are known, uretero-appandix replacement is less invasive and complicated, and recommended in some cases.
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Searle AR, Ismail KA, Macgregor D, Hutson JM. Changes in the length and diameter of the normal appendix throughout childhood. J Pediatr Surg 2013; 48:1535-9. [PMID: 23895968 DOI: 10.1016/j.jpedsurg.2013.02.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 01/30/2013] [Accepted: 02/02/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND/AIM It has been proposed that the narrow diameter of the appendix is important in providing a 'safe zone' for commensal intestinal flora, while the length of the appendix can be variable. This study aimed to investigate the relationship between appendiceal length, diameter and age, in children under the age of eighteen years, to determine if the appendix changes in size with age. METHODS The histological records of all cases of children undergoing appendicectomy at the Royal Children's Hospital (Melbourne) between 2009 and 2011 were retrospectively reviewed. Participants were excluded on the basis of histological evidence of acute inflammation, and data on the diameter and length of the appendix were collected from 210 children, aged zero to seventeen years. RESULTS Data were stratified by age for analysis into ≤ 3 years, >3 and ≤ 9, >9 and ≤ 13 and >13 years. Mean diameters per group were 3.7 (± 1.3), 6.3 (± 1.2), 6.7 (± 1.6) and 6.9 (± 1.6) millimetres respectively. Mean lengths per group were 39.7 (± 16.1), 66.3 (± 15.3), 63.7 (± 21.3) and 68.8 (± 18.2) millimetres. Both diameter and length were higher in the older age groups, compared with the ≤ 3 year olds (p < 0.001). A positive correlation was seen between age and appendix diameter (R = 0.5, p < 0.001) and length (R = 0.3, p=0.03) in the ≤ 3 group only. Mean diameter and length values did not differ significantly between groups aged > 3 years old. CONCLUSION This study showed that following an initial growth period during early infancy up to about 3 years, the appendix achieves its adult proportions and does not continue to grow throughout childhood.
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Affiliation(s)
- Asha R Searle
- Douglas Stephens Surgical Research Group, Murdoch Childrens Research Institute, Melbourne 3052, Australia
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Corbetta JP, Weller S, Bortagaray JI, Durán V, Burek C, Sager C, Lopez JC. Ureteral replacement with appendix in pediatric renal transplantation. Pediatr Transplant 2012; 16:235-8. [PMID: 22151119 DOI: 10.1111/j.1399-3046.2011.01608.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ureteral necrosis is an uncommon complication following RT which can adversely affect outcome. Even though authors agree that the native ureter ought to be preserved, there are cases in which graft function can only be salvaged by ureteral substitution. The scant references in the literature on the use of the appendix for left ureteral replacement in children prompted us to report the following two cases in whom the technique was employed and to assess the evolution of graft function in these patients.
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Affiliation(s)
- Juan P Corbetta
- Department of Urology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
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Obaidah A, Mane SB, Dhende NP, Acharya H, Goel N, Thakur AA, Arlikar J. Our Experience of Ureteral Substitution in Pediatric Age Group. Urology 2010; 75:1476-80. [DOI: 10.1016/j.urology.2009.07.1327] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 07/20/2009] [Accepted: 07/31/2009] [Indexed: 10/20/2022]
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Ashley MS, Daneshmand S. Re: Appendiceal substitution following right proximal ureter injury. Int Braz J Urol 2009; 35:90-1. [DOI: 10.1590/s1677-55382009000100014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Reggio E, Richstone L, Okeke Z, Kavoussi LR. Laparoscopic ureteroplasty using on-lay appendix graft. Urology 2008; 73:928.e7-10. [PMID: 18701147 DOI: 10.1016/j.urology.2008.06.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Revised: 06/04/2008] [Accepted: 06/10/2008] [Indexed: 11/18/2022]
Abstract
Complex ureteral reconstruction has been performed with ileum, appendix, or other intestinal segments for the treatment of long ureteral strictures. In the past decade, challenging ureteral reconstruction has been approached using laparoscopic urology. We report the case of a 6-cm iatrogenic stricture after treatment of stone disease. The stricture was treated using a laparoscopic on-lay appendix graft. This laparoscopic technique used the on-lay concept, which, in addition to minimizing postoperative pain and the length of hospitalization, allowed a tension-free watertight anastomosis and preserved the ureteral vascular supply. This approach should be considered a viable minimally invasive alternative for ureteral reconstruction when endoscopic treatment has failed.
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Affiliation(s)
- Ernesto Reggio
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA.
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Dagash H, Sen S, Chacko J, Karl S, Ghosh D, Parag P, Mackinnon AE. The appendix as ureteral substitute: a report of 10 cases. J Pediatr Urol 2008; 4:14-9. [PMID: 18631886 DOI: 10.1016/j.jpurol.2007.08.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 08/13/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ureteric replacement in part or in total is rarely needed in children. We present our experience in using the appendix to replace the ureter. METHODS A retrospective case note review was carried out at Sheffield Children's Hospital (UK), Ekta Institute of Child Health (Raipur, Chhattisgarh, India) and Christian Medical College Hospital (Vellore, India) of all cases of ureteric substitution using the appendix. RESULTS Ten patients were identified, operated in 2002-2007: seven males and three females with a median age of 2.5 years (range 2.5 months to 12 years). The reasons for ureteric replacement were traumatic ureteric avulsion (n=1), congenital ureteric stenosis (n=5), non-drainage following previous pyeloplasty for pelvi-ureteric junction obstruction (n=3) and ureteric stricture following reimplantation for vesico-ureteric reflux (n=1). The appendix was used in an anti-peristaltic manner in all cases, and in one case a transureteroureterostomy was performed. At a median follow up of 16months (1-72 months), all the patients were well except one whose kidney function had deteriorated. CONCLUSIONS Total or partial replacement of the ureter using the appendix, even in the first year of life, preserved renal function in nine cases. Ureteric continuity can be successfully restored in children using the appendix.
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Affiliation(s)
- Haitham Dagash
- Department of Paediatric Urology, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK.
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Milović N, Janjić P, Bancević V, Kupresanin S. [Uretero-transappendix-cystoneostomy as a technique for the reconstruction of the lower part of the ureter]. VOJNOSANIT PREGL 2005; 62:931-3. [PMID: 16375223 DOI: 10.2298/vsp0512931m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Any large missing part of the ureter may be replaced by transureteroureterostomy, psoas hitch, Boari flap, nephrectomy, renal autotransplanation or by the implementation of an intestinal graft. CASE REPORT A patient with a defect of the lumbal-pelvic portion of the right ureter, after the managemenet of a penetrating and perforating gun shot wound was presented. The missing part of the ureter was seccessfully replaced with an appendix. The technique of uretero-transappendix-cystoneostomy complete with a Boari flap and a psoas hitch was used. CONCLUSION By the use of an original combination of surgical techniques, a large defect of the ureter and the defect of the bladder, as well as the preservation of the renal function was achieved in a more successful manner.
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Affiliation(s)
- Novak Milović
- Vojnomedicinska akademija, Klinika za urologiju, Beograd.
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Horwitz GJ, Jarrard DF. Extension of a shortened ureter using the in situ appendix during Indiana pouch urinary diversion. Urology 2004; 63:167-9. [PMID: 14751375 DOI: 10.1016/j.urology.2003.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A short ureteral length can preclude the use of a continent urinary diversion during urinary tract reconstruction after bladder removal. We present a surgical technique using the in situ appendix to provide length to a shortened left ureter, thus allowing formation of a continent ileocecal urinary diversion.
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Affiliation(s)
- Greg J Horwitz
- Division of Urology, Department of Surgery, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
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Merrot T, Teklali Y, Zerhouni H, Chaumoître K, Alessandrini P. [Appendix-ureteroplasty in a child: report of a case]. ANNALES D'UROLOGIE 2003; 37:27-9. [PMID: 12701318 DOI: 10.1016/s0003-4401(02)00012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The use of vermiform appendix as a tube to replace right ureteral segment has been reported, rarely in child. Herein is reported a case of right ischemic ureteral stenosis following a reimplantation of the ureter for high grade reflux secondary to posterior urethral valves with only one functioning kidney. A long ureteral defect was bridged successfully by appendix interposition and then reimplanted in the bladder at four years of age. The interest of ureteroappendiculoplasty provides temporary solution to repair long ureteral defect, in spite of uncertain future, especially in childhood.
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Affiliation(s)
- T Merrot
- Service de chirurgie infantile, pavillon mère-enfant, centre hospitalier universitaire Nord, université de la Méditerranée, chemin des Bourrelly, 13015 Marseille, France.
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Jang TL, Matschke HM, Rubenstein JN, Gonzalez CM. Pyeloureterostomy with interposition of the appendix. J Urol 2002; 168:2106-7. [PMID: 12394719 DOI: 10.1016/s0022-5347(05)64306-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We describe the successful repair of a 6 cm. ureteral stricture involving the right ureteropelvic junction and proximal ureter using appendix as a ureteral substitute. MATERIALS AND METHODS A 37-year-old man involved in a motorcycle accident presented with a retroperitoneal urinoma and a 6 cm. proximal ureteral stricture. At flank exploration we were unable to perform successfully primary pyeloureterostomy through renal descensus with ureteral mobilization. The appendix was selected to bridge the ureteral defect. The right colon and cecum were mobilized to the area of the diseased ureter and the appendix was transected across the base of the cecum. Ureteral scar tissue was resected and the appendix was interposed in an isoperistaltic orientation from renal pelvis to proximal ureter. RESULTS Convalescence was unremarkable. Retrograde pyelography and flexible ureteroscopy 2 months postoperatively demonstrated a patent anastomosis and viable appendix. The ureteral stent was removed at that time. Excretory urography 3 months postoperatively revealed prompt enhancement of the 2 kidneys and visualization of the 2 ureters. Mercaptoacetyltriglycine-3 renal scan 5 months postoperatively confirmed no scintigraphic evidence of obstruction. The patient was asymptomatic 6 months postoperatively and renal function tests were normal. CONCLUSIONS The appendix can be considered for proximal ureteral defects extending to the right renal pelvis.
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Affiliation(s)
- Thomas L Jang
- Department of Urology, Northwestern University Medical School, Chicago, Illinois 60611, USA
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Pyeloureterostomy with Interposition of the Appendix. J Urol 2002. [DOI: 10.1097/00005392-200211000-00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aggarwal SK, Goel D, Gupta CR, Ghosh S, Ojha H. The use of pedicled appendix graft for substitution of urethra in recurrent urethral stricture. J Pediatr Surg 2002; 37:246-50. [PMID: 11819208 DOI: 10.1053/jpsu.2002.30265] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Recurrent posterior urethral strictures after failed urethroplasty may need urethral substitution. Skin or mucosal grafts, currently used for this purpose, have a high complication rate. The authors describe the use of pedicled appendix for posterior urethral substitution. METHODS Two boys with pelvic fracture urethral distraction injuries were treated for recurrent posterior urethral strictures after a failed perineal anastomotic urethroplasty. Through a perineal-transpubic approach the stricture tissue was excised, which resulted in a gap of 5 to 7 cm between the healthy ends. The vermiform appendix was mobilised on its own pedicle and transposed to the perineum; the proximal end of appendix was anastomosed to the prostatic urethra and the distal end (tip discarded) to the bulbar/penile urethra. Omentum was transposed to wrap the anastomosis and fill the dead space. RESULTS Normal micturition was restored in both patients. No further treatment was required after 1 dilatation in the first case. Both patients are continent. Potency status remains unchanged from the preoperative period with normal erections in 1 case. Follow-up (1 to 3 years) has been satisfactory with no complications. CONCLUSIONS The appendix is a promising organ for posterior urethral replacement. It can be brought to the perineum on its own vascular pedicle.
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