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Abdalla A, Cohn JA, Simhan J. Unraveling the Complexities of Uretero-Enteric Strictures: A Modern Review. Curr Urol Rep 2024; 25:287-297. [PMID: 39138815 DOI: 10.1007/s11934-024-01222-8] [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] [Accepted: 06/21/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review article is to provide a contemporary overview of benign uretero-enteric anastomotic stricture (UAS) management and outcomes. RECENT FINDINGS In this article, we will review the most recent studies investigating UAS and evaluate etiology, potential risk factors, presentation, diagnosis, and management options, along with personal insight gained from our experience with managing this challenging reconstructive complication. Benign UAS is a relatively common long-term complication of intestinal urinary diversion, affecting approximately 1 in 10 patients. It is thought to be caused by ureteral tissue ischemia and fibrosis at the anastomotic site. Risk factors appear to include any that increase the likelihood of leak or ischemia; it is not clear if anastomotic approach impacts risk for stricture as well. Management options are varied and include endourologic, open, and robotic approaches. Endoscopic approaches may be less morbid but are considerably less effective than reconstruction performed after a period of ureteral rest.
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Affiliation(s)
- A Abdalla
- Department of Urology, Albert Einstein Medical Center, Philadelphia, PA, 19141, USA
| | - Joshua A Cohn
- Department of Urology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - J Simhan
- Department of Urology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
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McCabe M, Sharma A, Kashyap R, Pineda-Solis K, Nair A, Joseph J, Wu G. Robotic-Assisted Management of Ureteral Complications in Post-Renal Transplant Patients: A Case Series and Literature Review. J Laparoendosc Adv Surg Tech A 2024; 34:639-645. [PMID: 38722056 DOI: 10.1089/lap.2024.0080] [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: 07/26/2024] Open
Abstract
Introduction: Urologic complications are thought to be the most common surgical complication of renal transplantation. Ureteral pathology, including stenosis, urine leak, and vesicoureteral reflux, predominates. Although endourologic and interventional radiological management may be utilized, failure rates remain relatively high and surgical reconstruction remains the definitive management. Robotic ureteral reconstruction has been demonstrated to provide patient benefit in nontransplant populations, but the literature on transplant reconstruction is very limited. This study reports an additional series of patients with a focus on surgical technique, as well as reviews the available evidence for robotic reconstruction for post-transplant ureteral complications. Methods: All institutional patients undergoing robotic-assisted reconstruction for post-transplant ureteral complications for the years 2019-2022 were included. Intra- and postoperative variables, patient demographics, and follow-up data were obtained retrospectively from parsing of patient records. Statistics were tabulated descriptively. Results: Eleven patients underwent ureteral reconstruction. Of the 11, 9 (81%) were male with a mean age of 51.9 years (16-70) and BMI of 33.8 (24.3-49.1). The most common (10/11) indication for reconstruction was stricture; the most common (10/11) technique used was Lich-Gregoir reimplantation. Mean operative time was 288 minutes (143-500). There were no intra- or immediate postoperative complications. Median length of stay was 2 days (1-22). There were two incidences of mortality at 2 and 5 months postoperatively unrelated to surgery. There were four readmissions within 30 days, three for urinary tract infection (UTI) and one for a pelvic abscess which required washout. The remainder of the cohort has been followed for a mean of 14.6 months (6-41) without any incidences of graft loss or recurrence of ureteral pathology. Conclusions: Robotic-assisted ureteral reconstruction is a technically challenging but highly feasible technique that may provide the benefits of minimally invasive surgery while still allowing definitive reconstruction. Centers with extensive robotic capabilities should consider the technique.
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Affiliation(s)
- Michael McCabe
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Ashwani Sharma
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Randeep Kashyap
- Department of Surgery, Division of Solid Organ Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Karen Pineda-Solis
- Department of Surgery, Division of Solid Organ Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Amit Nair
- Department of Surgery, Division of Solid Organ Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Jean Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Guan Wu
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
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Ou Y, Zhang G, Zhu X, Yin H, Gou X, Deng Y. Evaluation of risk factors, treatment options, and prognostic-related factors in patients with benign ureteral strictures: An 8-year single-center experience. Int J Urol 2023; 30:847-852. [PMID: 37287392 DOI: 10.1111/iju.15211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the etiology, therapeutic effect, and prognosis-related factors of benign ureteral strictures. METHODS We analyzed the date of 142 patients with benign ureteral strictures from 2013 to 2021. Ninety-five patients received endourological treatment and 47 patients underwent reconstruction. Preoperative, intraoperative, and postoperative information were compared and analyzed. Symptomatic improvement and radiographic blockage alleviation defined therapeutic success. RESULTS Stone-related factors caused 85.2% of cases. The overall success rate of endourological treatment was 51.6% versus 95.7% of reconstruction (p < 0.01). However, endourological treatment was better in terms of postoperative hospital stay time, operation time, and intraoperative blood loss (p < 0.001). In endourological group, patients with stricture length ≤2 cm, mild-to-moderate hydronephrosis, proximal or distal stricture had a higher success rate. Multivariate regression analysis showed that the surgical method was the only independent risk factor affecting success and recurrence. Reconstruction success rate was higher than endourological treatment (p = 0.001, OR 0.057, 95% CI (0.011-0.291)), and recurrence rate was also lower (p = 0.001, HR 0.074, 95% CI (0.016-0.338)). No obvious recurrence was seen in reconstruction, and the median recurrence time in endourological treatment was 51 months. CONCLUSIONS Stone-related factors are an important cause of benign ureteral strictures. Reconstruction is the gold standard treatment due to its high success rate and low recurrence rate. Endourological therapy is also preferred as the initial treatment in proximal or distal ureter with length ≤2 cm and mild-to-moderate hydronephrosis. Further close follow-up is required after treatment.
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Affiliation(s)
- Yangjie Ou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Guoqing Zhang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xin Zhu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Hubing Yin
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xin Gou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuanzhong Deng
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Wang Y, Ren X, Ji C, Zhong D, Wei X, Zhu Z, Zhou X, Zhang X, Wang S, Qin C, Song N. A modified biodegradable mesh ureteral stent for treating ureteral stricture disease. Acta Biomater 2023; 155:347-358. [PMID: 36402295 DOI: 10.1016/j.actbio.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/21/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022]
Abstract
Ureteral stricture disease (USD) is a common urologic condition. Patients with ureteral stricture disease may suffer from ipsilateral flank pain, nausea, urinary calculi, infection, and impaired renal function. The treatments of USD include surgery, followed by implantation of the ureteral stent to aid the drainage of the urine. The traditional ureteral stent may sometimes cause urological infection, encrustation, and discomfort. To decrease the complication of the ureteral stent, we modified the structure and material based on the traditional ureteral stent. The traditional nondegradable Double-J shape tubular ureteral stent was turned into the biodegradable mesh ureteral stent. The modified mesh ureteral stent and Double-J ureteral stent were inserted into the ureters of the USD animals, respectively. The results of the gross morphology, serology, urinalysis, histology, microstructure, et al. demonstrated that modified mesh ureteral stent has a favorable ability in supporting the ureter and has no effect on cell proliferation, migration, apoptosis, and cell cycle of the human uroepithelial cells. The mesh ureteral stent could relieve ureter obstruction and can be slowly biodegraded after 3-5 months of implantation without the need for a second surgery to remove the stent. Compared to the Double-J ureteral stent, the modified mesh ureteral stent has a lower rate of urinary tract infection and less encrustation. It is expected to be an alternative treatment approach for USD. However, due to the limited number of animals and clinical data, further study focused on the application value in clinical practice are essential. STATEMENT OF SIGNIFICANCE: This study demonstrates: 1. A modified biodegradable mesh ureteral stent; 2. Without the need for a second surgery to remove the stent; 3. A lower rate of urinary tract infection and less encrustation than a double-J ureteral stent; 4. An alternative treatment approach for USD.
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Affiliation(s)
- Yichun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xiaohan Ren
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Chengjian Ji
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Da Zhong
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xiyi Wei
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Zheng Zhu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xuan Zhou
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xi Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Shuai Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Chao Qin
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China.
| | - Ninghong Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China; The Affiliated Kezhou People's Hospital of Nanjing Medical University, China.
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Avitan O, Bahouth Z, Shprits S, Gorenberg M, Halachmi S. Allium Ureteral Stent as a Treatment for Ureteral Stricture: Results and Concerns. Urol Int 2022; 106:482-486. [PMID: 35231922 DOI: 10.1159/000522174] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/20/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ureteral strictures could be a chronic illness that leads to severe side effects and poor quality of life. A treatment with an Allium ureteral stent (URS), a self-expanding, large-caliber URS, was implemented in our department for ureteral stricture. Our study aim was to report the long-term results, including success rate, complications, and adverse effects. METHODS We retrospectively collected data on all patients who were treated with an Allium URS in our department between January 2017 and January 2021. Demographic, clinical, radiological, and perioperative parameters were retrieved and analyzed. The primary outcome was stricture resolution rates following stent removal. RESULTS Our cohort included 17 patients, 9 men and 8 women. The etiology of ureteral strictures was urolithiasis in 76.5% and pelvic procedure injury in 17.6%. The overall success rate was 35.29% in an average follow-up of 10.42 ± 2.39 months after stent removal. A higher failure rate was observed in the urolithiasis etiology group (90% vs. 66.7%, p = 0.38). The mean indwelling time of the Allium stent was 14.29 ± 1.29 months. CONCLUSIONS Although an Allium URS could be considered as a feasible and attractive treatment of ureteral strictures, due to its minimal invasiveness, the success rate of this treatment is relatively low. Therefore, this option should be carefully considered and should be discouraged in young and fit patients and reserved for older unfit patients who are unwilling to undergo surgical repair of ureteral strictures.
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Affiliation(s)
- Ofir Avitan
- Department of Urology, Bnai-Zion Medical Center, Haifa, Israel
| | - Zaher Bahouth
- Department of Urology, Bnai-Zion Medical Center, Haifa, Israel
| | - Sagi Shprits
- Department of Urology, Bnai-Zion Medical Center, Haifa, Israel
| | - Miguel Gorenberg
- Department of Nuclear Medicine, Bnai-Zion Medical Center, Haifa, Israel
| | - Sarel Halachmi
- Department of Urology, Bnai-Zion Medical Center, Haifa, Israel
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Wu Y, Zhu W, Yang K, Fan S, Guan B, Huang B, Wang J, Wang J, Li Z, Guan H, Huang Y, Li Z, Zhang P, Li X, Zhou L. Terminal augmented ureteroplasty with bladder onlay flap technique for recurrent distal ureteral stricture after ureteroneocystostomy: an initial case series. Transl Androl Urol 2021; 10:3332-3339. [PMID: 34532257 PMCID: PMC8421814 DOI: 10.21037/tau-21-252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Bladder flap has been shown to be a feasible treatment for distal ureteral stenosis; this technique has been improved such that it can be used to address complex urinary tract obstructions. The purpose of the present study was to describe a surgical technique of ureteroplasty with a bladder onlay flap, which consists of a nontransecting and terminal augmented anastomosis, for repairing recurrent distal strictures of the ureter. Methods We retrospectively reviewed 6 patients who underwent this procedure between May 2018 and November 2019. These patients were diagnosed with distal ureteral stenosis and had previously undergone ureteroneocystostomy (one with a Boari flap) but suffered recurrence of flank pain. Patient characteristics, perioperative data and follow-up outcomes were gathered. The success of the operation was judged by symptomatic relief (subjective success) and improved radiographic imaging and renal function (objective success). Results Preoperative computed tomography urography (CTU) showed hydronephrosis in all patients: severe hydronephrosis was observed in 83.3% of patients (5/6), and moderate hydronephrosis was observed in 16.7% (1/6). The mean stricture length was 2 cm. The mean operating time, estimated blood loss and postoperative hospital stays of the six patients were 193.3 min (160–270 min), 41.5 mL (10–58 mL) and 8.2 days (6–11 days), respectively. No serious complications (Clavien-Dindo grade ≥3) occurred during or after the operations. The mean follow-up time was 24.5 months (range, 14 to 29). The objective success rate was 83.3% (5/6), and the subjective success rate was 100%. Conclusions Our technique of ureteroplasty with a bladder onlay flap by nontransecting and terminal augmented anastomosis is feasible and improves the recovery rate after the repair of recurrent distal ureteral stenosis. Patients who have had previous unsuccessful surgeries might benefit from this approach.
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Affiliation(s)
- Yucai Wu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Weijie Zhu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Bao Guan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Bingwei Huang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Jianxin Wang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Yanbo Huang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Zhe Li
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
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Deininger S, Nadalin S, Amend B, Guthoff M, Heyne N, Königsrainer A, Strohäker J, Stenzl A, Rausch S. Minimal-invasive management of urological complications after kidney transplantation. Int Urol Nephrol 2021; 53:1267-1277. [PMID: 33655463 PMCID: PMC8192401 DOI: 10.1007/s11255-021-02825-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/19/2021] [Indexed: 11/25/2022]
Abstract
Kidney transplantation represents the gold standard treatment option for patients with end-stage renal disease. Improvements in surgical technique and pharmacologic treatment have continuously prolonged allograft survival in recent years. However, urological complications are frequently observed, leading to both postoperative morbidity and putative deterioration of allograft function. While open redo surgery in these patients is often accompanied by elevated surgical risk, endoscopic management of urological complications is an alternative, minimal-invasive option. In the present article, we reviewed the literature on relevant urological postoperative complications after kidney transplantation and describe preventive approaches during the pre-transplantation assessment and their management using minimal-invasive approaches.
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Affiliation(s)
- Susanne Deininger
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Silvio Nadalin
- Department of General and Transplant Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Bastian Amend
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Martina Guthoff
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Nils Heyne
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General and Transplant Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Jens Strohäker
- Department of General and Transplant Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
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Glaser SM, Mohindra P, Mahantshetty U, Beriwal S. Complications of intracavitary brachytherapy for gynecologic cancers and their management: A comprehensive review. Brachytherapy 2021; 20:984-994. [PMID: 33478905 DOI: 10.1016/j.brachy.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Intracavitary gynecologic brachytherapy in the form of tandem-based brachytherapy and vaginal cylinder-based brachytherapy represents a fundamental component of the treatment of women with cervical or uterine cancer due to the ability to deliver a therapeutic dose of radiation with sharp dose falloff. This results in highly effective treatment in terms of oncologic outcomes with an overall favorable toxicity profile. Still, complications and side effects of brachytherapy do exist. While advances in brachytherapy techniques have led to a significant decrease in the rates of toxicity, a thorough understanding of the potential complications is crucial to ensuring optimal outcomes for women with gynecologic cancer undergoing brachytherapy. Use of equivalent dose at 2 Gy per fraction (EQD2) models has allowed incorporation of external beam radiotherapy dose to the brachytherapy dose leading to development of consolidated dose constraints for organs-at-risk in the modern era. This manuscript offers a comprehensive review of potential complications associated with intracavitary brachytherapy for gynecologic cancer including predictive factors, mitigation tactics, and management strategies.
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Affiliation(s)
- Scott M Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA.
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
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9
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Mohyelden K, Hussein HA, El Helaly HA, Ibrahem H, Abdelwahab H. Long-Term Outcomes of Two Ipsilateral vs Single Double-J Stent After Laser Endoureterotomy for Bilharzial Ureteral Strictures. J Endourol 2020; 35:775-780. [PMID: 33096946 DOI: 10.1089/end.2020.0956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Laser endoureterotomy became a preferable choice for managing benign ureteral strictures. Ureteral stricture caused by bilharzias is characterized by focal destruction of ureteral musculature, ending by fibrosis, making it poor responder to endoureterotomy. There is no consensus about the ideal ureteral stent size after endoureterotomy. However, many researches recommend larger stents caliber (12-14F). We assess long-term efficacy of insertion of two ipsilateral Double-J stents vs single Double-J stent after laser endoureterotomy for bilharzial ureteral stricture. Materials and Methods: Within 4 years, 70 patients underwent retrograde laser endoureterotomy for bilharzial ureteral stricture (diagnosed by positive history of bilharziasis, positive serology test, and/or bilharzial cystoscopic finding). Patients with history of stone, urologic or pelvic surgery were excluded. Patients were randomized into two groups: the first group (35 patients) received ipsilateral two Double-J (7F each) postendoureterotomy, whereas the second group (35 patients) received one Double-J (7F). Double-Js were removed after 8 weeks. Follow-up was done regularly by clinical interpretation and imaging studies. Patients' characteristics, operative data, and postoperative outcomes (subjectively and objectively) were compared in both groups. Results: Sixty-three patients completed follow-up >18 months, mean follow-up 30 ± 4 months [19-41], and mean stricture length 1.4 ± 0.6 cm [0.5-3.0], with no statistical significance between both groups. Success proved by relief of symptoms and radiographic resolution of obstruction. The overall success rate was significantly better in 2-Double-J group than in 1-Double-J group (83.9% vs 53.1%) p = 0.009, and also for stricture >1.5 cm (85.7% vs 38.5%) p = 0.018, respectively. Conclusions: Insertion of two ipsilateral Double-J, after laser endoureterotomy for bilharzial ureteral stricture associated with long-term success rate better than insertion of 1-Double-J, especially for stricture segment >1.5 cm.
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Affiliation(s)
- Khaled Mohyelden
- Urology Department, Faculty of medicine, Fayoum University, Fayoum, Egypt
| | | | - Hisham A El Helaly
- Urology Department, Faculty of medicine, Fayoum University, Fayoum, Egypt
| | - Hamdy Ibrahem
- Urology Department, Faculty of medicine, Fayoum University, Fayoum, Egypt
| | - Hassan Abdelwahab
- Urology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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10
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Cheng S, Fan S, Wang J, Xiong S, Li X, Xu Y, Li Z, Guan H, Zhang P, Zhu H, Huang C, Zhang L, Yang K, Li X, Zhou L. Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy. Int Urol Nephrol 2020; 53:479-488. [PMID: 33037521 DOI: 10.1007/s11255-020-02679-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios. METHODS From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2-6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures. RESULTS A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2-6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time (P = 0.008), shorter postoperative hospital stay (P = 0.011) but higher hospital cost (P < 0.001). At a mean follow-up of 12.8 months, the overall success rate was 94.3%. There was no difference in postoperative complications or the success rate between the approaches. CONCLUSION Laparoscopic and robotic onlay flap/graft ureteroplasty can be safe and feasible to repair long proximal/middle ureteral strictures while robotic procedures showed higher efficiency, faster recovery but higher cost. Our algorithmic strategies may provide beneficial references for their standardization and dissemination into clinical care.
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Affiliation(s)
- Sida Cheng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Yangyang Xu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Chen Huang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
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11
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Asghar AM, Lee Z, Lee RA, Slawin J, Cheng N, Koster H, Strauss DM, Lee M, Reddy R, Drain A, Lama-Tamang T, Jun MS, Metro MJ, Ahmed M, Stifelman M, Zhao L, Eun DD. Robotic Ureteral Reconstruction in Patients with Radiation-Induced Ureteral Strictures: Experience from the Collaborative of Reconstructive Robotic Ureteral Surgery. J Endourol 2020; 35:144-150. [PMID: 32814443 DOI: 10.1089/end.2020.0643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: Management of radiation-induced ureteral stricture (RIUS) is complex, requiring chronic drainage or morbid definitive open reconstruction. Herein, we report our multi-institutional comprehensive experience with robotic ureteral reconstruction (RUR) in patients with RIUSs. Patients and Methods: In a retrospective review of our multi-institutional RUR database between January 2013 and January 2020, we identified patients with RIUSs. Five major reconstruction techniques were utilized: end-to-end (anastomosing the bladder to the transected ureter) and side-to-side (anastomosing the bladder to an anterior ureterotomy proximal to the stricture without ureteral transection) ureteral reimplantation, buccal or appendiceal mucosa graft ureteroplasty, appendiceal bypass graft, and ileal ureter interposition. When necessary, adjunctive procedures were performed for mobility (i.e., psoas hitch) and improved vascularity (i.e., omental wrap). Outcomes of surgery were determined by the absence of flank pain (clinical success) and absence of obstruction on imaging (radiological success). Results: A total of 32 patients with 35 ureteral units underwent RUR with a median stricture length of 2.5 cm (interquartile range [IQR] 2-5.5). End-to-end and side-to-side reimplantation techniques were performed in 21 (60.0%) and 8 (22.9%) RUR cases, respectively, while 4 (11.4%) underwent an appendiceal procedure. One patient (2.9%) required buccal mucosa graft ureteroplasty, while another needed an ileal ureter interposition. The median operative time was 215 minutes (IQR 177-281), estimated blood loss was 100 mL (IQR 50-150), and length of stay was 2 days (IQR 1-3). One patient required repair of a small bowel leak. Another patient died from a major cardiac event and was excluded from follow-up calculations. At a median follow-up of 13 months (IQR 9-22), 30 ureteral units (88.2%) were clinically and radiologically effective. Conclusion: RUR can be performed in patients with RIUSs with excellent outcomes. Surgeons must be prepared to perform adjunctive procedures for mobility and improved vascularity due to poor tissue quality. Repeat procedures for RIUSs heighten the risk of necrosis and failure.
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Affiliation(s)
- Aeen M Asghar
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Randall A Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Jeremy Slawin
- Department of Urology, New York University, Langone Medical Center, New York City, New York, USA
| | - Nathan Cheng
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Helaine Koster
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - David M Strauss
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Rohit Reddy
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Alice Drain
- Department of Urology, New York University, Langone Medical Center, New York City, New York, USA
| | - Tenzin Lama-Tamang
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Min S Jun
- Department of Urology, New York University, Langone Medical Center, New York City, New York, USA
| | - Michael J Metro
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Mutahar Ahmed
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Michael Stifelman
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Lee Zhao
- Department of Urology, New York University, Langone Medical Center, New York City, New York, USA
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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12
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Zattoni F, De Giorgi G, Kungulli A, Ferraioli G, Valotto C, Dal Moro F. Endourological management of uretero-ileal anastomosis stricture after cystectomy and Vescica Ileale Padovana (V.I.P.) orthotopic neobladder reconstruction. UROLOGY VIDEO JOURNAL 2019. [DOI: 10.1016/j.urolvj.2019.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Neulander EZ, Rivera I, Kaneti J, Wajsman Z. Ureterolysis with ureterotomy and omental sleeve wrap in patients with radiation induced pelvic retroperitoneal fibrosis. Cent European J Urol 2019; 72:307-311. [PMID: 31720035 PMCID: PMC6830484 DOI: 10.5173/ceju.2019.1965] [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: 05/31/2019] [Revised: 07/28/2019] [Accepted: 08/21/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction Secondary retroperitoneal fibrosis (RPF) due to pelvic radiation alone or together with pelvic surgery is one of the causes of obstructive renal failure. Ureteral obstruction is caused by ischemic stricture and encasement by fibrotic tissue. Endo-ureterotomy alone, without vascular supply, is not successful in these cases. Material and methods We present eleven cases of ureteral obstruction due to radiation and surgery induced RPF. Seven patients had radiation therapy with or without radical hysterectomy and three patients had anterior resection of the rectum with pre-emptive radiation and one patient had anal cancer treated with local excision and radiation therapy. Nine of the eleven patients had bilateral ureteral obstruction. Open ('intubated') stented ureterotomy and omental sleeve wrap was performed. In one patient, Boari flap ureteroneocystostomy was necessary. Results Of the eleven patients (twenty renal units) we succeeded in nine patients (eighteen renal units). In two patients with bilateral ureteral obstruction, we were able to reestablish ureteral patency in only one renal unit each. Conclusions Ureterolysis with ureterotomy and omental sleeve wrap is a valid surgical approach for alleviation of ureteral ischemic obstruction due to secondary retroperitoneal fibrosis caused by radiation alone or together with pelvic surgery.
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Affiliation(s)
- Endre Zoltan Neulander
- Ben Gurion University, Soroka University Medical Center, Department of Urology, Beer Sheva, Israel
| | - Inoel Rivera
- University of Florida, Department of Urology, USA
| | - Jacob Kaneti
- Ben Gurion University, Soroka University Medical Center, Department of Urology, Beer Sheva, Israel
| | - Zev Wajsman
- University of Florida, Department of Urology, USA
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14
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Lu C, Zhang W, Peng Y, Li L, Gao X, Liu M, Fang Z, Wang Z, Ming S, Dong H, Shen R, Xie F, Sun Y, Gao X. Endoscopic Balloon Dilatation in the Treatment of Benign Ureteral Strictures: A Meta-Analysis and Systematic Review. J Endourol 2019; 33:255-262. [PMID: 30628477 DOI: 10.1089/end.2018.0797] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Although balloon dilatation is one of the main endoscopic procedures used to treat benign ureteral strictures, its precise efficacy remains controversial. We aimed to identify, combine, and analyze existing published data to ascertain the efficacy of endoscopic balloon dilatation for benign ureteral strictures. METHODS In December 2018, a literature search was performed using Medline, Embase, and Web of Science databases. We included reports in which the study population consisted of patients who underwent endoscopic balloon dilatation for the treatment of benign ureteral strictures. Technical, short-term, and long-term success rates (expressed as mean ± standard error) were adopted as the outcome measures. RESULTS Using our search strategy, a total of 19 studies (all series reports) were included for analysis. Using a random-effects model, the pooled technical success rate of endoscopic balloon dilatation for benign ureteral strictures was found to be 89% ± 4%. Furthermore, the short-term success rate (i.e., 3 months after surgery) was 60% ± 10%, and the long-term success rate (i.e., 6-12 months after surgery) was 54% ± 14%. In the subgroup analysis, the success rate of endoscopic balloon dilatation for ≤2-cm benign ureteral strictures was significantly higher than that for >2-cm ones (odds ratio [OR]: 0.13; 95% confidence interval [CI]: 0.05-0.35). In addition, the success rate in cases with strictures of onset timing ≤3 months was relatively higher than that in cases with strictures of onset timing >3 months (OR: 0.46; 95% CI: 0.15-1.43). CONCLUSION Our study indicates that endoscopic balloon dilatation has a high success rate in the treatment of benign ureteral strictures with length ≤2 cm and onset timing ≤3 months. However, there is still no consensus on balloon type, dilatation pressure, expansion number, postoperative ureteral stent type, and stent retention time for the balloon dilatation technique.
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Affiliation(s)
- Chaoyue Lu
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wei Zhang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yonghan Peng
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ling Li
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiaomin Gao
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Min Liu
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ziyu Fang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zeyu Wang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shaoxiong Ming
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hao Dong
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rong Shen
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fei Xie
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiaofeng Gao
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
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15
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Almusafer M, Jawad Al-Tawri A. Complications of ureteroscopic stone lithotripsy: A multicentre local study. HAMDAN MEDICAL JOURNAL 2019. [DOI: 10.4103/hmj.hmj_73_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Reus C, Brehmer M. Minimally invasive management of ureteral strictures: a 5-year retrospective study. World J Urol 2018; 37:1733-1738. [PMID: 30377811 PMCID: PMC6684542 DOI: 10.1007/s00345-018-2539-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 10/20/2018] [Indexed: 02/06/2023] Open
Abstract
Introduction Ureteric strictures are well-documented complications related to surgery or radiation therapy. Minimally invasive treatment using endoscopic dilatation or laser incision is the standard practice. There are no existing guidelines on which techniques to use in the treatment of different stricture types and a paucity of data regarding long-term results. Purpose Our study aimed to retrospectively assess the long-term efficacy of minimally invasive treatment in benign and malignant ureteric strictures. Materials and methods Over a 5-year period, 2007–2012, we analyzed the data of 59 consecutive patients undergoing minimally invasive treatment for symptomatic ureteric strictures. We excluded 16 patients from final analysis due to failed access or loss to follow-up. All patients but one were treated with antegrade, retrograde balloon or catheter dilatations. Successful outcome was defined as an asymptomatic, completely catheter free patient, with stable renal function. Results 43 patients were eligible for retrospective final analysis. The largest proportion of strictures occurred following surgery combined with radiotherapy 8/43 (19%). Preoperative decompression was required in 30/43 (70%). We identified 32/43 (75%) balloon dilatations, 10/43 (23%) catheter dilatations and 1/43 (2%) laser incision. Overall success rate was 31/43 (72%). All 6 recurrences occurred within 36 months, 4 within the first 12 months. 3/6 patients were successfully re-dilated. Conclusion Minimally invasive treatment is a worthwhile alternative in strictures due to previous radiation and/or surgical treatment of malignancies. Most recurrences occurred within the first year. However, late recurrences arise; therefore, patients should be subject to long-term follow-up. Moreover, re-dilatation may be required.
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Affiliation(s)
- C Reus
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - M Brehmer
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
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17
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Meler E, Berent AC, Weisse C, Dunn M. Treatment of congenital distal ureteral orifice stenosis by endoscopic laser ablation in dogs: 16 cases (2010-2014). J Am Vet Med Assoc 2018; 253:452-462. [PMID: 30058968 DOI: 10.2460/javma.253.4.452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine characteristics of and outcomes for dogs with congenital distal ureteral orifice stenosis (CDUOS) treated by cystoscopic-guided laser ablation (CLA). DESIGN Retrospective case series. ANIMALS 16 client-owned dogs with CDUOS treated by CLA at 2 veterinary hospitals between 2010 and 2014. PROCEDURES Medical records were reviewed and data collected regarding clinical findings, imaging results, surgery characteristics, treatment, and outcome. Follow-up information was collected from dog owners and referring veterinarians via standardized interview. RESULTS Dogs included 10 males and 6 females; median age was 11.5 months (range, 4 to 112 months). Labrador Retriever (n = 6; 3 males) was the most common breed. Intramural ectopic ureteral openings were identified at the site of stenosis in 15 dogs (18/20 stenotic ureteral openings). Treatment with CLA to enlarge and relocate the stenotic opening was successful in all dogs. Median duration of anesthesia and hospitalization was 105 minutes and 24 hours, respectively. No complications were noted. Fourteen dogs remained alive (2 lost to follow-up) during a median follow-up period of 14.5 months. Owners of 11 of 13 dogs reported improvement in their dog's quality of life after CLA. The treated ureteral orifice remained patent in the 2 dogs that were reimaged. CONCLUSIONS AND CLINICAL RELEVANCE CDUOS should be considered as a differential diagnosis for dogs with idiopathic distal ureteral obstruction, particularly young male Labrador Retrievers, and was most often associated with an intramural ectopic ureter in this study. Treatment with CLA was safe and effective for opening the ureteral orifice.
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18
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Vasudevan VP, Johnson EU, Wong K, Iskander M, Javed S, Gupta N, McCabe JE, Kavoussi L. Contemporary management of ureteral strictures. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415818772218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ureteral stricture disease is a luminal narrowing of the ureter leading to functional obstruction of the kidney. Treatment of strictures is mandatory to preserve and protect renal function. In recent times, the surgical management of ureteral strictures has evolved from open repair to include laparoscopic, robotic and interventional techniques. Prompt diagnosis and early first line intervention to limit obstructive complications remains the cornerstone of successful treatment. In this article, we discuss minimally invasive, endo-urological and open approaches to the repair of ureteral strictures. Open surgical repair and endoscopic techniques have traditionally been employed with varying degrees of success. The advent of laparoscopic and robotic approaches has reduced morbidity, improved cosmesis and shortened recovery time, with results that are beginning to mirror and in some cases surpass more traditional approaches. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
| | | | - Kee Wong
- Whiston Hospital, Merseyside, UK
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19
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Lucas JW, Ghiraldi E, Ellis J, Friedlander JI. Endoscopic Management of Ureteral Strictures: an Update. Curr Urol Rep 2018; 19:24. [PMID: 29500521 DOI: 10.1007/s11934-018-0773-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW This review focuses on the role of endoscopic treatment of ureteral stricture disease (USD) in the era of minimally invasive surgery. RECENT FINDINGS There is a relative paucity of recent literature regarding the endoscopic treatment of USD. Laser endopyelotomy and balloon dilation are associated with good outcomes in treatment-naïve patients with short (< 2 cm), non-ischemic, benign ureteral strictures with a functional renal unit. If stricture recurs, repetitive dilation and laser endopyleotomy is not recommended, as success rates are low in this scenario. Patients with low-complexity ureteroenteric strictures and transplant strictures may benefit from endoscopic treatment options, although formal reconstruction offers higher rates of success. Formal ureteral reconstruction remains the gold-standard treatment for ureteral stricture disease as it is associated with higher rates of complete resolution. However, in carefully selected patients, endoscopic treatment modalities provide a low-cost, low-morbidity alternative.
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Affiliation(s)
- Jacob W Lucas
- Department of Urology, Einstein Healthcare Network, 1200 Tabor Road, 3rd Floor Sley Building, Philadelphia, PA, 19141, USA
| | - Eric Ghiraldi
- Department of Urology, Einstein Healthcare Network, 1200 Tabor Road, 3rd Floor Sley Building, Philadelphia, PA, 19141, USA
| | - Jeffrey Ellis
- Department of Urology, Einstein Healthcare Network, 1200 Tabor Road, 3rd Floor Sley Building, Philadelphia, PA, 19141, USA
| | - Justin I Friedlander
- Department of Urology, Einstein Healthcare Network, 1200 Tabor Road, 3rd Floor Sley Building, Philadelphia, PA, 19141, USA. .,Division of Urology and Urologic Oncology, Temple Health and the Fox Chase Cancer Center, Philadelphia, PA, USA.
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20
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Post-kidney Transplant Robot-assisted Laparoscopic Ureteral (Donor-receiver) Anastomosis for Kidney Graft Reflux or Stricture Disease. Urology 2017; 108:96-101. [DOI: 10.1016/j.urology.2017.05.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 11/21/2022]
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21
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Iqbal S, Raiz I, Faiz I. Bilateral Hydroureteronephrosis with a Hypertrophied, Trabeculated Urinary Bladder. Malays J Med Sci 2017; 24:106-115. [PMID: 28894411 DOI: 10.21315/mjms2017.24.2.14] [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] [Received: 06/12/2015] [Accepted: 08/02/2016] [Indexed: 10/19/2022] Open
Abstract
Bilateral hydroureteronephrosis involves the dilatation of the renal pelvis, calyces and ureter; it develops secondary to urinary tract obstruction and leads to a build-up of back pressure in the urinary tract, and it may lead to impairment of renal function and ultimately culminate in renal failure. Although clinically silent in most cases, it can be diagnosed as an incidental finding during evaluation of an unrelated cause. In a minority of patients, it presents with signs and symptoms. Renal calculus is the most common cause, but there are multiple non-calculus aetiologies, and they depend on age and sex. Pelviureteric junction obstruction, benign prostatic hypertrophy, urethral stricture, neurogenic bladder, retroperitoneal mass and bladder outlet obstruction are some of the frequent causes of hydroureteronephrosis in adults. The incidence of non-calculus hydronephrosis is more common in males than in females. Ultrasonography is the most important baseline investigation in the evaluation of patients with hydronephrosis. Here, we report a rarely seen case of bilateral hydroureteronephrosis associated with a hypertrophied, trabeculated bladder in an adult male cadaver, suspected to be due to a primary bladder neck obstruction, and analyse its various other causes, clinical presentations and outcomes.
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Affiliation(s)
- Showkathali Iqbal
- Amala Institute of Medical Sciences, Amala Nagar; Thrissur - 680555, Kerala, India
| | - Iqbal Raiz
- Government Medical College, Kozhikode, Kerala, India
| | - Iqbal Faiz
- Madras Medical College, Chennai, Tamil Nadu, India
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22
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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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Hung SC, Chiu KY, Cheng CL, Ou YC, Ho HC, Wang SS, Chen CS, Li JR, Yang CK, Chang LW. Ureteroscopy-Assisted Laparoscopic Segmental Resection of Ureteral Stricture with a Modified Flank Position: Clinical Experience. J Laparoendosc Adv Surg Tech A 2017; 27:691-695. [PMID: 28402160 DOI: 10.1089/lap.2016.0632] [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: 11/12/2022] Open
Abstract
PURPOSE To share the surgical technique that possesses the advantage of a perioperative ureteroscope without position change, which allows for a laparoscopic segmental resection of the ureteral stricture to be performed more precisely. PATIENTS AND METHODS Between 2006 January and 2015 December, 10 patients with a ureteral stricture received a laparoscopic segmental resection and ureteroureterostomy in our clinical institute. The etiology included stone, endometriosis, crossing vessel, and idiopathic benign ureteral polyp. With the advance of bilateral lower extremities extended and abducted, 1 assistant used a ureteroscope as a direct guide to the precise location of the stricture affected ureter. Thus, the surgeon was able to perform a more specific resection without an unnecessary excision, which may have compromised the blood supply or increased the tension at anastomosis. RESULTS Five patients received the traditional transperitoneal laparoscopic approach, whereas the other 5 patients received a ureteroscopy-assisted laparoscopic segmental resection and ureteroureterostomy. The operating time appears to be no different between the two groups (124 minutes versus 142 minutes, P = .351), and, thus, no additional time is consumed for the ureteroscope procedure. After at least 1 year of follow-up, only 1 patient in the traditional laparoscopic group suffered from recurrence. One patient had a right ureteral stricture due to stone impaction, where with the advantage of a ureteroscope guide without change position, the operator was able to make a limited excision at the affected location. No complications related to the decubitus and bilateral leg in the extended position were noted. CONCLUSIONS Ureteroscopy-assisted laparoscopic segmental resection of the ureter without a change in position is a feasible and safe procedure when dealing with a refractory ureter stricture. Although it is convenient, the surgeon should be aware of possible pressure sores at the dependent part.
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Affiliation(s)
- Sheng-Chun Hung
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Kun-Yuan Chiu
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Chen-Li Cheng
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Yen-Chuan Ou
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan .,2 Department of Research, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Hao-Chung Ho
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Shian-Shiang Wang
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Chuan-Shu Chen
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Jian-Ri Li
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Chun-Kuang Yang
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Li-Wen Chang
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
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Treacy PJ, Rastinehad AR, Imbert de la Phalecque L, Albano L, Durand M. Endoureteral Management of Renal Graft Ureteral Stenosis by the Use of Long-Term Metal Stent: An Appealing Treatment Option. J Endourol Case Rep 2016; 2:155-158. [PMID: 27704056 PMCID: PMC5035826 DOI: 10.1089/cren.2016.0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Ureteral stenosis is part of the common complications of renal graft reported in 3% to 7% of cases. Multiple treatments have been introduced regarding length and position of the stenosis. Metal stents for urologic purpose were created in 1998. Double percutaneous antegrade and transurethral retrograde access to a ureteral stenosis to a long-term metal stent procedure has been rarely described. Case Presentation: Here, we present a case of a ureteral stricture in a double ipsilateral kidney graft with a common ureter. A 67-year-old patient presented with obstructive nephritis associated with acute renal failure 6 years after a double renal graft with a uretero-ureteral end-to-side anastomosis. Abdominal CT scan showed double pelvic dilation. The patient underwent double percutaneous nephrostomies and antegrade pyelogram showed both renal pelvic and ureter dilations caused by a severe chronic ureteral stenosis at junction into the bladder. A Double-J ureteric stent was then inserted retrogradely over a guidewire as first-line treatment. Due to recurrent urinary tract infections (UTIs), removal and replacement of Double-J stents were carried out by placing a thermoexpandable metal stent Memokath® 051 (Bard, Pnn Medical) through the common ureter by a double antegrade and retrograde approach. Treatment was effective with a good renal function maintained after a 3-year follow-up without UTIs. Conclusion: Double antegrade and retrograde access to a long-term metal stent treatment can be seen as an alternative treatment to either endoscopy or open surgery. Further studies should be continued using larger series.
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Affiliation(s)
| | | | | | - Laetitia Albano
- Department of Kidney Transplantation, Hôpital Pasteur 2, Nice Sophia-Antipolis University , France
| | - Matthieu Durand
- Department of Urology, Hôpital Pasteur 2, Nice Sophia-Antipolis University, France.; Department of Urology, MSSM, New York City, New York.; INSERM, U1189, ONCO-THAI, Lille, France
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Abstract
Radical cystectomy and urinary diversion is the gold-standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer. Ureteroenteric anastomotic stricture is a well-known complication of urinary diversion and is associated with serious sequelae that lead to total or partial loss of kidney function, infectious complications, and the need for additional procedures. Although the exact aetiology of benign ureteroenteric anastomotic strictures is unclear, they most likely occur secondary to ischaemia at the anastomotic region. Diagnosis can be achieved using retrograde contrast studies, CT scan or MAG3 renography. Open revision remains the gold-standard treatment for ureteroenteric anastomotic strictures; however, endourological techniques are being increasingly used and, in select patients, might be the optimal approach.
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Abraham GP, Das K, Siddiaiah AT, Ramaswami K, George PD, Abraham JJ. Laparoscopic reconstruction of ureteral strictures involving solitary renal units-1 year and 5 year outcomes. J Minim Access Surg 2015; 11:236-40. [PMID: 26622112 PMCID: PMC4640021 DOI: 10.4103/0972-9941.144095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CONTEXT: Long-term outcome following a laparoscopic reconstruction of ureteral strictures (US) involving solitary renal units (SRU) are scarcely reported. AIMS: The aim was to report short-term (1 year) and long-term (5 years) outcomes following a laparoscopic reconstruction of US in a solitary kidney. SETTINGS AND DESIGN: Retrospective. MATERIALS AND METHODS: Records of patients operated for similar scenarios between January 2004 and January 2014 were evaluated. Clinical, biochemical and radiological profile were noted. Operative and post-operative profile were recorded. Follow-ups were scheduled at regular intervals (3 months post-procedure, 6 monthly for 2 years and yearly thereafter. Imaging was repeated at yearly intervals). Outcome was assessed by comparing pre-operative and post-operative clinical, biochemical, and radiological parameters. STATISTICAL ANALYSIS USED: SAS software 9.2 version. A P < 0.05 was inferred as statistically significant. RESULTS: Seven patients underwent a laparoscopic reconstruction. Stricture location was upper ureter (n = 1), mid ureter (n = 2), lower ureter (n = 4). Surgeries performed were ureteroureterostomy, Boari flap ureteroneocystostomy and ureteroneocystostomy with psoas hitch. Four patients reported prior contralateral nephrectomy. Three patients underwent prior endoscopic correction. Four patients presented with elevated serum creatinine (>1.4 mg/dl). Till last follow-up, improvement in symptomatology and improvement or stabilisation of serum creatinine was perceived in all. Ureteral patency with resolution of hydronephrosis was observed in five patients at 1 year follow-up. Two patients revealed ureteral patency with persistence of hydronephrosis. Clinical, biochemical and radiological outcomes were maintained till long-term follow-up. CONCLUSION: Laparoscopic reconstruction of US in SRU offers impressive short- and long-term outcome.
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Affiliation(s)
- George P Abraham
- Department of Urology, Lakeshore Hospital and PVS Memorial Hospital, Kochi, Kerala, India
| | - Krishanu Das
- Department of Urology, Lakeshore Hospital and PVS Memorial Hospital, Kochi, Kerala, India
| | - Avinash T Siddiaiah
- Department of Urology, Lakeshore Hospital and PVS Memorial Hospital, Kochi, Kerala, India
| | - Krishnamohan Ramaswami
- Department of Urology, Lakeshore Hospital and PVS Memorial Hospital, Kochi, Kerala, India
| | - P Datson George
- Department of Urology, Lakeshore Hospital and PVS Memorial Hospital, Kochi, Kerala, India
| | - Jisha J Abraham
- Department of Urology, Lakeshore Hospital and PVS Memorial Hospital, Kochi, Kerala, India
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Ibrahim HM, Mohyelden K, Abdel-Bary A, Al-Kandari AM. Single Versus Double Ureteral Stent Placement After Laser Endoureterotomy for the Management of Benign Ureteral Strictures: A Randomized Clinical Trial. J Endourol 2015; 29:1204-9. [PMID: 26102617 DOI: 10.1089/end.2015.0445] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Endoureterotomy is a viable option for treating patients with benign ureteral stricture. We compared the efficacy and safety of double versus single ureteral stent placement after laser endoureterotomy. PATIENTS AND METHODS This study included 55 patients with benign ureteral strictures; all patients underwent retrograde laser endoureterotomy. Patients were randomized either to single or double ureteral stents. Single stents were placed in 27 ureters while double stents were placed in 28 ureters. The stent diameter used was 7 F, and stents were indwelling for 8 weeks. Imaging was performed 1 month after stent removal and repeated regularly every 3 months. Clinical characteristics, operative results, and functional outcomes were compared for strictures managed in both groups. Success was evaluated both subjectively and objectively. RESULTS Fifty-five patients with a mean age of 46 (16-75) years had benign ureteral strictures; the mean stricture length was 1.92 (1-3) cm. The mean follow-up was 25.7 (9-42) months. The overall success rate was 67.3% (37 patients) with no radiologic evidence of obstruction, 6 (10.9%) patients showed symptomatic improvement while 12 (21.8%) patients underwent surgical reconstruction. Success was significantly higher for ureteral strictures (>1.5 cm) managed with double stent placement (82.4%), compared with single stent placement (38.9%) with a P value of 0.009. CONCLUSIONS Double stent placement of the ureter after laser endoureterotomy achieved a higher success rate compared with single stent placement in cases of benign ureteral strictures. Although ureteral strictures (≤1.5 cm) achieved better outcome after laser endoureterotomy, strictures (>1.5 cm) favored better with double stent versus single stent placement.
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Affiliation(s)
| | | | - Ahmed Abdel-Bary
- 2 Department of Urology, Beni-Suef University , Beni Suef, Egypt
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28
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Liourdi D, Kallidonis P, Kyriazis I, Tsamandas A, Karnabatidis D, Kitrou P, Spyroulias GA, Kostopoulou ON, Marousis K, Kalpaxis DL, Goumenos DS, Liatsikos E. Evaluation of the Distribution of Paclitaxel by Immunohistochemistry and Nuclear Magnetic Resonance Spectroscopy After the Application of a Drug-Eluting Balloon in the Porcine Ureter. J Endourol 2015; 29:580-9. [DOI: 10.1089/end.2014.0683] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Despoina Liourdi
- Department of Internal Medicine, General Hospital of Aeghio, Aeghio, Greece
| | | | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | | | | | | | | | | | - Kostas Marousis
- Department of Biochemistry, University of Patras, Patras, Greece
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29
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Duty BD, Kreshover JE, Richstone L, Kavoussi LR. Review of appendiceal onlay flap in the management of complex ureteric strictures in six patients. BJU Int 2015; 115:282-7. [PMID: 24471943 DOI: 10.1111/bju.12651] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate appendiceal onlay flap ureteroplasty for repairing complex right proximal and mid-ureteric strictures. PATIENTS AND METHODS Between August 2006 and August 2012 four women and two men (mean age 34.2 years) underwent right laparoscopic appendiceal onlay flap ureteroplasty. The mean stricture length was 2.5 cm. Stricture formation was secondary to impacted ureteric stones in three patients and failed pyeloplasty for congenital pelvi-ureteric junction obstruction in the remaining three. Each patient had ipsilateral flank pain before surgery. RESULTS The mean operating time, estimated blood loss and hospital stay were 244 min, 175 mL and 3.2 days, respectively. No intra- or peri-operative complications were noted. The objective success rate was 100% (all patients had radiographic and/or endoscopic resolution of their ureteric strictures). The subjective success rate was 66%, (two patients developed recurrent discomfort, which upon exploration was found to be attributable to fibrosis away from the appendiceal onlay graft, where the gonadal vessels crossed the ureter). Both patients with recurrent pain underwent laparoscopic ureterolysis and bladder advancement flap proximal to the appendiceal onlay, which markedly improved one patient's pain but the other patient continued to have discomfort, ultimately resulting in a laparoscopic nephroureterectomy. CONCLUSIONS Appendiceal onlay ureteroplasty is a viable treatment option for patients with complex right proximal and mid-ureteric strictures, while minimising the potential morbidity of appendiceal and ileal interposition.
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Affiliation(s)
- Brian D Duty
- Oregon Health and Science University, Portland, OR, USA
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30
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Tyritzis SI, Wiklund NP. Ureteral strictures revisited…trying to see the light at the end of the tunnel: a comprehensive review. J Endourol 2014; 29:124-36. [PMID: 25100183 DOI: 10.1089/end.2014.0522] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A ureteral stricture is a rather rare urological event defined as a narrowing of the ureter causing a functional obstruction and renal failure, if left untreated. The aim of this review article is to summarize and discuss current knowledge on the incidence, pathogenesis, management, and follow up of proximal, mid, and distal ureteral strictures.
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Affiliation(s)
- Stavros I Tyritzis
- 1 Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm, Sweden
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31
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Emiliani E, Breda A. Laser endoureterotomy and endopyelotomy: an update. World J Urol 2014; 33:583-7. [PMID: 25246158 DOI: 10.1007/s00345-014-1405-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Although minimally invasive approach is one of the first-line treatment choices for ureteral strictures, there are still controversies on the ideal method to treat this entity. The objective of this update was to define the level of evidence around endoscopic treatment of ureteropelvic junction (UPJ) and ureteral strictures. METHODS We reviewed the current available literature on the PubMed database from the last decade up to May 2014 on laser endoureterotomy and endopyelotomy. RESULTS The level of evidence for the endoscopic treatment of UPJ and ureteral strictures is low. Despite this, it appears that endoureterotomy and endopyelotomy performed mainly with Ho:YAG laser achieve good success rates with minimal perioperative morbidity. CONCLUSIONS Laser endoureterotomy and endopyelotomy should be considered a reasonable treatment option in selected patients.
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Affiliation(s)
- Esteban Emiliani
- Fundación Puigvert, Universitat Autonoma de Barcelona, Carrer Cartagena 340-350, 08025, Barcelona, Spain,
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Komninos C, Koo KC, Rha KH. Laparoendoscopic management of midureteral strictures. Korean J Urol 2014; 55:2-8. [PMID: 24466390 PMCID: PMC3897625 DOI: 10.4111/kju.2014.55.1.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022] Open
Abstract
The incidence of ureteral strictures has increased worldwide owing to the widespread use of laparoscopic and endourologic procedures. Midureteral strictures can be managed by either an endoscopic approach or surgical reconstruction, including open or minimally invasive (laparoscopic/robotic) techniques. Minimally invasive surgical ureteral reconstruction is gaining in popularity in the management of midureteral strictures. However, only a few studies have been published so far regarding the safety and efficacy of laparoscopic and robotic ureteral reconstruction procedures. Nevertheless, most of the studies have reported at least equivalent outcomes with the open approach. In general, strictures more than 2 cm, injury strictures, and strictures associated either with radiation or with reduced renal function of less than 25% may be managed more appropriately by minimally invasive surgical reconstruction, although the evidence to establish these recommendations is not yet adequate. Defects of 2 to 3 cm in length may be treated with laparoscopic or robot-assisted uretero-ureterostomy, whereas defects of 12 to 15 cm may be managed either via ureteral reimplantation with a Boari flap or via transuretero-ureterostomy in case of low bladder capacity. Cases with more extended defects can be reconstructed with the incorporation of the ileum in ureteral repair.
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Affiliation(s)
- Christos Komninos
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. ; Department of Urology, General Hospital of Nikaia 'St. Panteleimon', Athens, Greece
| | - Kyo Chul Koo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Shirazi M, Natami M, Hekmati P, Farsiani M. Result of endoureterotomy in the management of primary obstructive megaureter in the first year of life: preliminary report. J Endourol 2013; 28:79-83. [PMID: 23937376 DOI: 10.1089/end.2013.0098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The present study aimed to investigate the efficacy of endoureterotomy in patients who were less than 1-year-old with primary obstructive megaureter (POMU). PATIENTS AND METHODS Three of 10 patients with POMU aged between 2 and 12 months for whom conservative management was not applicable had recurrent urinary tract infection (UTI) and urosepsis, while the rest had decreased renal function. After obtaining the clinical history and performing physical examinations and imaging studies (ultrasonography, voiding cystourethrography (VCUG), radionuclide renal scan), the patients underwent endoureterotomy using a neonatal ureteroscope (4.5F) and Bugbee electrode with pure cutting current at the 6 o'clock position. A Double-J stent was inserted and removed 1 week later. This was followed by serial physical examination, renal function test, urine analysis, urine culture, and imaging studies in the 1st month and every 3 months after Double-J stent removal. RESULTS Hydroureteronephrosis was significantly decreased in nine patients. Postoperative VCUG revealed no sign of iatrogenic vesicoureteral reflux. In addition, a follow-up renal scan showed remarkable improvement in the renal function in the patients who had decreased renal function, except for one patient in whom uncontrolled urosepsis developed in the follow-up; the patient underwent cutaneous ureterostomy. No UTI was detected in the group who presented with recurrent UTI and urosepsis. CONCLUSION According to the results of our study, endoureterotomy may be an alternative in management of POMU. Of course, further studies with longer follow-up periods are needed to confirm the applicability of this method in patients younger than 1 year.
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Affiliation(s)
- Mehdi Shirazi
- Department of Urology, Shiraz Medical School , Shiraz, Fars, Iran
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34
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Shah HN, Badlani GH. Genitourinary Tuberculosis; An Update. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0197-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Soria F, Morcillo E, Pamplona M, Uson J, Sanchez-Margallo FM. Evaluation in an Animal Model of a Hybrid Covered Metallic Ureteral Stent: A New Design. Urology 2013; 81:458-63. [DOI: 10.1016/j.urology.2012.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/25/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022]
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Ballouhey Q, Thoulouzan M, Lunardi P, Bellec L, Huyghe E, Plante P, de Petriconi R, Soulié M. Étude prospective chez 100 patients des résultats de la technique d’anastomose urétéro-iléale en double cheminée dans la néovessie de Hautmann. Prog Urol 2012; 22:255-60. [DOI: 10.1016/j.purol.2011.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 10/29/2011] [Accepted: 11/13/2011] [Indexed: 11/30/2022]
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Bakari AA, Gadam IA, Aliyu S, Suleiman I, Ahidjo AA, Pindiga UH. Use of mitrofanoff and yang-monti techniques as ureteric substitution for severe schistosomal bilateral ureteric stricture: a case report and review of the literature. Niger J Surg 2012; 18:30-3. [PMID: 24027391 PMCID: PMC3716246 DOI: 10.4103/1117-6806.95490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Distal ureteric stricture is a common complication of urinary schistosomiasis which is a disease more prevalent in the tropics and subtropics. The surgical management of this complication is more challenging when it affects more than half of both ureters. We report the case of a 17-year-old Nigerian with a long standing recurrent painless terminal hematuria associated with bilateral colicky loin pains. Ultrasound scan showed bilateral hydro ureters and hydro nephrosis with deranged biochemical renal function. The patient had bilateral tube nephrostomy and antibiotic therapy. Definitive bilateral ureteric substitution was done using Mitrofanoff technique for the right ureter and Yang-Montie technique for the left ureter. The patient′s renal function became normal and he was discharged home without complication. The related literatures were reviewed. Surgical nonurothelial ureteral substitution is necessary for long, extensive, severe bilateral ureteric strictures so as to prevent progressive renal damage and end stage renal failure.
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Abstract
Retrograde exploration of the ureter and kidneys is currently a widely used and well-established procedure to deal with problems of a diagnostic and therapeutic nature with reduced invasiveness. The process of miniaturizing the instruments combined with the steady improvement in video quality has continuously amplified its potential applications, maintaining the procedure safe and rapid. During an operation, however, unexpected events may condition a change to the programme or determine the onset of even more serious complications. Our aim is to analyze such events and complications and recommend potential solutions to prevent and/or deal with such happenings.
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Affiliation(s)
- Alessandro D'Addessi
- Urology Department, Catholic University School of Medicine, Rome, Italy. adaddessi @ rm.unicatt.it
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39
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Soria F, Rioja LÁ, Morcillo E, Martin C, Pamplona M, Sánchez FM. New combined approach in metallic ureteral stenting to avoid urothelial hyperplasia: study in swine model. J Urol 2011; 185:1939-45. [PMID: 21421242 DOI: 10.1016/j.juro.2010.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE We assessed the therapeutic value of a new treatment option for ureteral strictures that may avoid urothelial hyperplasia, which is the main cause of metallic stent failure. MATERIALS AND METHODS We used 24 pigs in this study. An experimental model of ureteral stricture was induced in all animals. Obstruction was confirmed by ultrasound and retrograde ureteropyelogram 6 weeks after model creation. The pigs were then randomly allocated to 2 experimental groups. Therapy involved placement of a 6 × 30 mm metallic ureteral covered stent in the ureteral stricture in group 1 and subsequent endoureterotomy at the ureteral segments adjacent to the 2 ends of the stent in group 2. A double pigtail stent was then deployed for 3 weeks. Completion studies 6 months after therapy included retrograde ureteropyelogram, endoluminal ultrasound and ureteroscopy to assess urothelial hyperplasia formation. RESULTS At the end of the study evidence of urothelial hyperplasia was seen in 50% of the pigs in group 1 and in 29% in group 2. Four and 2 cases of cranial stent migration in groups 1 and 2, respectively, were seen at 6 months. Hyperplasia and renal involvement were statistically significantly different between the groups with more damage in group 1 than in group 2. CONCLUSIONS Hyperplasia was markedly reduced when ureteral peristalsis was inhibited by endoureterotomy at the area of interaction between the stent and the ureter.
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Affiliation(s)
- Federico Soria
- Endoscopy Department, Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain.
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40
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López Amaya JE, Mejía Restrepo J, Nicolau Molina C, Zuluaga Santamaría A, Mazzaro M. [The ureters: findings at multidetector computed tomography]. RADIOLOGIA 2010; 52:311-20; quiz 378-9. [PMID: 20627329 DOI: 10.1016/j.rx.2010.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 03/12/2010] [Accepted: 03/21/2010] [Indexed: 12/01/2022]
Abstract
Multidetector computed tomography (MDCT) and advances in CT urography techniques have enabled vast improvements in the depiction of the ureter. Studies of the ureter can find a wide variety of conditions including congenital defects and anatomic variants (anomalies in the origin, distribution, and distal insertion of the ureter) as well as all benign and malignant causes of focal and diffuse wall thickening (inflammatory and infectious processes, and neoplasms, as well as iatrogenic thickening and postsurgical changes). Other benign processes like ureteral kinking and stenosis due to extrinsic compression of the iliac vessels are also well characterized by MDCT. The aim of this article is to show the spectrum of ureteral variants and disease apart from common entities related to stones.
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Affiliation(s)
- J E López Amaya
- Sección Imagen Corporal, Centro Avanzado de Diagnóstico Médico (CEDIMED), Medellín, Colombia.
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López Amaya J, Mejía Restrepo J, Nicolau Molina C, Zuluaga Santamaría A, Mazzaro M. The ureters: Findings at multidetector computed tomography. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70019-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Holmium laser endoureterotomy for benign ureteral stricture: a single center experience. J Urol 2009; 182:2775-9. [PMID: 19837432 DOI: 10.1016/j.juro.2009.08.051] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE We assessed the long-term outcome of laser endoureterotomy for benign ureteral stricture. MATERIALS AND METHODS From a database of 69 patients who underwent retrograde laser endoureterotomy from October 2001 to June 2007 we identified 35 with a benign ureteral stricture. Clinical characteristics, operative results and functional outcomes were investigated. Success was defined as symptomatic improvement and radiographic resolution of obstruction. RESULTS Median followup was 27 months (range 10 to 72). All except 1 patient were followed at least 16 months. All patients completed clinical followup and 33 completed imaging. Of 35 patients 29 (82%) were symptom-free during followup and 26 of 33 (78.7%) were free of radiographic evidence of obstruction. All except 1 failure occurred within less than 9 months postoperatively. The success rate was higher for nonischemic strictures (100% vs 64.7%, p = 0.027) and tended to be higher for strictures 1 cm or less (89.4% vs 64.2%, p = 0.109). CONCLUSIONS Holmium laser endoureterotomy is effective for benign ureteral stricture in well selected patients. Most failures occur within less than 9 months after surgery, which may indicate a need for closer followup during postoperative year 1. Factors that might may outcome are ischemia and stricture length.
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Milhoua PM, Miller NL, Cookson MS, Chang SS, Smith JA, Herrell SD. Primary endoscopic management versus open revision of ureteroenteric anastomotic strictures after urinary diversion--single institution contemporary series. J Endourol 2009; 23:551-5. [PMID: 19193136 DOI: 10.1089/end.2008.0230] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To review our institutional experience in the management of ureteroenteric strictures by primary endoscopic intervention or primary open revision. PATIENTS AND METHODS Between January 2000 and December 2007, 28 patients with ureteroenteric strictures underwent endoscopic management (n = 21) or open revision (n = 7). Strictures were characterized with regard to length and side as well as time to failure between the two groups. Success was defined as symptomatic improvement and evidence of patency on follow-up radiologic imaging. RESULTS Of all study patients, 78.6% were symptomatic on presentation. Endoscopic intervention (balloon dilation, electroincision, or holmium endoureterotomy) was successful in six patients for an overall success rate of 27% with a median follow-up of 21 months. Open revision was successful in 87.5% (7 of 8) patients for whom initial endoscopic surgery had failed. The success rate of primary open revision was 71.4% (5 of 7 patients) with a mean follow-up of 18.1 months. For the entire series, left-sided strictures were more common than right sided strictures; however, side and stricture length were not found to be significant (P > 0.05) with regard to patency. Functional renal imaging studies were performed in 42.9% of all study patients postoperatively. CONCLUSIONS Endoscopic management continues to have success rates that remain lower than that of open revision. Left-sided strictures remain more common than right-sided strictures; however, side and stricture length were not found to be statistically significant in our series. The lack of consistent postoperative functional renal studies highlights the importance of diligent monitoring and warrants further study to develop a surveillance algorithm.
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Affiliation(s)
- Paul M Milhoua
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Arrabal-Martín M, Jiménez-Pacheco A, Arrabal-Polo MA, Guardia FVDDL, López-León V, Zuluaga-Gómez A. Cold cutting of ureteral stenosis with endoscopic scissors. Urology 2009; 74:422-6. [PMID: 19428079 DOI: 10.1016/j.urology.2008.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Revised: 10/22/2008] [Accepted: 11/23/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To study the procedure and results of cold cutting of ureteral stenosis with endoscopic scissors. Intrinsic or extrinsic ureteral stenosis can be congenital or acquired. Endoscopic dilation and incision is 1 potential option for ureteral intrinsic stenosis. METHODS During a 3-year period (2005-2007), a prospective study was performed of cold cutting of ureteral stenosis with endoscopic scissors in 17 consecutive patients (11 women and 6 men), aged 22-64 years. Of the 17 patients, 6 had been diagnosed with proximal ureteral stenosis, 3 with iliac ureteral stenosis, and 8 with pelvic ureteral stenosis. The procedure was performed with a semirigid 8.5Ch ureteroscope, catheterizing and dilation of the stenosis with a balloon catheter, cold cutting of the ureteral wall with scissors, including margins of healthy tissue at both ends of the stenosis, and a 6F double-J ureteral stent for 6 weeks. RESULTS The results were evaluated after 3 months with urography in 15 cases and diuretic renography in 2 cases. Analysis of the postoperative complications and urography was done at 12-24 months. Immediate success was obtained after the first endoscopic ureterotomy with scissors in 16 of 17 cases (94%). At 12-24 months, success was maintained in 88.5% of cases. CONCLUSIONS Cold cutting of ureteral stenosis with endoscopic scissors is a safe technique for the patient. This procedure could be a therapeutic option in cases of benign intrinsic ureteral stenosis of <15 mm.
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Affiliation(s)
- Miguel Arrabal-Martín
- Department of Urology, "San Cecilio" University Hospital, Granada, Andalucia, Spain.
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Jacobsen NEB. Overcoming the Stigma of Complications of Continent Cutaneous Diversion. Bladder Cancer 2009. [DOI: 10.1007/978-1-59745-417-9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dos Santos Abreu LDA, Tanaka M, de Abreu SC, Kawano PR, Yamamoto H, Otsuka RAP, Travassos MR, Amaro JL, Fugita OE. Laparoscopic management of iatrogenic lesions. J Endourol 2008; 22:1279-83. [PMID: 18484884 DOI: 10.1089/end.2008.0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To present our series of patients who underwent laparoscopic correction of iatrogenic lesions and a review of the literature. PATIENTS AND METHODS We evaluated 23 patients who underwent laparoscopic correction of iatrogenic lesions. Thirteen patients had open surgery, 6 had an endoscopic procedure, and 4 had a laparoscopic approach as the first surgical procedure. Vesicovaginal fistulas (VVF) developed in seven patients after open abdominal hysterectomies, and 1 patient presented with a VVF after ureterolithotripsy. A urethral cutaneous fistula developed in one patient after a laparoscopic resection of endometriosis nodules, and 1 patient presented with a ureterovaginal fistula after a perineoplasty. Three patients presented with encrusted ureteral stents after ureterolithotripsy. Ureteral stenosis developed in seven patients: three after open abdominal surgery, three after ureteroscopy, and one after pyeloplasty. One patient had a ureteral injury during laparoscopic partial nephrectomy, and two patients had bowel injuries after a tension-free vaginal tape procedure and a laparoscopic radical prostatectomy. RESULTS All patients underwent laparoscopic correction of the iatrogenic injuries. One patient had an early recurrence of a VVF, and one patient had a recurrence of a ureteral stenosis. There was one conversion to open surgery because of technical difficulties and one major bleeding event that necessitated blood transfusion. A lower limb compartmental syndrome developed in one patient. CONCLUSION Despite the small number of patients and different types of surgeries performed, laparoscopic management of iatrogenic lesions seems to be feasible and safe in experienced hands. Its precise role in the management of this stressful condition still needs to be determined.
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Endoscopic management of obstructive complications in ureterosigmoidostomy. Urology 2007; 70:1048-52. [PMID: 18158011 DOI: 10.1016/j.urology.2007.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 05/08/2007] [Accepted: 07/03/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Although rarely used today for supravesical urinary diversion, ureterosigmoidostomy remains useful in patients with bladder exstrophy. However, management of ureteral stricture and ureteral urolithiasis is challenging because of the lack of anatomic landmarks. METHODS We reviewed our prospectively collected database from 1994 to 2006 for all patients requiring surgical treatment for obstructive complications associated with ureterosigmoidostomy. RESULTS Our analysis revealed 3 patients (mean age 46 years; 2 men and 1 woman). All 3 patients had undergone ureterosigmoidostomy as a component of bladder exstrophy management. All patients presented with renal failure due to obstruction and required antegrade endoscopic management. Two patients had anastomotic strictures and one had obstructive urolithiasis. One patient in whom the stricture was judged to be chronic was treated with an endoureterotomy and Acucise balloon. The second patient, who had an acute obstruction after colonoscopic biopsy of his anastomosis, was treated with antegrade balloon dilation. Both patients had stents placed across the anastomosis for 6 weeks postoperatively. Despite reflux of stool into the collecting system, neither patient manifested with local or systemic signs of infection. The patient with urolithiasis required antegrade basket stone extraction. CONCLUSIONS Obstructive complications after ureterosigmoidostomy should be managed using antegrade endoscopic techniques.
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Koziak A, Salagierski M, Marcheluk A, Szcześniewski R, Sosnowski M. Early experience in reconstruction of long ureteral strictures with allogenic amniotic membrane. Int J Urol 2007; 14:607-10. [PMID: 17645603 DOI: 10.1111/j.1442-2042.2007.01781.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To present our experience with the application of human amniotic membrane for the reconstruction of extensive ureteral wall defects. METHODS Between 2003 and 2006, 11 patients underwent reconstructive surgery of the ureter. A human amniotic membrane allograft was used to supplement ureteral wall defects. Indications for the procedure included ureteral strictures of a 5.5 cm average (range, 3-8 cm) localized in different parts of the ureter: upper (5), middle (5) and lower (3). The etiology of ureteral loss was: postinflammatory after a complicated stone disease (5), iatrogenic (4) and idiopathic (2). Diagnosis of ureteral stricture was based on antegrade pyelography and excretory urography. Two patients had synchronous treatment for upper and middle ureteral stenosis. Treatment efficacy was assessed by excretory urography and ultrasound. RESULTS The mean hospitalization time was 11.9 days, mean operation time 128 min and with an average follow up of 25.2 months. Complications included: stricture recurrence (1) and symptomatic urinary tract infections (2). Excretory urography showed lack of obstruction and normal width of ureters. In one patient, residual hydronephrosis was present on ultrasound. CONCLUSIONS The described method seems to be a promising tool in the reconstruction of extensive ureteral strictures.
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Affiliation(s)
- Andrzej Koziak
- Urology Department, Specialized Regional Hospital in Siedlce, Siedlce, Poland
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de la Rosette JJMCH, Skrekas T, Segura JW. Handling and prevention of complications in stone basketing. Eur Urol 2006; 50:991-8; discussion 998-9. [PMID: 16530928 DOI: 10.1016/j.eururo.2006.02.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Accepted: 02/10/2006] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To review the incidence, risk factors, and treatment options of intraoperative and postoperative complications of stone basketing in urology with emphasis on certain principles that must be upheld to prevent those complications. METHODS A literature search was performed using the MEDLINE database on stone basketing between 1970 and 2005. RESULTS Iatrogenic trauma due to retrieval of a stone is well known but the exact incidence is difficult to ascertain. Rarely, stone basketing can cause major trauma to the ureter, such as avulsion or intussusception, requiring open or laparoscopic intervention for ureteral continuity restoration. Mucosal abrasion, ureteral perforation, and stricture formation have also been described as complications of stone basketing. Occasionally, the engaged or broken basket can provoke anxiety even for experienced urologists. Factors that increase the risk of complications, strategies for repair, and techniques for prevention are discussed extensively. CONCLUSION Infrequent, surgical misadventures during stone basketing can occur and must be treated appropriately. Careful attention to instrument selection and surgical techniques and awareness of risk factors and type and site of potential injury are essential to reduce these complications.
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Soria Gálvez F, Rioja Sanz LA, Blas Marín M, Durán Flores ME, Usón Gargallo J. [Endourologic treatment of ureteral strictures. Experimental comparative study]. Actas Urol Esp 2005; 29:296-304. [PMID: 15945257 DOI: 10.1016/s0210-4806(05)73243-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare efficacy and efficiency of two different endourological therapies for ureteral stricture, and to evaluate pathological reactions of the ureters following both endourological techniques. MATERIAL AND METHODS Ten pigs underwent experimental induction of ureteral stricture. Four weeks later, ureteral strictures were demonstrated by imaging techniques. Animals were divided in two groups, according to the received therapy: -Group I. (5 pigs), endoballoon rupture endoureterotomy. -Group II (5 pigs), Acucise balloon endoureterotomy. Ureteral stents were placed for 3 weeks following endoureterotomy. Animals were followed up four weeks after ureteral stents retrieval. RESULTS In all cases, ureteral stricture was proved four weeks after model induction. In one case from each group, it was needed a second balloon dilatation to achieve complete endoureterotomy. Leading to ureteral restenosis, stent migration occurred in one animal from group I. Success was achieved in 80% of cases from group I, and 100% of cases from group II. CONCLUSIONS Our results suggest that both endourological therapies are effective. Nevertheless, a higher efficiency was proved with Acucise endoureterotomy. Our pathological evidences do not support Davis's studies on ureteral healing following endoureterotomy.
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Affiliation(s)
- F Soria Gálvez
- Unidad de Endoscopia, Centro de Cirugía de Mínima Invasión, Cáceres
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