Endourologic Management of an Iatrogenic Ureteral Avulsion Using a Thermoexpandable Nickel-Titanium Alloy Stent (Memokath 051)

Endourological management of mucosal ureteral avulsion: Case report

The ureteral avulsion is the most horrific complication of ureteroscopy. The traditional treatment of ureteral avulsion is open ureteral repair. However, mucosal avulsion is a new terminology that could be managed endoscopically. Herein, we present a patient with mucosal avulsion. This case was followed-up with imaging and there wasn't any evidence of ureteral stenosis. We believe that mucosal ureteral avulsion could be managed by endourology techniques in selected patients. However, pros and cons of this treatment option should be carefully discussed with patients and long term follow up is necessary in these group of patients.

•

The traditional treatment of ureteral avulsion is open ureteral repair.

•

Mucosal avulsion is a new terminology that we believe that mucosal ureteral avulsion could be managed by endourology techniques in selected patients.

•

Pros and cons of this treatment option should be carefully discussed with patients and long term follow up is necessary in these group of patients.

Management of ureteric avulsion during ureteroscopy: a systematic review and our experience

Background

Ureteric avulsion is a disastrous intraoperative complication that can happen to any urologist during a common endoscopic procedure like ureteroscopy. The aim of this study is to evaluate the various management options of ureteric avulsion during ureteroscopy and also report our relevant experience in this topic.

Results

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses of existing literature in English language was used in the period 1967–2019 with a literature search in PubMed, Cochrane Library and Google Scholar. Forty-three patients in twenty-three articles who had undergone management of ureteric avulsion during ureteroscopy were identified for review. There were 15 proximal, 19 two-point (“scabbard”) and 9 distal avulsions. All distal avulsions were managed successfully with ureteroneocystostomies or Boari flaps. Boari flaps and ureteropyelostomy with ureterovesicostomy were the common procedures used for proximal avulsions. Proximal avulsions had more varied outcomes with salvage rates of 86.9%. Procedures which incorporated the avulsed distal ureter for reconstruction had poor results.

Conclusion

Management of ureteric avulsion during ureteroscopy is a surgical challenge. While management of distal avulsions is straightforward in the form of ureteroneocystostomies and has uniformly good results in most hands, proximal avulsions need expertise in management and choosing ideal reconstruction, with variable results following reconstruction. Extended Boari flaps, ileal ureter and autotransplantation are good options for proximal avulsions. Reconstruction using the distal avascular ureter should be avoided for better long-term results.

Traditional Chinese medicine on treating ureteral calculi: A systematic review and meta-analysis protocol

BACKGROUND

Ureteral calculi generally refer to the temporary obstruction of the human body after the ureteral stenosis. When the ureteral stones are not discharged in time, they can grow in the original site, causing the patient to have corresponding clinical manifestations, such as: renal colic, hematuria, etc, when severe, can cause renal obstruction and hydronephrosis, seriously endangering the patient's health. Ureteral calculi usually occur in young and middle-aged people. The peak age of the disease is between 20 and 50 years old. It also occurs in the young and middle-aged labor force. The men incidence rate is 2 to 3 times that of women. Ureteral calculi is one of the current refractory diseases, and the effect after treatment with integrated Chinese and Western medicine is remarkable.

METHODS AND ANALYSIS

We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2018. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of ureteral.

ETHICS AND DISSEMINATION

This systematic review will evaluate the efficacy and safety of Traditional Chinese medicine for ureteral. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.Registration number: PROSPERO CRD42019137095.

Bladder Neck Contracture after Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia Treated with a Thermo-Expandable Metal Stent (Memokath® 045)

Bladder neck contracture following transurethral resection of the prostate is a rare but feared complication. Treatment is often challenging with significant recurrence rates. In this report, we present a complicated case treated with a simple procedure. A 75-year-old male developed urinary retention due to bladder neck contracture after transurethral resection of the prostate. He was initially treated with several transurethral incisions, but the obstruction recurred few months after each incision. At urethroscopy, the bladder neck was completely obstructed. Using both retrograde and antegrade endoscopy, it was possible to place a through-and-through guidewire, after which the length of the stricture could be measured. Subsequently, the stricture was slightly dilated, and a double-cone thermo-expandable metal stent (Memokath 045) could be placed. The correct position was monitored with antegrade and retrograde endoscopy, securing the proximal cone expanded above the stricture and the distal cone above the sphincter. The patient was discharged the same day with spontaneous voiding and minimal residual urine. Twenty-one months after stent placement, the patient still had no complaints of his urination. Thus, the double-cone thermo-expandable metal stent, Memokath 045, may be a durable option for treatment of complicated bladder neck contracture after TURP for benign prostatic hyperplasia.