Symptomatic Distal Ureteral Stone in an Ileal Ureter: Treatment by Combined Supine Ureteroscopy and Mini Percutaneous Nephrolithotomy

Distal ureteral calculi in a patient with ileal conduit and urinary diversion treated via antegrade ureteroscopic lithotripsy: A case report

Ureteral calculi management in patients with urinary diversion is challenging for most urologists. The surgeon should consider the patient's diversion type, BMI, stone size and location, and his/her experience with the procedure. We report an 85-year-old ileal conduit diversion man presented with ureteral calculi and treated via antegrade ureteroscopic lithotripsy.

Endourological approach in patients with anatomical urinary tract challenges

Objective:

This article reports our experience managing neoplasms, stenosis and urolithiasis in patients with anatomical variations of the urinary system, using an endourological approach, either with an antegrade access or with combined access.

Patients and methods:

A retrospective review was performed using medical records of all patients who underwent percutaneous endourological treatment at our institution between 2014 and 2019. Those with such urinary anatomical variations were selected.

Results:

Out of 185 patients, 10 were identified. The study group included patients with urinary diversion, renal transplantation and congenital anomalies. Patients were divided into two sets, A and B, based on the presence or absence of urolithiasis, respectively. In set A, the median operative time was 213 minutes (standard deviation ( SD)=65.91 minutes). Only one patient had lithiasis in the first postoperative evaluation. Two patients had postoperative complications graded ⩾II in the Clavien–Dindo classification. Regarding set B, the median operation time was 75 minutes ( SD=66.89 minutes). Two patients had postoperative complications graded ⩾II in the Clavien–Dindo classification.

Conclusions:

Patients with anatomical tract challenges currently have a longer life expectancy and are therefore prone to urological complications in their unusual structures. Treatment of urological complications is essential, and minimal invasive procedures should be considered to resolve them and to reduce morbidity.

Level of evidence:

Not applicable.

Buccal ureteroplasty for recurrent extended strictures and obliterations of distal ureter

At the current stage of development of urology, selection of the surgical method for cases of severe obstructive diseases of the upper urinary system remains a challenge. This study aimed to explore the results of application of a buccal graft (BG) to remedy extended recurrent strictures and obliterations of the distal ureter. Seven patients with the mentioned diseases had undergone surgery: for six of them, the method of choice was complete BG ureteroplasty, one had onlay ureteroplasty. One intervention was laparoscopic, the remaining surgeries were open. The length of the replaced ureteral defect was 5–8 cm. In five cases, the flap was additionally vascularized with the iliac muscle, in one we used omentum tissue, in another — both the iliac muscle and the omentum. There were no fatalities registered, nor severe complications as per the Clavien–Dindo classification. The patients were followed-up for 4–18 months; as of today, no recurrence cases were identified. Control examinations showed complete patency of the neoureter and good vascularization of the BG. Thus, this method can be an option in cases disallowing distal ureter restoration with tissues of the patient's own urinary tract or segments of the gastrointestinal tract.

Treatment of urinary calculi after Yang-Monti ileal ureter reconstruction: a case report

BACKGROUND

The development of ureteral calculi after Yang-Monti ileal ureter reconstruction has not been reported. This study was performed to explore the safety and effectiveness of ureteroscopy combined with laser lithotripsy in the treatment of ipsilateral lower ureteral calculi and lower calyceal calculi after Yang-Monti ileal ureter reconstruction.

CASE PRESENTATION

A 48-year-old man was admitted to our hospital with ipsilateral distal ureteral calculi and ipsilateral lower calyceal calculi. One year prior to this admission, the patient had undergone Yang-Monti ileal ureter reconstruction due to long-segment ureteral stenosis. After conservative treatment failed, we used a rigid ureteroscope with a holmium laser to break up the distal ureteral calculi, and successfully removed the renal calculi with a digital flexible ureteroscope and basket extractor.

CONCLUSION

The successful outcome of the present case suggests that ureteroscopy combined with laser lithotripsy is a valuable option for the management of urinary calculi following Yang-Monti ileal ureter reconstruction.

Updates in endourological management of urolithiasis

Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy-assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.