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Chaudhari R, Khant SR. The serendipitous use of a peritoneal flap for the primary repair of an iatrogenic ureteric injury – a case report. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415816661654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rajeev Chaudhari
- Department of Urology and Advanced Urodynamic Centre, Ruby Hall Clinic, India
| | - Shahil R Khant
- Department of Urology and Advanced Urodynamic Centre, Ruby Hall Clinic, India
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Smith NA, Silva PC, Ferreira ML, Schanaider A. Ureteral reconstruction with abdominal wall muscle flap: experimental study in rabbits. Rev Col Bras Cir 2016; 41:455-6. [PMID: 25742414 DOI: 10.1590/0100-69912014006013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/05/2014] [Indexed: 11/21/2022] Open
Abstract
The authors detail the experimental development of a technique for the reconstruction of the ureter using a tubular shape, muscle flap of the abdominal wall. the preliminary results indicate the feasibility of this surgical technique.
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Affiliation(s)
- Nelson Alfred Smith
- Faculty of Medicine, Federal University of Rio De Janeiro, Rio de Janeiro, RJ, Brazil
| | - Paulo Cesar Silva
- Department of Surgery, Faculty of Medicine, Federal University of Rio De Janeiro, Rio de Janeiro, RJ, Brazil
| | - Manoel Luiz Ferreira
- Department of Surgery, Faculty of Medicine, Federal University of Rio De Janeiro, Rio de Janeiro, RJ, Brazil
| | - Alberto Schanaider
- Department of Surgery, Faculty of Medicine, Federal University of Rio De Janeiro, Rio de Janeiro, RJ, Brazil
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Rodríguez Alonso A, González Blanco A, Suárez Pascual G, Bonelli Martín C, Lorenzo Franco J, Cuerpo Pérez MA. Sustitución parcial del uréter por un segmento de íleon tratado según el procedimiento de Monti. Actas Urol Esp 2005; 29:607-10. [PMID: 16092688 DOI: 10.1016/s0210-4806(05)73306-4] [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: 11/24/2022]
Abstract
The partial substitution of the ureter using a pediculated segment of the ileum is a technique used to re-establish ureteral transit and preserve the renal unit, following the resection of extensive ureteral lesions. Standard surgical procedure for an ileoureteroplasty consists of isolating an ileal duct of equal or greater length than the ureteral defect and interposing it in the urinary tract in an isoperistaltic direction. Monti described a surgical technique that allows for the creation of catheterizable stomas in continent urinary diversions, using the Mitrofanoff principle. These passageways were created from one or several 2.5 cm long ileal sections by means of their detubulization and transverse retubulization. The clinical case study presented here corresponds to a 57 year-old male with a history of ureteral lithiasis, with a 9 cm stenosis of the sacroiliac ureter. He was treated surgically by means of a resection of the stenotic ureter and the interposition of a duct made up of 2.5 ileal sections, treated in accordance with the Monti procedure. Since this operation, the patient's metabolic state has been completely normal. Morphological and functional results have also proved totally satisfactory, as the use of image techniques have shown.
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Fabrizio MD, Kavoussi LR, Jackman S, Chan DY, Tseng E, Ratner LE. Laparoscopic nephrectomy for autotransplantation. Urology 2000; 55:145. [PMID: 10754163 DOI: 10.1016/s0090-4295(99)00367-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Proximal ureteral injuries often require extensive reconstruction to repair. Management options include nephrectomy, ileal ureter interposition, extensive spiral bladder flaps, or autotransplantation. We report a patient who sustained a proximal ureteral avulsion and underwent a less invasive repair by way of a laparoscopic nephrectomy and subsequent autotransplantation.
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Affiliation(s)
- M D Fabrizio
- Johns Hopkins Medical Institute, James Buchanan Brady Urological Institute, Baltimore, Maryland, USA
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Abstract
Ureteral replacement with ileal bowel segments has become common in the armamentarium of the reconstructive urologist. The use of ileal bowel substitution, whether total or segmental, has provided yet another surgical alternative for renal preservation. The indications, surgical technique, and results with the ileal ureter are reviewed.
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Affiliation(s)
- R M Mattos
- Department of Urology, Lahey Hitchcock Medical Center, Burlington, Massachusetts, USA
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Redman JF. Ureteroureterostomy for Repair of a Mid Ureteral Stricture Using a Ureter with Vasculature Based on an Ileal Conduit. J Urol 1995. [DOI: 10.1016/s0022-5347(01)67019-8] [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]
Affiliation(s)
- John F. Redman
- Department of Urology, University of Arkansas College of Medicine and Arkansas Children's Hospital, Little Rock, Arkansas
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Bejany DE, Lockhart JL, Politano VA. Ileal segment for ureteral substitution or for improvement of ureteral function. J Urol 1991; 146:302-5. [PMID: 1856921 DOI: 10.1016/s0022-5347(17)37776-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A total of 29 patients received an ileal segment interposition between the upper and lower urinary tract for partial or total ureteral substitution, or for ileal wrapping around a massively dilated, aperistaltic ureter. Indications for an operation included the presence of an extensively diseased or short ureter and an aperistaltic megaureter that had failed previous reconstructive attempts. Nine patients (group 1) underwent an ileal sleeve procedure in an attempt to increase the ureteral peristaltic activity and facilitate drainage. Among these patients 7 (78%) had a stable upper tract radiologically and normal serum creatinine (less than 1.6 mg./100 ml.), while 2 (22%) had deterioration of the renal function. Ten patients (group 2) had undergone a myriad of reconstructions that failed and then underwent complete ureteral substitution with ileum. Among them, renal function (as evidenced by excretory urography and serum creatinine) is stable in 7 (70%) and deteriorated in 3 (30%). In 10 patients (group 3) the ureters were partially replaced by ileum in addition to a bladder augmentation procedure. Of these patients 8 (80%) have stable renal function and 2 (20%) had renal failure. Over-all, 7 patients have different degrees of renal failure; among them 2 (6.9%) are on dialysis and 2 (6.9%) have received a transplanted kidney. In groups 2 and 3 the results with an antireflux operation indicated that among 6 ureteroileal reimplantations 5 (83%) were successful, among 12 intravesical intestinal nipples 6 (50%) failed to prevent reflux and there was no case of obstruction, while among 4 ileocecal intussusceptions 2 (50%) were successful and 2 failed. Mucous secretion produced temporary ureteral obstruction in 1 ureter (3.4%), which resolved without surgical intervention. Some of the aforementioned procedures were done in the past and in some situations a different reconstructive technique would be considered presently. The surgical complexity and magnitude of the procedures justify their performance only in difficult clinical situations as an alternative to urinary diversion or renal autotransplantation.
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Affiliation(s)
- D E Bejany
- Department of Urology, University of Miami, School of Medicine, Florida
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Seiler RK, Filmer RB, Reitelman C. Traumatic disruption of the ureteropelvic junction managed by ileal interposition. J Urol 1991; 146:392-5. [PMID: 1856938 DOI: 10.1016/s0022-5347(17)37803-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The use of ileal interposition in the management of a patient with delayed diagnosis of traumatic disruption of the ureteropelvic junction is presented. The unusual presentation of this problem, potential options in reconstructing the ureter and successful outcome are discussed.
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Affiliation(s)
- R K Seiler
- Department of Urology, Children's Hospital of Michigan, Wayne State University, Detroit
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Waters WB, Herbster G, Jablokow VR, Reda DJ. Ureteral replacement using ileum in compromised renal function. J Urol 1989; 141:432-6. [PMID: 2913371 DOI: 10.1016/s0022-5347(17)40788-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ureteral replacement by ileum is an accepted technique in a highly selective patient population. Two major contraindications in using an ileal ureter are compromised renal function (serum creatinine greater than 2) and a functionally abnormal bladder. We used ileum to bridge a ureteral defect in animals with half of a solitary kidney and low grade azotemia to see if the antirefluxing mechanism of the lower ureter prevented further deterioration in renal function. Twelve female mongrel dogs underwent a right nephrectomy, followed by a left partial nephrectomy six weeks later. Group I (six dogs) had a six cm. segment of ileum interposed between the upper and lower ureteral segments (nonrefluxing). Group II (five dogs) had a ten cm. segment of ileum placed from the upper third of the ureter to the bladder (refluxing). Cystograms, intravenous pyelograms, serum electrolytes, BUN and creatinine were obtained preoperatively, six weeks after the right nephrectomy, one month after left partial nephrectomy and six months after ileal replacement prior to sacrifice. The BUN and creatinine deteriorated in Group II compared to Group I, p = .02 and p = 0.4 respectively (Mann-Whitney test). The BUN and creatinine also deteriorated between one month after left partial nephrectomy and six months after ileal replacement within Group II, p = .07 and p = .14, respectively (Wilcoxon matched-pairs test) but not in Group I. These data suggest that the antirefluxing mechanism of the lower ureter might prevent further deterioration in renal function. We feel that ileum can be used with caution, as an interposition in compromised renal function.
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Affiliation(s)
- W B Waters
- Section of Urology, V.A. Hospital, Hines, Illinois
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Secondary ureteropyelostomy in renal transplant recipients. World J Urol 1988. [DOI: 10.1007/bf00326623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Green DF, Lytton B, Glickman M. Ureteropelvic junction obstruction after percutaneous nephrolithotripsy. J Urol 1987; 138:599-602. [PMID: 3625864 DOI: 10.1016/s0022-5347(17)43270-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Percutaneous nephrolithotripsy is reported to have few complications. However, we have treated 6 cases of complete ureteropelvic junction obstruction that occurred at a number of centers after percutaneous nephrolithotripsy. In 2 patients stones were impacted at the ureteropelvic junction, 3 had pre-existing stenosis and 1 had had no previous structural abnormality. All stones were less than 2 cm. in size and 5 were removed by ultrasonic disintegration. A nephrostogram after percutaneous nephrolithotripsy showed complete ureteropelvic junction obstruction in 4 cases and partial obstruction that progressed to total obstruction in 6 days in 1. In 1 case the nephrostogram was normal but occlusion was noted 2 weeks later. Initial management consisted of nephrostomy drainage for an average of 3.2 months. One patient was treated successfully with a ureteral stent for 6 weeks after balloon dilation, 1 had unsuccessful balloon dilation and 1 had undergone an unsuccessful endoscopic pyelolysis. Pyeloplasty was successful in 3 cases. In 1 patient 2 attempts at pyeloplasty failed and nephrectomy was performed. In the remaining patient ureterocalycostomy failed and interposition of a small segment of ileum was done. Pre-existing stenosis of the ureteropelvic junction or a stone impacted at the junction probably contributed to the obstruction and stenosis in 5 patients. The passage of ureteral guide wires should be avoided in these patients and impacted stones should be dislodged before endoscopic removal. Extracorporeal shock wave lithotripsy is an option in these cases if the stone can be dislodged or bypassed with a stent. Patients with pre-existing ureteropelvic junction obstruction might be treated best by open nephrolithotomy and pyeloplasty or by percutaneous nephrolithotripsy and endoscopic pyelolysis for ureteropelvic junction narrowing.
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Casale AJ, Colodny AH, Bauer SB, Retik AB. The use of bowel interposed between proximal and distal ureter in urinary tract reconstruction. J Urol 1985; 134:737-40. [PMID: 4032584 DOI: 10.1016/s0022-5347(17)47415-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The replacement of lost ureter with bowel interposition is a feasible alternative in the reconstruction of the urinary tract. When adequate ureteral length is not present, interposition of a portion of small bowel between the proximal and distal ureteral segments is an option that minimizes the amount of bowel in the urinary tract. This, in turn, reduces mucus production and electrolyte absorption in the reconstructed urinary tract, and allows for more bowel to remain as part of the functioning gastrointestinal tract. This procedure allows use of the antirefluxing function of the normal ureterovesical junction when present. We have used successfully interposition of the small bowel between the proximal and distal ureteral segments for undiversion in 5 children. Generally, we strive to join urothelium to urothelium without the use of bowel in urinary tract reconstruction but when this is not feasible, bowel interposition has been a useful option.
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