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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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Chai S, Xiao X, Chen J, Zhang H, Gao X, Zhou Y, Cheng G, Xu Y, Zeng J, Li W, Ju W, Li B. Treating Multifocal Ureteral Strictures with Combined Techniques: 14 Cases of Initial Experience. J Endourol 2024; 38:283-289. [PMID: 38149608 DOI: 10.1089/end.2023.0454] [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] [Indexed: 12/28/2023] Open
Abstract
Purpose: To evaluate the safety and feasibility of lingual mucosal graft ureteroplasty (LMGU) combined with ureteral reimplantation (UR) for repairing managing multifocal ureteral strictures (MUS). Methods: Between December 2020 and December 2022, 14 patients underwent LMGU combined with UR. Their perioperative data were collected retrospectively and analyzed. For the proximal diseased ureter, the narrow segment was incised longitudinally to open the ventral wall of ureter, and a lingual mucosal graft was placed as an onlay graft. Meanwhile, UR was applied to treat distal ureteral strictures. Results: Of 14 patients, three (21.4%) had previously undergone a failed ureteral reconstruction. The mean (standard deviation [SD]) proximal stricture length was 4.0 cm (1.56), and distal ureteral stricture length was 4.3 cm (0.94). The mean (SD) operative time was 236 minutes (57), the estimated blood loss was 78 mL (41.5), and the length of postoperative stay was 6 days. One (7%) patient underwent double LMGU to treat proximal 2 segments of ureteral stricture. No open conversions and intraoperative complications occurred. With a mean follow-up of 15 months (range 6-29), the recurrence-free rate was 14/14 (100%). Conclusions: LMGU combined with UR is a feasible and effective technique for managing MUS and can be an alternative to ileal ureteral replacement or renal autotransplantation in some selected patients with MUS.
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Affiliation(s)
- Shuaishuai Chai
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xingyuan Xiao
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jiawei Chen
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xincheng Gao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuancheng Zhou
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gong Cheng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yujie Xu
- Department of Urology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Jinmin Zeng
- Department of Urology, Jingzhou Central Hospital, Yangtze University, Jingzhou, China
| | - Wencheng Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Ju
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bing Li
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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3
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Huang C, Yang K, Gao W, Gu Y, Zhu HJ, Li X. Ileal ureter replacement and ileocystoplasty for the treatment of bilateral ureteral strictures and bladder contracture: technique and outcomes. Minerva Urol Nephrol 2024; 76:97-109. [PMID: 38426424 DOI: 10.23736/s2724-6051.23.05492-7] [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: 03/02/2024]
Abstract
BACKGROUND The aim of this study was to explore the feasibility of ileal ureter replacement and ileocystoplasty for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture. METHODS A retrospective review of clinical data from seven patients who underwent bilateral Ileal Ureter Replacement and ileocystoplasty from April 2019 to February 2023 was conducted. The surgeries were performed using open, laparoscopic, and robot-assisted laparoscopic approaches. Baseline characteristics, perioperative, and mid-term results of the patients were collected. Follow-up period of 3-28 months. A detailed description of the technique was reported. RESULTS The mean age of the patients was 52.86±6.06 years. The average duration of surgery was 365±28.54 minutes, and the estimated intraoperative blood loss was 357.14±184.06 mL. The mean length of harvested ileum was 37.86±8.40 cm. The preoperative serum creatinine level was 88.02±18.05 μmol/L, postoperative day 1 creatinine level was 90.7±12.93μmol/L, postoperative 3-month creatinine level was 93.77±33.34 μmol/L, and the mean creatinine level at the last follow-up was 94.89±27.89μmol/L. The postoperative bladder capacity was 249.43±32.50 mL on average. The average length of hospital stay was 26.57±15.46 days. No complications of Clavien-Dindo grade 3 or higher were observed. During the follow-up period, no patients experienced deterioration of renal function after surgery. CONCLUSIONS Bilateral ileal ureter replacement and ileocystoplasty are effective surgical technique for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture caused by radiation therapy.
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Affiliation(s)
- Chen Huang
- Department of Urology, Jian Gong Hospital, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China
| | - Wenzhi Gao
- Department of Urology, Miyun Hospital, Peking University First Hospital, Beijing, China
| | - Yaming Gu
- Department of Urology, Miyun Hospital, Peking University First Hospital, Beijing, China
| | - Hong J Zhu
- Department of Urology, Jian Gong Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China -
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4
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Singh J, Wang L, Smith TG, Graber W, Matin S, Pisters L, Lenaine Westney O. Ileal Interposition for Ureteral Reconstruction Following Treatment for Abdominopelvic Malignancy: Complications and Outcomes From a Comprehensive Cancer Center. Urology 2024; 183:215-220. [PMID: 37802194 DOI: 10.1016/j.urology.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To characterize the outcomes of ileal interposition for the management of ureteral obstruction from tumor and ureteral stricture following treatment for abdominopelvic malignancy. MATERIALS AND METHODS A retrospective database analysis was performed for all cases of ileal interposition performed by 5 surgeons from January 2013 to December 2020. Patients were ≥18 years of age and included if undergoing ileal interposition in either the primary setting of a surgical procedure for tumor extirpation or in the delayed setting. RESULTS In total, 23 patients who underwent repair of 27 ureteral units were included. The mean age was 60.2 years. Median follow-up was 21.6 months. The most common primary diagnoses were urothelial (35%), colorectal (31%), and cervical (22%) cancer. The etiologies of ureteral obstruction were malignant in 48% and ureteral stricture in 52%. Types of repairs included unilateral interposition in 13 patients, bilateral interposition in 1 patient, interposition to an ileal conduit in 3 patients, and interposition with cystoplasty in 6 patients. There was a statistically significant difference between the mean preoperative (Creatinine 1.05 mg/dL, Estimated Glomerular Filtration Rate 77 ml/min/1.73 m2) renal function and postoperative (Creatinine 1.26 mg/dL, Estimated Glomerular Filtration Rate 67 mL/min/1.73 m2) renal function at the most recent follow-up (P = .024). Eight minor (grade 1-2) and 6 major (grade ≥3) complications developed for a minor and major complication rate of 35% and 26%, respectively. CONCLUSION Ileal interposition is successfully utilized as a reconstructive technique at the time of enbloc resection involving the ureter and to address ureteral stricture in the delayed setting.
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Affiliation(s)
- Jas Singh
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Lin Wang
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas G Smith
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William Graber
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Surena Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Louis Pisters
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - O Lenaine Westney
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Soyster ME, Arnold PJ, Burns RT, Zappia JL, Roth JD, Francesca Monn M, Bihrle R, Mellon MJ. Ileal Ureter Utilization in Patients With Previous Urinary Diversions. Urology 2023; 177:184-188. [PMID: 37076019 DOI: 10.1016/j.urology.2023.04.001] [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: 02/06/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To evaluate a subset of patients who develop strictures requiring Ileal Ureter (IU) in the setting of prior urinary diversion or augmentation (ileal conduits, neobladders, continent urinary diversions). To our knowledge, there are no prior studies on patients with IU substitution into established lower urinary tract reconstructions. METHODS A retrospective review of patients (18 years) undergoing IU creation from 1989 to 2021 was performed. A total of 160 patients were identified. In total, 19 (12%) patients had IUs into diversions. We examined demographics, stricture cause, diversion type, renal function, and postoperative complications. RESULTS Nineteen patients were identified. Sixteen were male. Mean age was 57.7(SD 17.0) years. Diversions included continent urinary reservoirs (4), neobladders (5), ileal conduits (7), and bladder augmentations with Monti channels (3). Fifteen had unilateral surgery, and 4 had bilateral "reverse 7" IU creation. Average length of stay was 7.6 days (SD 2.9). Average follow-up was 32.9 months (SD 27). Mean preoperative creatinine was 1.5 (SD 0.4); mean postoperative creatinine at most recent follow-up was 1.6 (SD 0.7). There was no significant difference between pre- and postoperative creatinine (P = .18). One patient had a ventriculoperitoneal Shunt infection resulting ventriculoperitoneal shunt externalization, 1 had Clostridium difficile infection potentially causing an entero-neobladder fistula, 2 with ileus, 1 urine leak, and 1 wound infection. None required renal replacement therapy. CONCLUSION Patients with urinary diversions and prior bowel reconstructive surgeries with subsequent ureteral strictures are a challenging cohort of patients. In properly selected patients, ureteral reconstruction with ileum is feasible and preserves renal function with minimal long-term complications.
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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
| | - Jason L Zappia
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Joshua D Roth
- 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
| | - Richard Bihrle
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Matthew J Mellon
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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6
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Kaouk J, Chavali JS, Ferguson E, Schwen ZR, Beksac AT, Ramos-Carpinteyro R, Geskin A, Vallabhaneni S, Wee A, Eltemamy M. Single Port Robotic Kidney Autotransplantation: Initial Case Series and Description of Technique. Urology 2023; 176:87-93. [PMID: 36921843 DOI: 10.1016/j.urology.2023.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/02/2023] [Accepted: 02/19/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Minimally invasive kidney autotransplantation (KAT) has demonstrated reduced morbidity, however multiport robotic approach required patient repositioning and multiple sets of incisions. We present our initial series of single-port (SP) robotic KAT, ideal for multi-quadrant surgeries, and aim to evaluate feasibility and safety of the novel approach. METHODS Between 2018 and 2022, 8 consecutive patients underwent SP KAT using the DaVinci SP platform. Patient clinicopathologic variables and perioperative outcomes were recorded. Indications for KAT include complex or recurrent ureteral stricture, ureteral avulsion, and chronic visceral pain due to multiple etiologies. RESULTS All SP KATs were successfully performed without repositioning or conversion to open. Operative times ranged from 366 to 701 minutes, warm and cold ischemia times between 4 to 10 minutes and 86 to 209 minutes, respectively. Median hospital length of stay was 3 days. At a median of 13 months follow-up, latest postoperative GFRs were stable, ranging from +23% to -10%. There were no complications. CONCLUSION We demonstrate our single port, multiquadrant robotic kidney auto transplantation technique performed though a single incision further reducing surgical morbidity. All cases were completed successfully without conversion or loss of graft function. All patients reported resolution of flank pain and no radiological evidence of urinary obstruction on follow up.
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Affiliation(s)
- Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Jaya S Chavali
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ethan Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Zeyad R Schwen
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Alp T Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Albert Geskin
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Alvin Wee
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Mohamed Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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7
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Shimizu N, Naya Y, Sekine K, Hou K, Okato A, Suyama T, Araki K, Masuda H, Kojima S. Laparoscopic redo pyeloplasty with a buccal mucosal graft. IJU Case Rep 2023; 6:124-127. [PMID: 36874993 PMCID: PMC9978060 DOI: 10.1002/iju5.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Redo pyeloplasty can be difficult due to scar tissue or fibrosis. Ureteral reconstruction with a buccal mucosal graft is performed safely and successfully, but most reports of ureteral reconstruction using a buccal mucosal graft are of robot-assisted surgery, with few reports of laparoscopic-assisted surgery. A case of laparoscopic-assisted redo pyeloplasty using a buccal mucosal graft is presented. Case presentation A 53-year-old woman was diagnosed with ureteropelvic junction obstruction, and a double-J stent was placed to relieve backache. She visited our hospital 6 months after double-J stent placement. Three months later, laparoscopic pyeloplasty was performed. At 2 months postoperatively, anatomic stenosis occurred. Holmium laser endoureterotomy and balloon dilation were performed; however, the anatomic stenosis recurred, and laparoscopic redo pyeloplasty with a buccal mucosal graft was performed. After redo pyeloplasty, obstruction was improved, and her symptoms disappeared. Conclusion This is the first case of using a buccal mucosal graft for laparoscopic pyeloplasty in Japan.
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Affiliation(s)
- Nobuhiko Shimizu
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Yukio Naya
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Keita Sekine
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Kyokushin Hou
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Atsushi Okato
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Takahito Suyama
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Kazuhiro Araki
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Hiroshi Masuda
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Satoko Kojima
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
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8
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Gonzalez AN, Mishra K, Zhao LC. Buccal Mucosal Ureteroplasty for the Management of Ureteral Strictures: Patient Selection and Considerations. Res Rep Urol 2022; 14:135-140. [PMID: 35433528 PMCID: PMC9007613 DOI: 10.2147/rru.s291950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/19/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ashley N Gonzalez
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
- Correspondence: Ashley N Gonzalez, Email
| | - Kirtishri Mishra
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
- University Hospitals Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lee C Zhao
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
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Gao X, Liang C, Wang J, Xiao X, Li B. Laparoscopic onlay lingual mucosal graft ureteroplasty combined with ureterovesical reimplantation for one-stage reconstruction of complex ureteral strictures: a case report. Transl Androl Urol 2021; 10:3907-3914. [PMID: 34804833 PMCID: PMC8575565 DOI: 10.21037/tau-21-639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/15/2021] [Indexed: 11/12/2022] Open
Abstract
The treatment of ureteral stricture is a challenging task, especially when multiple strictures are present. Here, we report on a 63-year-old male patient diagnosed with hydronephrosis with left ureteral strictures who was admitted to our hospital. During treatment, a left percutaneous nephrostomy tube was inserted for hydronephrosis. Antegrade and retrograde pyelography were performed simultaneously. The results suggested there were 3 segment ureteral strictures in the left ureter: 2 located in the distal ureter and 1 in the proximal ureter. The treatment choices for multiple ureteral strictures are kidney autotransplantation or an ileal ureteral replacement (IUR), which are both morbid procedures and are technically challenging. With the excellent results of lingual mucosal graft (LMG) in ureteroplasty, this patient underwent a one-stage left ureter reconstruction with combined laparoscopic LMG ureteroplasty and ureterovesical reimplantation. However, disease of the oral mucosa and a reduced bladder volume caused by radio cystitis or chemical cystitis, may limit the use of this technique. Regular postoperative antegrade pyelography and the Whitaker test showed the unimpeded drainage of the left ureter. Based on the satisfactory outcome of this patient, combined laparoscopic LMG ureteroplasty and ureterovesical reimplantation for unilateral multiple ureteral strictures is a viable option that has fewer complications.
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Affiliation(s)
- Xincheng Gao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaoqi Liang
- Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jianli Wang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingyuan Xiao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bing Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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10
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Li X, Zhu W, Zeng Z, Wang Q, Fang D, Li Z, Guan H, Huang Y, Zhang P, Zhu H, Li X, Zhou L. Bilateral ileal ureter substitution for patients with ureteral strictures secondary to gynecological tumors radiotherapy: a multi-center retrospective study. Transl Androl Urol 2021; 10:3226-3238. [PMID: 34532248 PMCID: PMC8421837 DOI: 10.21037/tau-21-255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background The selection of treatment for bilateral ureteral strictures caused by radiotherapy in patients with gynecological tumors often brings great challenges to urologists. This study was designed to analyze the characteristics of radiation-induced ureteral strictures and summarize the surgical experience of bilateral ileal ureter substitution. Methods We retrospectively collected the medical records of 18 patients between June 2010 and June 2019 who had a radiation-induced bilateral ureteral strictures. Time interval from radiotherapy to the discovery of ureteral stricture was categorized into short-term (less than 12 months) and long-term (over 12 months) groups. All patients received reverse “7” bilateral ileal ureteral substitution. Surgical success was defined as no restenosis, relief of symptoms, and improved/stabilized hydronephrosis. Results The patients had been suffered from ureteral stricture for a median of 12 [2–106] months. The mean length of the left and right ureteral stricture was 9.6±2.6 and 8.8±3.2 cm, respectively. The mean length of the ileal graft was 29.1±7.4 cm. The mean operative time was 308.4±70.2 min, and the mean estimated blood loss was 254.7±166.2 mL. The postoperative hospital stays in the short-term group was significantly shorter than that in the long-term group (14.0 vs. 20.6 days, P=0.049). During a median follow-up time of 24.1 (4.5–71.9) months, the success rate was 94.4%. Eight minor complications and two major complications occurred in 7 patients. Conclusions Bilateral ileal ureter substitution can be an effective strategy for radiation-induced ureteral stricture in patients with gynecological tumors.
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Affiliation(s)
- Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Weijie Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhen Zeng
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qian Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Dong Fang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Yanbo Huang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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11
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Ureteral reconstruction for complex strictures: a review of the current literature. Int Urol Nephrol 2021; 53:2211-2219. [PMID: 34524628 DOI: 10.1007/s11255-021-02985-6] [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] [Received: 05/26/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Frequently employed procedures for ureteral reconstruction include balloon dilation, pyeloplasty and ureteral re-implants. However, these procedures do not work for complex ureteral disease. The goal of this literature review is to report on techniques and success rates for the following techniques: buccal graft ureteroplasty, appendiceal interposition, transureteroureterostomy, ileal ureter and autotransplantation. METHODS A comprehensive literature search for English-language original and review articles was conducted using PubMed. The following terms were queried: "ureteral reconstruction", "buccal graft", "appendiceal interposition", "ileal ureter", "transureteroureterostomy", "autotransplantation". RESULTS Procedures involving the buccal mucosa or appendix offer minimally invasive techniques and low morbidity with good short-term success. Drawbacks to appendiceal interposition include the availability and length of appendix, and 10-20% of patients may have insufficient appendix upon intra-operative assessment. Transureteroureterostomy is typically limited to extensive exonerations due to concerns of injury to the contralateral kidney, even with reported success rates > 90%. Ileal ureter may carry a risk of metabolic acidosis in patients with renal insufficiency along with bowel-related complications. Ileal ureter and autotransplantation are reserved for the most severe cases due to their high morbidity but do offer options for the complex patient. CONCLUSION Ureteral stricture disease not amenable to pyeloplasty, ureteroureterostomy or ureteroneocystostomy offers a challenge to urologist. Careful patient selection with pre-operative assessment of renal and bladder is vital to a successful operation with minimal complications.
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Launer BM, Redger KD, Koslov DS, Sax-Bolder AN, Higuchi TT, Windsperger AP, Flynn BJ. Long-term Follow Up of Ileal Ureteral Replacement for Complex Ureteral Strictures: Single Institution Study. Urology 2021; 157:257-262. [PMID: 34310914 DOI: 10.1016/j.urology.2021.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report our 16-year experience with ileal ureter interposition for complex ureteral stricture. Ureteral reconstruction continues to evolve to include less invasive techniques to successfully manage ureteral stricture. However, long, complex, obliterative and especially radiated ureteral strictures are not amenable to less invasive techniques and may require Ileal ureter interposition. MATERIALS AND METHODS Retrospective review of a single institution's ureteral reconstruction database was performed. Demographics, operative details, success rate, complication rate, and length of follow-up were noted. Unilateral replacements utilized ileal ureteral interposition. Success rate was defined as no need for further open intervention. RESULTS Between 2003 and 2019, 188 ureteral reconstructions were performed, of which 46 required ileal ureter interposition. Of these 46 patients, 10 required bilateral reconstruction. Average age was 53 years, 26 (57%) were female. The average stricture length was 9.1 cm (2-20 cm). Stricture etiology included iatrogenic causes (n = 24, 52%), radiation causes (n = 12; 26%), vascular disease (n = 3; 7%), and idiopathic retroperitoneal fibrosis (n = 3; 7%). Forty-three surgeries were performed by open abdominal approach; 3 were performed robotically. The average length of operation was 412 minutes, blood loss 417 mL and LOS was 10 days. At mean follow up of 4.4 years (1-16 years), overall success rate was 83%, with 17% (n = 8) patients requiring subsequent major surgery (5 successful ureteral revision, 3 nephrectomy) and 11 (24%) patients experiencing a major complication. CONCLUSION In our long-term follow up of over 4 years, ileal ureteral interposition remains a successful option for complex ureteral strictures in properly selected patients.
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Affiliation(s)
- Bryn M Launer
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO
| | - Kirk D Redger
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO
| | - David S Koslov
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO
| | - Anessa N Sax-Bolder
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO
| | - Ty T Higuchi
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO
| | - Andrew P Windsperger
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO
| | - Brian J Flynn
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO.
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Ali-El-Dein B, El-Hefnawy AS, D' Elia G, El-Mekresh MM, Shokeir AA, Gad H, Bazeed MA. Long-term Outcome of Yang-Monti Ileal Replacement of the Ureter: A Technique Suitable for Mild, Moderate Loss of Kidney Function and Solitary Kidney. Urology 2021; 152:153-159. [PMID: 33359492 DOI: 10.1016/j.urology.2020.09.061] [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] [Received: 08/20/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To present long-term outcome of Yang-Monti ileal ureter, with a focus on patients with mild/moderate loss of kidney function and solitary kidney. PATIENTS AND METHODS Between March 2001 and December 2019, Yang-Monti ileal ureter was performed on 36 patients with ureteric defects and median age 46.5 years. Of these, 4, 14, 15 and 3 patients had stage 1, stage 2, stage 3a and stage 4a chronic kidney disease, respectively; 6 had solitary kidney. Patients were regularly followed for complications, morphological, and functional outcome. RESULTS Ureteric stricture etiology was iatrogenic (16), Bilharzial (7), tuberculous (4), retroperitoneal fibrosis (5), malignancy (3), and gunshot injury (1). The median (range) ureteric defect length was 11 (8-16) cm. Four grade 1/2 postoperative Clavien-Dindo complications were noted. Median follow-up was 68 months (range 12-215). Intestinal obstruction developed in 1 patient and urinary tract infection in 10. At last follow-up, serum creatinine, split renographic clearance, and estimated glomerular filtration rate showed significant improvement compared to preoperative values, in the whole series, in cases with chronic kidney disease (stages 2, 3a and 3b) and solitary kidney. Four cases with chronic kidney disease (stage 3) showed deterioration of the kidney function parameters. Magnetic resonance urography showed improvement of hydronephrosis in most patients. No metabolic complications were noted. CONCLUSION Yang-Monti Ileal ureter is durable and effective in improving kidney function with few complications. It can be safely used in cases of mild/moderate kidney function loss and solitary kidney. A threshold eGFR <40 mL/min/1.73 m2 is considered relative contraindication.
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Affiliation(s)
- Bedeir Ali-El-Dein
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Ahmed S El-Hefnawy
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Gianluca D' Elia
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohsen M El-Mekresh
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed A Shokeir
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hosam Gad
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mahmoud A Bazeed
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Zhong W, Hong P, Ding G, Yang K, Li X, Bao J, Bao G, Cui L, Men C, Li Z, Zhang P, Chu N, Zhou L. Technical considerations and outcomes for ileal ureter replacement: a retrospective study in China. BMC Surg 2019; 19:9. [PMID: 30658620 PMCID: PMC6339271 DOI: 10.1186/s12893-019-0472-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/04/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Ileal ureter replacement is an alternative treatment for various length ureter defects. We present our experience and outcome of ileal ureter replacement in China. METHODS We retrospectively collected data of patients who underwent ileal ureter replacement between January 2010 and January 2015. We reviewed the medical history, indications for surgery, operative data, perioperative data, and outcomes. Besides, follow-up data included symptom, urine routine test, serum creatinine, serum electrolyte status, and radiographic test. RESULTS There were 23 patients who underwent ileal ureter replacement by the same surgeon. Twenty patients were performed unilateral ileal ureter replacement, two patients underwent a combination of ileal ureter replacement and Boari flap-psoas hitch, and one received bilateral ileal ureter replacement. Among these patients, the main cause leading to surgical treatment was iatrogenic injuries (n = 15), especially urinary surgery procedure (n = 11). The median follow-up time was 45 months. There were 6 early complications and 6 late complications after operation. Only one patient suffered from small bowel-related complication and was cured by conservative treatment. Only the patient who underwent bilateral ileal ureter replacement had metabolic acidosis. And 22 patients (95.7%) had a good renal function. CONCLUSIONS Ileal ureter replacement is an efficacious and safe procedure for the therapy of long ureteral defects. With appropriate technical considerations, the complication rate may decrease.
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Affiliation(s)
- Wenlong Zhong
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Peng Hong
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Guangpu Ding
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Junsheng Bao
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Guochang Bao
- Department of Urology, Affiliated Hospital of Chifeng University, Chifeng, Inner Mongolia, China
| | - Liang Cui
- Department of Urology, The General Hospital of Civil Aviation Administration of China, Beijing, China
| | - Changping Men
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Zhe Li
- Department of Urology, China Meitan General Hospital, Beijing, China
| | - Peng Zhang
- Department of Urology, China Meitan General Hospital, Beijing, China
| | - Ning Chu
- Department of Urology, Heilongjiang provincial hospital, Harbin, Heilongjiang, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China.
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Long term outcomes in the use of ileal ureter for radiation-induced ureteral strictures. Int Urol Nephrol 2018; 50:1375-1380. [DOI: 10.1007/s11255-018-1904-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
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Pamecha Y, Shelke U, Patil B, Patwardhan S, Kini S. Use of ileum for complex ureteric reconstruction: Assessment of long-term outcome, complications, and impact on renal function. Urol Ann 2018; 10:369-374. [PMID: 30386088 PMCID: PMC6194786 DOI: 10.4103/ua.ua_5_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Defect in ureteral continuity can be due to various etiologies. The surgical options for management of complex long-segment ureteric defects are limited. Use of ileum is indicated in these cases; however, the technique is challenging and outcomes need to be assessed in detail. Material and Methods: It is an observational study conducted over 4 years. After preoperative optimization, ureteric reconstruction was performed using standard techniques of ileal interposition in cases of unilateral and bilateral long-segment ureteric defects. Patients were followed up at regular interval to assess outcomes and see for complications. Results: A total of 14 patients were studied. Two most common indications for performing ileal ureter were iatrogenic injury and radiation-induced strictures (5–5 cases). Most common site of ureteric involvement was lower and midureter seen in 6 cases. The mean length of the ileum used was 11.2 cm. Mean preoperative nadir creatinine level was 1.57 mg/dL in this study. Average postoperative creatinine level at 4-week follow-up was 1.75 mg/dL and 1.45 mg/dL and 1.37 mg/dL, at 3 and 12 months, respectively. The most common short-term complication was paralytic ileus and long-term complication was recurrent urinary tract infection UTI. There was no mortality. Conclusion: Ileal ureter is found to be relatively easy and safe surgery even in patients with borderline high creatinine. There was no worsening of renal function attributable to the conduit in this study. In patients with limited surgical options, it is a suitable alternative, rather than keeping patient on permanent percutaneous nephrostomy or regular stent change. Metabolic acidosis and mucous-associated complications such as pain, infection, and stone formation can be minimized by adherence to strict protocol.
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Affiliation(s)
- Yash Pamecha
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Umesh Shelke
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Bhushan Patil
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sujata Patwardhan
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Siddharth Kini
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Zhao LC, Weinberg AC, Lee Z, Ferretti MJ, Koo HP, Metro MJ, Eun DD, Stifelman MD. Robotic Ureteral Reconstruction Using Buccal Mucosa Grafts: A Multi-institutional Experience. Eur Urol 2017; 73:419-426. [PMID: 29239749 DOI: 10.1016/j.eururo.2017.11.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Minimally invasive treatment of long, multifocal ureteral strictures or failed pyeloplasty is challenging. Robot-assisted buccal mucosa graft ureteroplasty (RBU) is a technique for ureteral reconstruction that avoids the morbidity of bowel interposition or autotransplantation. OBJECTIVE To evaluate outcomes for RBU in a multi-institutional cohort of patients treated for revision ureteropelvic junction obstruction and long or multifocal ureteral stricture at three tertiary referral centers. DESIGN, SETTING, AND PARTICIPANTS This retrospective study involved data for 19 patients treated with RBU at three high-volume centers between October 2013 and July 2016. SURGICAL PROCEDURE RBU was performed using either an onlay graft after incising the stricture or an augmented anastomotic repair in which the ureter was transected and re-anastomosed primarily on one side, and a graft was placed on the other side. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. RESULTS AND LIMITATIONS The onlay technique was used for 79%, while repair was carried out using the augmented anastomotic technique for the remaining cases. The reconstruction was reinforced with omentum in 95% of cases. The ureteral stricture location was proximal in 74% and mid in 26% of cases. A prior failed ureteral reconstruction was present in 53% of patients. The median stricture length was 4.0cm (range 2.0-8.0), operative time was 200min (range 136-397), estimated blood loss was 95ml (range 25-420), and length of stay was 2 d (range 1-15). There were no intraoperative complications. At median follow-up of 26 mo, the overall success rate was 90%. CONCLUSIONS RBU is a feasible and effective technique for managing complex proximal and mid ureteral strictures. PATIENT SUMMARY We studied robotic surgery for long ureteral strictures using grafts at three referral centers. Our results demonstrate that robotic buccal mucosa graft ureteroplasty is a feasible and effective technique for ureteral reconstruction.
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Affiliation(s)
- Lee C Zhao
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
| | - Aaron C Weinberg
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA.
| | - Ziho Lee
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Mark J Ferretti
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Harry P Koo
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Michael J Metro
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
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Use of the Ileum for Ureteral Stricture and Obstruction in Bilateral, Unilateral, and Single-kidney Cases. Urology 2017; 111:203-207. [PMID: 28818535 DOI: 10.1016/j.urology.2017.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/21/2017] [Accepted: 08/02/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the functional outcomes of ileal ureter replacement for complex ureteral loss, including bilateral and single ureter stricture, as a result of various etiologies. METHODS In 2013-2016, 31 patients underwent ileal ureter replacement surgery. The data for their assessments included etiology, combined surgical procedures, ureteral replacement type, postoperative complications, and changes in renal function. RESULTS The 31 study patients had a median age of 56.0 (range 18-65) years and were followed for a median of 23.6 (range 6.5-43.2) months. There were 14 bilateral, 12 unilateral, and 5 single-kidney cases. The main indication for surgery was ureteral defects after gynecological surgery and radiation in 24 patients (77.4%). The mean operation time was 370.6 minutes and the median hospital stay was 25.2 (range 6-79) days. Various types of ileal arrangement were performed to cover bilateral ureter loss. After 30 days past surgery, 24 patients (77.4%) were in a stable state and 5 (16.1%) had decreased serum levels of creatinine. Short-term complications greater than grade 3 on the Clavien scale occurred in 10 patients (33.3%), and long-term complications occurred in 27 (87.1%). However, all cases were well relieved by conservative care, and surgical intervention was needed in only 1 case. Apart from 2 patients who died because of the progression of cervical cancer, all patients had stent-free status at 22.4 months. CONCLUSION Ileal ureter replacement is a useful reconstructive surgery for complex ureteral loss, such as bilateral and single-kidney cases resulting from various etiologies.
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Morrison CD, Kielb SJ. Use of Bowel in Reconstructive Urology: What a Colorectal Surgeon Should Know. Clin Colon Rectal Surg 2017; 30:207-214. [PMID: 28684939 DOI: 10.1055/s-0037-1598162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Urologists routinely use bowel in the reconstruction of the urinary tract. With an increasing prevalence of urinary diversions, it is important for surgeons to have a basic understanding of varied use and configuration of bowel segments in urinary tract reconstruction that may be encountered during abdominal surgery. The aim of this review article is to provide an overview of the various reconstructive urological surgeries requiring bowel and to guide physicians on how to manage these patients with urinary diversions.
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Affiliation(s)
- Christopher D Morrison
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Stephanie J Kielb
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Waldorf B, Lee Z, Kidd L, Kaplan J, Harris A, Metro M, Liu J, Eun D. Robotic Buccal Ureteroplasty: a Review of the Current Literature. Curr Urol Rep 2017; 18:40. [PMID: 28401476 DOI: 10.1007/s11934-017-0683-x] [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: 01/16/2023]
Abstract
PURPOSE OF REVIEW This study aimed to provide an overview of the literature on buccal mucosal ureteroplasty for ureteral stricture disease, with a specific focus on the application of the robotic platform to buccal ureteroplasty. RECENT FINDINGS In our review, we highlight the results of Zhao et al. from the New York University School of Medicine Department of Urology, as well as our own results from Temple University Hospital. Zhao et al. published the first series of four patients who underwent robotic buccal ureteroplasty. Mean stricture length was 3.0 cm, and at a mean follow-up of 15 months, all repairs remained patent. We also describe our results in 10 patients who underwent robotic buccal ureteroplasty at Temple University Hospital. Median stricture length was 3.0 cm, and at a median follow-up of 5 months, all repairs remain patent. Robotic buccal ureteroplasty offers a promising option for repair of complex ureteral strictures.
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Affiliation(s)
- Benjamin Waldorf
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA.
| | - Ziho Lee
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Laura Kidd
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Joshua Kaplan
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Andrew Harris
- Paul B. Hall Regional Medical Center, Paintsville, KY, USA
| | - Michael Metro
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Jeffrey Liu
- Temple Head and Neck Institute, Temple University School of Medicine, Philadelphia, PA, USA
| | - Daniel Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
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Ureteral Reconstruction With Ileum: Long-term Follow-up of Renal Function. Urology 2017; 104:225-229. [PMID: 28237532 DOI: 10.1016/j.urology.2017.02.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess long-term renal preservation and surgical outcomes in patients undergoing ureteric substitution with ileum. This has been a mainstay of reconstruction options for lengthy ureteral defects. METHODS Consecutive patients aged 18 or older undergoing ileal ureters at our institution were retrospectively reviewed (from 1989 to June 2013). Patients with <6 months of follow-up were excluded. Demographic, surgical, and renal functional outcomes were reviewed. Renal function was assessed by the Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease Study equations. RESULTS Of the 108 patients meeting the inclusion criteria, 86 (79.6%) had single-renal unit reconstruction and 22 had bilateral reconstruction. Eighty-four (77.8%) had radiation-induced stricture and 24 had iatrogenic or trauma-induced strictures. The median follow-up was 51 months (interquartile range: 22-112). Short-term complications included Clavien grade I (16 [14.8%]), Clavien grade II (3 [2.8%]), Clavien grade III (9 [8.3%]), and Clavien grade IV (3 [2.8%]). Long-term complications included fistula in 6 patients (5.6%), renal failure requiring dialysis in 2 patients (1.9%), hyperchloremic metabolic acidosis in 4 patients (3.7%), and incisional hernia in 11 patients (10.2%). Nine patients (8.3%) had small-bowel obstructions; 3 (2.8%) required adhesiolysis. Four patients (3.7%) had an anastamotic stricture. Nineteen patients (17.6%) had worsening renal function. Cox proportional hazards regression found that those with bilateral repair were at 3.7 times increased risk of worsening renal function (P = .02). CONCLUSION Ureteral substitution with ileum provides an effective and versatile long-term reconstructive option with minimal renal function compromise in properly selected patients. Bilateral reconstruction may contribute to worse long-term renal function.
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Jeong IG, Han KS, Park SH, Song SH, Song G, Park HK, Choo MS, Hong B. Ileal Augmentation Cystoplasty Combined with Ileal Ureter Replacement After Radical Treatment for Cervical Cancer. Ann Surg Oncol 2015; 23:1646-52. [DOI: 10.1245/s10434-015-5032-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Indexed: 11/18/2022]
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Xu YM, Feng C, Kato H, Xie H, Zhang XR. Long-term Outcome of Ileal Ureteric Replacement With an Iliopsoas Muscle Tunnel Antirefluxing Technique for the Treatment of Long-segment Ureteric Strictures. Urology 2015; 88:201-6. [PMID: 26577622 DOI: 10.1016/j.urology.2015.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/31/2015] [Accepted: 11/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the long-term outcome of ileal ureteric replacement using a proximal antirefluxing technique for the treatment of long-segment ureteric strictures. PATIENTS AND METHODS Between January 1997 and December 2013, 41 patients with a long ureteral stricture or defect and 3 patients with unilateral mid-lower ureteral cancer (20 bilateral and 24 unilateral, 28 males and 16 females) were treated by ureteral substitution using a proximal antirefluxing technique. The distal part of the upper ureter (4 cm) was fixed between the psoas muscle and the ileal segment (the iliopsoas tunnel technique). The distal ileum was connected to the urinary bladder with an end-to-side anastomosis. A successful outcome was defined as the absence of major complications, worsening baseline renal function, metabolic derangements, or obstruction. RESULTS One patient with unilateral mid-lower ureteral cancer died 3 years postoperatively because of metastasis, and the remaining 43 patients were followed for 12-180 months (mean 69 months). Intravenous urography showed that the hydronephrosis improved significantly or disappeared after 6-12 months in 34 patients, with improvement in 9 patients. Cystography showed no evidence of ileoureteral reflux. Seven patients needed long-term oral alkalization to prevent hyperchloremic acidosis. CONCLUSION In our experience, outcomes following subtotal ureteric replacement are encouraging. The ileal ureter replacement by the proximal antirefluxing technique appears to be a reliable procedure for treating long-segment ureteral stricture and preservation of renal function.
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Affiliation(s)
- Yue-Min Xu
- Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Chao Feng
- Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haruaki Kato
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hong Xie
- Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China
| | - Xin-Ru Zhang
- Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China
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Gomez-Gomez E, Malde S, Spilotros M, Shah PJ, J. Greenwell T, Ockrim JL. A tertiary experience of ileal–ureter substitution: Contemporary indications and outcomes. Scand J Urol 2015; 50:192-9. [DOI: 10.3109/21681805.2015.1106579] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Robot-Assisted Ureteral Reconstruction Using Buccal Mucosa. Urology 2015; 86:634-8. [DOI: 10.1016/j.urology.2015.06.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 11/21/2022]
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Possible complications of ureteroscopy in modern endourological era: two-point or "scabbard" avulsion. Case Rep Urol 2015; 2014:308093. [PMID: 25610699 PMCID: PMC4291154 DOI: 10.1155/2014/308093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 10/09/2014] [Accepted: 10/13/2014] [Indexed: 12/14/2022] Open
Abstract
Indication has led ureteroscopy to be a worldwide technique, with the expected appearance of multiple types of complications. Severe complications are possible including ureteral perforation or avulsion. Ureteral avulsion has been described as an upper urinary tract injury related to the action of blunt trauma, especially from traffic accidents, being the mechanism of injury, the result of an acute deceleration/acceleration movement. With the advent of endourology, that term is also applied to the extensive degloving injury resulting from a mechanism of stretching of the ureter that eventually breaks at the most weakened site, or ureteral avulsion is referred to as a discontinuation of the full thickness of the ureter. The paper presents a case report and literature review of the two-point or "scabbard" avulsion. The loss of long segment of the upper ureter, when end-to-end anastomosis is not technically feasible, presents a challenge to the urological surgeon. In the era of small calibre ureteroscopes these complications, due to growing incidence of renal stones will become more and more actual. Our message to other urologists is to know such a complication, to know the ways of treatment, and to analyse ureteroscopic signs, when to stop or pay attention.
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Li Y, Li C, Yang S, Song C, Liao W, Xiong Y. Reconstructing full-length ureteral defects using a spiral bladder muscle flap with vascular pedicles. Urology 2014; 83:1199-204. [PMID: 24767531 DOI: 10.1016/j.urology.2014.01.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 12/31/2013] [Accepted: 01/27/2014] [Indexed: 12/18/2022]
Abstract
INTRODUCTION This study investigates the efficacy of ureteral reconstruction using a spiral bladder muscle flap with vascular pedicles (ie, the superior vesical arteries) to repair full-length ureteral defects and explores a surgical approach for repairing long ureteral defects (>20 cm) using a bladder muscle flap. TECHNICAL CONSIDERATIONS The characteristics of the ureteral reconstruction surgery include the following: (1) Surgeons fully expose the bladder in the retroperitoneal space. (2) While dissecting the superior vesical arteries, the integrities of the blood vessel trunk and the primary branches are maintained as much as possible. (3) While preparing the bladder muscle flap, the surgeons make an S-shaped cut along the route of the superior vesical arteries along the bladder. In general, the basal width of the muscle flap is approximately 2-3 cm in length, and the total length is approximately 1-2 cm longer than the defective ureter. (4) During the surgery, kidney descent and fixation and psoas hitch are performed to reduce end-to-end anastomotic tension. (5) The addition of a submucosal tunnel to prevent postoperative ureteral reflux is unnecessary. (6) A pedicled greater omentum graft is transferred to cover the reconstructed ureter to enhance blood supply when necessary. CONCLUSION Ureteroplasty using a spiral bladder muscle flap with vascular pedicles (ie, the superior vesical arteries) is an ideal treatment to repair full-length ureteral defects. Moreover, this technique is particularly useful for ureteral defects longer than 20 cm. This procedure should be strongly promoted.
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Affiliation(s)
- Yongwei Li
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chenglong Li
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Sixing Yang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Chao Song
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenbiao Liao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yunhe Xiong
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
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Janitzky A, Borski J, Porsch M, Wendler JJ, Baumunk D, Liehr UB, Schostak M. [Long-term results for subcutaneous Detour® prosthesis for ureteral obstruction: experiences of implantation, aftercare and management of complications]. Urologe A 2013; 51:1714-21. [PMID: 23095948 DOI: 10.1007/s00120-012-3039-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND We present the long-term results of implementation of the Detour® prosthesis as an alternative to established methods of surgical, percutaneous or internal urinary diversion. PATIENTS AND METHODS Between 2004 and 2012 a total of 40 prostheses were implanted in 31 patients (mean age 65 years) with ureteral strictures of various origins. In the follow-up the patients underwent examinations and completed questionnaires. RESULTS The average follow-up was 23 months (range 1-92 months). Sonographic examinations showed no urinary retention in 38 out of 40 implanted systems. The retention values were stable in 19 patients, improved in 7 and worse in 3. The quality of life (QoL) was high (EORTC QLQ-C30 90%). Intraoperative complications were 2 intestinal lesions and 3 bleeding of the renal-pelvic system. Postoperative urinary tract infections and wound complications were encountered. In the long-term course three infected hydronephroses occurred which were treated and cured with antibiotics and temporary nephrostomy and 4 systems were explanted, including 2 exchanges. CONCLUSIONS The system may be considered for patients with ureteral strictures with palliative and curative intent. There were no significant disadvantages in comparison with established methods. There were fewer risks in implantation and complications were manageable. The quality of life was significantly improved.
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Affiliation(s)
- A Janitzky
- Universitätsklinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Straße 44, 39120 Magdeburg, Deutschland.
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Knight RB, Hudak SJ, Morey AF. Strategies for open reconstruction of upper ureteral strictures. Urol Clin North Am 2013; 40:351-61. [PMID: 23905933 DOI: 10.1016/j.ucl.2013.04.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article presents a review of the literature regarding surgical techniques and outcomes for reconstruction of strictures involving the upper ureter. The preoperative assessment for proximal ureteral stricture is briefly reviewed, followed by a discussion of ureteroureterostomy, transureteroureterostomy, ureterocalicostomy, bladder flaps, downward nephropexy, bowel interposition grafts, onlay or tubular grafting, renal autotransplantation, and nephrectomy. The future direction for reconstruction of the proximal ureter is proposed.
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Affiliation(s)
- Richard B Knight
- Department of Urology, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, TX 78234, USA.
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Abstract
Injury to the genitourinary (GU) tract occurs in up to 10% of all traumas, with the kidneys being the most frequently affected. Trauma to different areas of the GU tract can be caused in a variety of ways, and the diagnostics and management of the injuries vary widely depending on the mechanism and location. Overall, fatalities from GU trauma are not common. However, significant morbidity can occur without prompt recognition and appropriate intervention. A basic understanding of urologic trauma is necessary for all emergency practitioners when caring for trauma patients.
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Affiliation(s)
- Sanjay Shewakramani
- Department of Emergency Medicine, Georgetown University Hospital, Washington, DC 20007, USA.
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Central Role of Boari Bladder Flap and Downward Nephropexy in Upper Ureteral Reconstruction. J Urol 2011; 186:1345-9. [DOI: 10.1016/j.juro.2011.05.086] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Indexed: 12/27/2022]
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Long-term functional outcomes after ileal ureter substitution: a single-center experience. Urology 2011; 78:692-5. [PMID: 21741686 DOI: 10.1016/j.urology.2011.04.054] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 04/29/2011] [Accepted: 04/29/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the indications and outcomes of ileal ureter replacement for ureteral reconstruction, which remains a technique of choice in certain cases, notably when the ureter has been injured. METHODS A retrospective review of the data from patients treated with ureteroileoplasty from 1980 to 2010 was performed. The following data were analyzed: age, etiology of ureter injury, and pre- and postoperative creatinine levels. Follow-up visits occurred at 3 and 6 months postoperatively and at least annually thereafter. RESULTS A total of 17 patients with a median age of 43 years were included. The main etiology of the ureteral defect was an iatrogenic ureteral injury after a urologic procedure (n=6). The mean length of hospital stay was 12.4±8 days (range 7-26). Four major complications (grade 3) and 5 minor complications (grade 2) developed. The median follow-up time was 174 months. The mean creatinine level before surgery, at 1 month after surgery, and at the last follow-up visit was 1.3±0.3 mg/dL (range 0.6-3.4), 1.4±0.4 mg/dL (range 0.6-3.6), and 1.8±0.6 mg/dL (range 0.7-4.7), respectively. By the end of the follow-up period, 15 patients still had ileal ureters. Of these, 3 required dialysis. CONCLUSIONS The indications for an ileal ureter have evolved in recent years. The ileal ureter appears to remain a reasonable option for ureteral reconstruction to preserve long-term renal function.
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Brourman JD. Successful replacement of an obstructed ureter with an ileal graft in a cat. J Am Vet Med Assoc 2011; 238:1173-5. [PMID: 21529240 DOI: 10.2460/javma.238.9.1173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 10-year-old spayed female domestic shorthair cat with a 1-week history of vomiting, lethargy, and anorexia was examined. CLINICAL FINDINGS Abdominal radiography and ultrasonography revealed that calculi and a nonpatent stricture obstructed the right ureter, which resulted in secondary dilatation of the ureter proximal to the obstruction and severe hydronephrosis. The left kidney was small and suspected to be failing. Concentrations of BUN and creatinine were elevated. Despite administration of fluids, azotemia persisted. TREATMENT AND OUTCOME Surgery was performed. The obstructed right ureter was replaced with a vascularized segment of ileum. Azotemia resolved, and the cat improved with regard to clinical signs. The cat was clinically normal for > 36 months after the surgery. CLINICAL RELEVANCE An ileal graft can successfully be used as a surgical option for ureteral obstruction in cats.
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Affiliation(s)
- Jeff D Brourman
- WestVet Animal Emergency and Specialty Center, 5019 N Sawyer Ave, Garden City, ID 83714, USA.
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González Resina R, Congregado Ruiz B, Medina López RA, Torrubia Romero FJ. [Complete vesico-ureteral reconstruction with ileum in a case of genitourinary tuberculosis]. Actas Urol Esp 2009; 33:706-11. [PMID: 19711758 DOI: 10.1016/s0210-4806(09)74213-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Genitourinary tuberculosis represent 3.2% of the possible sites of the disease. The lack of treatment or an inadecuate one may lead to severe complications. We report a case and review thoroughly the literature of genitourinary tuberculosis which needed a complete vesico-ureteral reconstruction. CLINICAL CASE A 39 year old female patient with history of pulmonary tuberculosis who had lumbar pain and left ureterohydronephosis. She required a percutaneous urinary derivation and was diagnosed of tuberculosis by means of the urine culture. 18 months afterwards she had a right renal annulation and a left distal ureteral stenosis. A right nephectomy was performed and the left proximal ureter was desinserted accidentally, 1 cm below the pielo-ureteral junction, which required a permanent nephostomy. Then her bladder became gradually retractile. Because she was a young patient and had bad quality of life a complete reconstruction of her left urinary way was performed with an ileum made neobladder and neoureter. DISCUSSION AND CONCLUSSIONS: Bladder and ureter reconstruction with ileum is a good option in difficult cases of lack or irreversible damage of the urinary way. Vesico-ureteral reconstruction letting urethral miction improves quality of life.
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Laparoscopic Assisted Ileal Ureter: Technique, Outcomes and Comparison to the Open Procedure. J Urol 2009; 182:1032-9. [DOI: 10.1016/j.juro.2009.05.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Indexed: 11/18/2022]
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Armatys SA, Mellon MJ, Beck SDW, Koch MO, Foster RS, Bihrle R. Use of ileum as ureteral replacement in urological reconstruction. J Urol 2008; 181:177-81. [PMID: 19013597 DOI: 10.1016/j.juro.2008.09.019] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE We reviewed indications and outcomes in patients undergoing ileal ureter replacement for ureteral reconstruction. MATERIALS AND METHODS Between December 1989 and September 2007, 105 patients underwent ileal ureter replacement, of whom 14 were excluded from study due to incomplete data. The remaining 91 patients (99 renal units) comprised the study cohort. RESULTS Mean patient age was 46.8 years and mean followup was 36.0 months. Indications for an ileal ureter were stricture following genitourinary surgery in 29 cases (31.9%), radiation induced stricture in 17 (18.7%), nonurological surgery iatrogenic injury in 16 (17.6%) and retroperitoneal fibrosis in 11 (12.1%). Only 4 patients (4.4%) had primary ureteral cancer. Long-term complications included anastomotic stricture in 3 patients (3.3%) and fistula in 6 (6.6%). Serum creatinine decreased or remained stable in 68 patients (74.7%) and hyperchloremic metabolic acidosis developed in 3. No patient complained of excessive urinary mucous production. CONCLUSIONS In 68.1% of patients indications for an ileal ureter included radiation induced stricture or iatrogenic injury. The ileal ureter is a reasonable option for long-term ureteral reconstruction with preserved renal function in carefully selected patients.
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Affiliation(s)
- Sandra A Armatys
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Xu YM, Qian L, Qiao Y, Wu DL, Sa YL, Zhang XR, Chen R, Si JM. Ileal ureteric replacement with an ileo-psoas muscle tunnel antirefluxing technique for the treatment of long segment ureteric strictures. BJU Int 2008; 102:1452-6. [PMID: 18549432 DOI: 10.1111/j.1464-410x.2008.07783.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To develop and report our initial experience with a novel antirefluxing technique for segmental ileal ureteric replacement for the treatment of long ureteric strictures. PATIENTS AND METHODS Between January 2000 and January 2007, 12 cases of ureteric strictures (nine bilateral and three unilateral) were treated using a novel surgical technique in which the ureter was replaced with a segment of ileum using an end-to-side anastomosis. An antireflux valve was constructed by fixing the distal part of upper ureter (4 cm) between the psoas muscle and ileal segment (the ileo-psoas tunnel technique). The distal ileum was connected to the urinary bladder with an end-to-side anastomosis. RESULTS The 12 cases were followed-up for a mean (range) of 39.42 (12-64) months. There were no cases of pyelonephritis or signs of renal failure after surgery. There was dramatic improvement in hydronephrosis, as assessed by intravenous urography, in the 4-9 months after surgery. Cystography showed no evidence of ileo-ureteric reflux. Mild hyperchloraemic acidosis was detected in two patients and was successfully treated with oral alkalization. CONCLUSIONS In our initial experience, ileal ureteric replacement combined with the ileo-psoas tunnel antirefluxing technique is a highly effective procedure for the treatment of ureteric strictures.
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Affiliation(s)
- Yue-Min Xu
- Department of Urology, Sixth People's Hospital, Jiaotong University of Shanghai, Shanghai, China.
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Castillo OA, Sanchez-Salas R, Vitagliano G, Diaz MA, Foneron A. Laparoscopy-Assisted Ureter Interposition by Ileum. J Endourol 2008; 22:687-92. [DOI: 10.1089/end.2007.0170] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Octavio A. Castillo
- Section of Endourology and Laparoscopic Urology, Clínica Santa María, Santiago, Chile
- Department of Urology, Faculty of Medicine, Universidad de Chile. Santiago, Chile
| | - Rafael Sanchez-Salas
- Section of Endourology and Laparoscopic Urology, Clínica Santa María, Santiago, Chile
| | - Gonzalo Vitagliano
- Section of Endourology and Laparoscopic Urology, Clínica Santa María, Santiago, Chile
| | - Manuel A. Diaz
- Section of Endourology and Laparoscopic Urology, Clínica Santa María, Santiago, Chile
| | - Alejandro Foneron
- Section of Endourology and Laparoscopic Urology, Clínica Santa María, Santiago, Chile
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40
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Kamat NN, Khandelwal P. Laparoscopy-Assisted Reconstruction of a Long-Segment Ureteral Stricture Using Reconfigured Ileal Segment: Application of the Yang Monti Principle. J Endourol 2007; 21:1455-60. [DOI: 10.1089/end.2006.0150] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nagesh N. Kamat
- Department of Urology, Kamats Kidney Hospital, Baroda, India
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Rutigliano DN, Georges A, Wolden SL, Kayton ML, Meyers P, La Quaglia MP. Ureteral reconstruction for retroperitoneal tumors in children. J Pediatr Surg 2007; 42:355-8. [PMID: 17270548 DOI: 10.1016/j.jpedsurg.2006.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Removal of solid tumors of the pelvis and abdominal cavity may require resection of an involved ureteral segment. Ureteral stricture can also be a result of intense therapy. We present our experience with urinary reconstruction in this situation. METHODS A retrospective review of pediatric oncology patients with solid abdominal/pelvic tumors who underwent a ureteral reconstructive procedure was done. Institutional review board wavier was obtained for the review. Patient data were collected on diagnosis, procedures performed, renal function, and follow-up. RESULTS Thirteen patients were identified: 8 male and 5 female. The mean age at surgery was 10.1 years. The most common reason for surgery was en bloc tumor resection (n = 8) followed by ureteral strictures (n = 3). The Boari flap, Leadbetter-Politano reimplantation, and psoas hitch were the most common procedures preformed. Follow-up studies included measurements of serum urea nitrogen/creatinine levels as well as renal scans to assess functional status; 2 patients had elevated serum urea nitrogen/creatinine levels at follow-up. The mean follow-up time was 18 months; 4 patients died-none was secondary to renal complications. There were no local tumor recurrences. CONCLUSIONS Abdominal and pelvic tumors frequently involve the ureter, and their removal should not necessitate acceptance of poor surgical margins. Complete surgical resection of tumor including involved ureteral segments can prolong survival in patients with extensive abdominopelvic cancers. In another group of patients, ureteral strictures arise secondary to therapy and reconstruction may preserve renal function.
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Affiliation(s)
- Daniel N Rutigliano
- Division of Pediatric Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
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Wolters HH, Palmes D, Brockmann J, Suwelack B, Hertle L, Senninger N, Brinkmann O. Therapeutical options in ureteral necrosis following kidney transplantation. Transpl Int 2006; 19:516-8. [PMID: 16771875 DOI: 10.1111/j.1432-2277.2006.00310.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Matlaga BR, Shah OD, Assimos DG. Re: The use of bowel for ureteral replacement for complex ureteral reconstruction: long-term results. J Urol 2006; 176:410-1; author reply 411. [PMID: 16753455 DOI: 10.1016/s0022-5347(06)00578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Indexed: 11/17/2022]
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Elkas JC, Berek JS, Leuchter R, Lagasse LD, Karlan BY. Lower urinary tract reconstruction with ileum in the treatment of gynecologic malignancies. Gynecol Oncol 2005; 97:685-92. [PMID: 15863183 DOI: 10.1016/j.ygyno.2005.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Revised: 01/07/2005] [Accepted: 01/10/2005] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Advanced or recurrent gynecologic malignancies can invade or obstruct the lower urinary tract. If extirpation is necessary for cytoreduction or repair of radiation sequelae, treatment has typically involved creation of either an ileal conduit or a cutaneous continent urinary diversion. As an alternative, a more limited resection with urinary tract reconstruction using ileum for interposition or augmentation may allow for the preservation of urethral voiding. CASES We describe the use of ileal segments for lower urinary tract reconstruction in the treatment of ten patients with advanced or recurrent gynecologic malignancies. The clinical history, surgical technique, and patient outcomes are reviewed. DISCUSSION These cases demonstrate that limited bladder or ureteral resection with reconstruction using ileal segments may offer select patients preservation of urethral voiding.
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Affiliation(s)
- John C Elkas
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Walter Reed Army Medical Center, Room 6762, Building 2, 6900 Georgia Avenue NW, Washington, D.C. 20307, USA.
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Matlaga BR, Shah OD, Singh D, Streem SB, Assimos DG. Ureterocalicostomy: A contemporary experience. Urology 2005; 65:42-4. [PMID: 15667860 DOI: 10.1016/j.urology.2004.08.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Accepted: 08/18/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To report our contemporary experience with ureterocalicostomy to determine whether the indications or results have changed in modern practice. Ureterocalicostomy is a well-established treatment for patients with complicated ureteropelvic junction (UPJ) obstruction and other forms of proximal ureteral obstruction. Although both retrograde and antegrade endourologic interventions have become accepted forms of management, the success rates do not approach those of open or even laparoscopic interventions, potentially leading to a greater number of patients with treatment failure and the need for more complicated reconstruction. METHODS Between July 1991 and February 2004, 11 patients (4 women and 7 men), aged 19 to 68 years (mean 38), underwent open surgical ureterocalicostomy. The indications for surgery were primary UPJ obstruction in 4, failed cutting balloon incision for UPJ obstruction in 3, proximal ureteral stricture after ureteroscopic stone removal in 2, and obliterated UPJ after percutaneous nephrolithotomy and failed antegrade endopyelotomy in 1 patient each. RESULTS Hospitalization ranged from 4 to 7 days (mean 5.1). No patient experienced a significant perioperative complication. With follow-up ranging from 5 to 32 months (mean 10.1), relief of obstruction was evident in all patients as documented by intravenous urography or nuclear renography. Furthermore, differential function on the involved side improved from a mean of 54.6% preoperatively to 60.1% postoperatively (P <0.05). CONCLUSIONS The spectrum of indications for ureterocalicostomy has changed, although excellent results can still be achieved. Although laparoscopic approaches are currently being evaluated, most patients currently undergoing this reconstructive procedure still require open operative intervention.
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Affiliation(s)
- Brian R Matlaga
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1094, USA
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Tewari M, Shukla HS. Right colectomy with isoperistaltic side-to-side stapled ileocolic anastomosis. J Surg Oncol 2005; 89:99-101. [PMID: 15660366 DOI: 10.1002/jso.20191] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We describe here a novel technique of isoperistaltic side-to-side ileocolic anastomosis following right hemicolectomy with minimal use of linear cutter (GIA-80) in 16 of our patients. Compared to the traditional standard technique, we found our new technique to be simple, safe, and cost-effective. It probably also helped in faster and uncomplicated recovery of our patients.
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Affiliation(s)
- Mallika Tewari
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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