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Cho EY, Chaudry AE, Puri D, Kim S, Viers BR, Witthaus M, Buckley JC. Outcomes of Robot-assisted Appendiceal Ureteroplasty From a Multi-institutional Experience. Urology 2024; 192:136-140. [PMID: 39069159 DOI: 10.1016/j.urology.2024.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To evaluate the viability of robot-assisted appendiceal ureteroplasty as an innovative surgical approach for the reconstruction of ureteral strictures in cases where traditional methods are unsuitable. METHODS We conducted a retrospective review of 14 patients who underwent robot-assisted appendiceal ureteroplasty for right-sided ureteral stricture disease at three academic centers between March 2018 and November 2022. Patients were selected based on stricture characteristics, tissue quality, and the need for tissue transfer techniques. Surgical outcomes, including stricture-free rates, renal function, and complication rates, were analyzed. RESULTS The median patient age was 63years, with a balanced gender distribution. The median stricture length was 4.75 cm. The majority of strictures were located in the proximal ureter (50%). Surgical approaches included appendiceal onlay flaps (71.4%) and interposition flaps (28.6%). The median operative time was 268 minutes, with an average estimated blood loss of 75 mL. Postoperatively, ureteral patency was achieved in 92.9% of patients. Two patients (14.3%) experienced urinary tract infections requiring readmission. There was no significant change in serum creatinine levels postoperatively. Hydronephrosis grade significantly improved following surgery (P = .025). CONCLUSION Robot-assisted appendiceal ureteroplasty is a safe and effective technique for managing ureteral strictures. It offers a high success rate with minimal complications, making it a valuable addition to the urologic surgeon's armamentarium for complex ureteral reconstructions.
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Affiliation(s)
- Eric Y Cho
- Department of Urology, University of California San Diego, San Diego, CA
| | - Ameen E Chaudry
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Dhruv Puri
- Department of Urology, University of California San Diego, San Diego, CA.
| | - Sunchin Kim
- Department of Urology, University of Arizona College of Medicine - Tucson, Tucson, AZ
| | | | | | - Jill C Buckley
- Department of Urology, University of California San Diego, San Diego, CA
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Xu MY, Song ZY, Liang CZ. Robot-assisted repair of ureteral stricture. J Robot Surg 2024; 18:354. [PMID: 39340614 PMCID: PMC11438720 DOI: 10.1007/s11701-024-01993-9] [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] [Received: 05/10/2024] [Accepted: 05/23/2024] [Indexed: 09/30/2024]
Abstract
As robot-assisted laparoscopic techniques continue to advance, becoming increasingly complex and refined, there has been significant progress in the minimally invasive treatment of ureteral strictures. This abstract aims to provide an overview and description of various surgical techniques that utilize robots for repairing ureteral strictures. We have summarized the progression of these surgical methods and highlighted the latest advancements in the procedures. When compared to open surgery, robot-assisted reconstruction techniques demonstrate superior functional outcomes, fewer postoperative complications, and a faster recovery in the treatment of ureteral strictures. This abstract aims to provide an overview and description of various surgical techniques utilizing robots to repair ureteral strictures. Robotic ureteral stricture correction has emerged as a valuable therapeutic option, particularly when endoscopic procedures are not feasible. Compared to traditional open surgery, robotic methods exhibit superior therapeutic effectiveness, fewer postoperative complications, and accelerated recovery. Reconstructive procedures such as reimplantation, psoas hitch, Boari flap, ureter-to-ureter anastomosis, appendix graft, buccal mucosa graft (BMG), ileal transplantation, or kidney autotransplantation can be performed depending on the extent and location of the stricture. Robotic surgical techniques also offer advantages, such as an expanded field of vision and the incorporation of supplementary technologies such as FireflyTM, indocyanine green (ICG), and near-infrared fluorescence (NIRF) imaging. However, further long-term, multicenter investigations are necessary to validate the positive findings reported in existing case series. Compared with open surgery, robot-assisted reconstruction techniques yield superior functional outcomes, fewer postoperative complications, and accelerated recovery for the treatment of ureteral strictures.
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Affiliation(s)
- Mu-Yang Xu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, People's Republic of China
- Institute of Urology, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Zheng-Yao Song
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, People's Republic of China
- Institute of Urology, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Chao-Zhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, People's Republic of China.
- Institute of Urology, Anhui Medical University, Hefei, Anhui, People's Republic of China.
- Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Hefei, Anhui, People's Republic of China.
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Chen S, Fan S, Yang K, Li Z, Gao W, Wang X, Li Z, Wang B, Huang C, Zhu H, Gu Y, Li X. Robotic appendiceal ureteric interposition or replacement: the surgical technique. BJU Int 2024. [PMID: 39225148 DOI: 10.1111/bju.16523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- Silu Chen
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Shubo Fan
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Kunlin Yang
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Zhihua Li
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Wenzhi Gao
- Department of Urology, Peking University First Hospital - Miyun Hospital, Beijing, China
| | - Xiang Wang
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Zhenyu Li
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Bing Wang
- Department of Urology, Peking University First Hospital - Miyun Hospital, Beijing, China
| | - Chen Huang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Yaming Gu
- Department of Urology, Peking University First Hospital - Miyun Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
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Trenti E, Palermo S, D'Elia C, Comploj E, Ladurner C, Gamper C, Pycha S, Palermo M, Pycha A. Treatment of long ureteric strictures with a free peritoneal graft: long-term results. Aktuelle Urol 2023. [PMID: 37023778 DOI: 10.1055/a-2058-7983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
ZIEL DER STUDIE Beschreibung einer neuen Technik zur Rekonstruktion von komplexen Ureterstrikturen unter Verwendung eines freien Peritoneallappens. MATERIAL UND METHODEN Zwischen 2006 und 2021 behandelten wir 11 Patienten mit langen komplexen Harnleiterstrikturen, die in 9 Fällen den mittleren- und in 2 Fällen den proximalen Harnleiter betrafen. Die Länge der Strikturen variierte von 3 bis 12 cm (Mittelwert 7 cm). In drei Fällen handelte es sich um eine retroperitoneale Fibrose nach einem gefäßchirurgischen Eingriff, in zwei Fällen um einen Morbus Ormond, in vier Fällen um eine ausgedehnte Resektion großer Harnleitertumoren, in drei Fällen um wiederholte endoskopische Eingriffe bei Harnsteinen und in einem Fall um eine viermal fehlgeschlagene Pyeloplastik. Der Harnleiter wurde längs gespalten, ein freier Peritoneallappen aus dem nahe gelegenen gesunden Bauchfell entnommen und nach Positionierung eines Harnleiterkatheters als Onlay-Patch mit einer fortlaufenden Naht an der verbleibenden Harnleiterplatte fixiert. Der Ureter wurde zuletzt mit Omentum gedeckt. ERGEBNISSE Die Nachbeobachtungszeit reichte von 12 bis 122 (Mittelwert 61,6) Monate. Sieben Patienten waren nach 12, 18, 60, 78, 98, 99 und 122 Monaten (Mittelwert 69,5 Monate) rezidivfrei, ohne Erweiterung des oberen Harntrakts und mit normaler Nierenfunktion. Bei vier Patienten kam es zu einem Rezidiv: Bei einem Patienten wurde das Rezidiv nach 60 Monaten ohne Symptome und mit leichter Hydronephrose festgestellt, ohne dass eine Operation erforderlich war. Bei einem Patienten mit Morbus Ormond trat das Rezidiv 6 Monate nach dem Eingriff symptomlos im distalen Teil des 10 cm langen Omlays auf. Es wurde eine Resektion des stenotischen Segments mit Psoas-Hitch durchgeführt. Bei den beiden anderen Patienten trat 3 und 6 Monate nach dem Eingriff eine Obstruktion unterhalb des rekonstruierten Segments mit Hydronephrose auf, ohne dass die Nierenfunktion beeinträchtigt war. Bei diesen Patienten wurde keine weitere Operation durchgeführt. Die Limitation dieser Studie besteht in der kleinen Studiengröße, die auf die strenge Indikationsstellung zurückzuführen ist. SCHLUSSFOLGERUNGEN Die beschriebene Technik ermöglicht den Erhalt der verbleibenden Gefäßversorgung des Harnleiters und stellt eine praktikable und nützliche Alternative zu Nephrektomie, Ileum-Ureter, Uretero-Uretero-Stomie und Autotransplantation in hochselektierten Fällen dar.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Armin Pycha
- Urology, Bolzano Hospital, Bolzano, Italy
- Faculty of Medicine, Sigmund Freud Private University Vienna, Wien, Austria
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Robotic versus laparoscopic ureteroplasty with a lingual mucosa graft for complex ureteral stricture. Int Urol Nephrol 2023; 55:597-604. [PMID: 36327006 DOI: 10.1007/s11255-022-03385-0] [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: 08/18/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Ureteroplasty with a lingual mucosa graft (LMG) for complex ureteral stricture was reported promising. We aimed to compare outcomes of robotic versus laparoscopic ureteroplasty using a LMG (RU-LMG vs. LU-LMG, respectively). METHODS From October 2018 to January 2021, 32 ureteroplasties using LMGs were performed by one experienced surgeon, including 16 robotic and laparoscopic procedures each. Patient demographics and peri-operative, post-operative, and follow-up data were prospectively collected and compared. RESULTS The robotic group had a higher rate of previous reconstruction than the laparoscopic group (62.50% vs. 18.75%; p = 0.012). The stricture length was significantly longer in the robotic group (4.8 ± 1.2 cm) than the laparoscopic group (3.7 ± 1.2 cm; p = 0.013). All procedures were completed successfully without open conversion. The operative time was shorter in the robotic group (192 ± 54 min) than the laparoscopic group (254 ± 46 min; p = 0.001). The robotic group had a shorter length of post-operative stay (6.1 ± 2.4 d vs. 8.9 ± 4.3 d; p = 0.033) but a higher hospital cost (76,801 ± 17,974 vs. 42,214 ± 15,757 RMB; p < 0.001) than the laparoscopic group. The mean follow-up time was 21 ± 7 months for the robotic group and 29 ± 9 months for the laparoscopic group respectively (p = 0.014). No difference was detected in the success rate (93.75% and 100%, respectively; p = 0.309) and complication rate (18.75% and 31.25%, respectively; p = 0.414) between the robotic and laparoscopic groups. CONCLUSION Both RU-LMG and LU-LMG are feasible, effective, and safe for repair of complex ureteral strictures. RU-LMG had a shorter operative time and a shorter length of post-operative stay but a higher hospital cost.
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Laparoscopic ureteroplasty with oral mucosal graft for ureteral stricture: Initial experience of eighteen patients. Asian J Surg 2023; 46:751-755. [PMID: 35835671 DOI: 10.1016/j.asjsur.2022.06.156] [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: 01/06/2022] [Revised: 06/12/2022] [Accepted: 06/30/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To investigate the feasibility and clinical efficacy of laparoscopic ureteroplasty with oral mucosal graft for ureteral stricture and describe the initial experience of eighteen operations. METHODS A retrospective analysis was performed on the clinical data of 18 patients who underwent laparoscopic ureteroplasty with oral mucosal graft for long segment or complex ureteral stricture admitted to the Second Affiliated Hospital of Anhui Medical University from July 2018 to June 2021. After the stricture ureter segment was freed during the operation, the ureteral stenosis segment was longitudinally cut. The required oral mucosa is removed according to the length of the stenosis. Oral mucosal grafts were harvested and placed in the ureter as an anterior onlay with omental wrapping. RESULTS Ureteral repair was performed laparoscopically in all cases, with no conversion to open surgery and no serious complications. The median length of ureteral stenosis was 3 cm (range, 2-7 cm), the mean operative time was 205.8 ± 33.4 min, indwelling time of the drainage tube was 4.9 ± 1.6 days, and the median length of postoperative stay was 7 days (range, 4-14 days). The double J tube was removed three to six weeks postoperatively. One of the eighteen patients had restenosis after surgery, and the other patients showed no deterioration of the severity of the obstructive uropathy after follow-up imaging examination. CONCLUSION Laparosopic ureteroplasty with oral mucosal graft is a simple, safe and efficient option for the treatment of ureteral stricture. Although the results of the initial experience are encouraging, a large cohort study with longer follow-up period is need to be done.
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Fan S, Han G, Li Z, Wang X, Li X, Xiong S, Li D, Zhang J, Meng C, Zhang P, Yang K, Li X, Zhou L. Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series. BMC Surg 2022; 22:435. [PMID: 36544120 PMCID: PMC9773509 DOI: 10.1186/s12893-022-01885-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Complete intracorporal robotic ileal ureteric replacement is challenging. We aimed to present the surgical technique of robotic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures. METHODS From March 2019 to March 2021, 18 patients underwent robotic ileal ureter replacement with extracorporeal ileal segment preparation by one experienced surgeon. The demographic, perioperative, and follow-up data were recorded. Success was defined as the resolution of the presenting symptom, a stable estimated glomerular filtration rate and unobstructive drainage on imaging examination. RESULTS All 18 surgeries were successfully completed without conversion. The median length of the intestinal tube used was 20 (12-30) cm. The median operative time was 248 (170-450) min, the median estimated blood loss was 50 (10-200) ml, and the median postoperative hospital stay was 7 (5-27) days. At a median follow-up of 16 (13-28) months, all patients were symptom-free. No or mild hydronephrosis was confirmed in 17 patients; 1 patient had moderate hydronephrosis without peristalsis of the ileal ureter. The renal function was stable in all patients. The overall success rate was 100%. Postoperative complications, including 4 cases of urinary infections (Grade I), 1 case of an incision hernia (Grade I), 4 cases of kidney stone formation (Grade I), 6 cases of metabolic acidosis (Grade I), 4 cases of incomplete ileus (Grade II), and 1 case of an incision infection (Grade IIIb). CONCLUSIONS Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation is safe, feasible, and effective for the treatment of long ureteral strictures, especially in high-volume tertiary referral centers with extensive robotic surgery experience capable of managing severe peri-operative complications.
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Affiliation(s)
- Shubo Fan
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - GuanPeng Han
- grid.11135.370000 0001 2256 9319Department 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
- grid.411472.50000 0004 1764 1621Nursing Department, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Xiang Wang
- grid.11135.370000 0001 2256 9319Department 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
- grid.11135.370000 0001 2256 9319Department 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
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Dan Li
- grid.411472.50000 0004 1764 1621Nursing Department, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Jun Zhang
- grid.411472.50000 0004 1764 1621Nursing Department, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Chang Meng
- grid.11135.370000 0001 2256 9319Department 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
- grid.414252.40000 0004 1761 8894Department of Urology, Emergency General Hospital, No. 29, Xibahenanli, Chaoyang District, Beijing, 100028 China
| | - Kunlin Yang
- grid.11135.370000 0001 2256 9319Department 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
- grid.11135.370000 0001 2256 9319Department 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
- grid.11135.370000 0001 2256 9319Department 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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[Trends in upper urinary tract reconstruction surgery over a decade based on a multi-center database]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54. [PMID: 35950394 PMCID: PMC9385503 DOI: 10.19723/j.issn.1671-167x.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To study the trend of surgical type, surgical procedure and etiological distribution of upper urinary tract repair in recent 10 years. METHODS The preoperative and perioperative variables and follow-up data of upper urinary tract reconstruction surgery in RECUTTER (Reconstruction of Urinary Tract: Technology, Epidemiology and Result) database from 2010 to 2021 were searched, collected and analyzed. The surgical type, surgical procedure, duration of hospitalization, time of operation, incidence of short-term complications, and proportion of the patients undergoing reoperations were compared between the two groups of 2010-2017 period and 2018-2021 period. RESULTS A total of 1 072 patients were included in the RECUTTER database. Congenital factors and iatrogenic injuries were the main causes of upper urinary tract repair. Among them, 129 (12.0%) patients had open operation, 403 (37.6%) patients had laparoscopic surgery, 322 (30.0%) patients had robot-assisted laparoscopic surgery and 218 (20.3%) patients had endourological procedure. In the last decade, the total number of surgeries showed a noticeable increasing annual trend and the proportion of robot-assisted laparoscopic surgery in 2018-2021 was significantly higher than that in 2010-2017 (P < 0.001). The 1 072 patients included 124 (11.6%) cases of ileal ureter replacements, 440 (41.1%) cases of pyeloplasty, 229 (21.4%) cases of balloon dilation, 109 (10.2%) cases of ureteral reimplantation, 49 (4.6%) cases of boari flap-Psoas hitch surgery, 60 (5.6%) cases of uretero-ureteral anastomosis, 61 (5.7%) cases of lingual mucosal onlay graft ureteroplasty or appendiceal onlay flap ureteroplasty. Pyeloplasty and balloon dilatation had been the main types of surgery, while the proportion of lingual mucosal onlay graft ureteroplasty plus appendiceal onlay flap ureteroplasty had increased significantly in recent years (P < 0.05). In addition, the time of operation was significantly increased (P < 0.05) after 2018, which was considered to be related to the sharp increase in the proportion of robot-assisted laparoscopic surgery. We found that minimally invasive surgery (endourological procedure and robot-assisted laparoscopic surgery) as an independent risk factor (P=0.050, OR=0.472) could reduce the incidence of short-term post-operative complications. CONCLUSION We have justified the value of the RECUTTER database, created by the Institute of Urology, Peking University in data support for clinical research work, and provided valuable experience for the construction of other multi-center databases at home and abroad. In recent 10 years, we have observed that, in upper urinary tract reconstruction surgery, the surgery type tends to be minimally invasive and the surgery procedure tends to be complicated, suggesting the superiority of robot-assisted laparoscopic surgery.
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Ogawa N, Imamura T, Minagawa T, Ogawa T, Ishizuka O. Autologous Bilayered Adipose-Derived Mesenchymal Cell-Gelatin Sheets Reconstruct Ureters in Rabbits. Tissue Eng Part A 2022; 28:855-866. [PMID: 35850515 DOI: 10.1089/ten.tea.2022.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Repair of ureteral defects or strictures due to disease or trauma is usually dependent upon surgery that often requires either reoperation or an alternative treatment. By taking advantage of tissue engineering and regenerative techniques, it may be possible to define new approaches to ureteral repair. In this study, we fabricated autologous bilayered adipose-derived mesenchymal cell (AMC)-gelatin sheets and transplanted them into rabbits to replace surgically excised ureteral segments. AMCs harvested from abdominal adipose tissues of female New Zealand White rabbits were cultured on collagen-coated dishes and labeled with PKH26, a red fluorescent dye, for later identification. Monolayers of the cultured PKH26-labeled AMCs were detached and applied to gelatin hydrogel sheets. Two gelatin sheets were then united with the AMC monolayers apposed together, forming a bilayered AMC-gelatin sheet. Following each partial ureterectomy, a bilayered autologous AMC-gelatin sheet was transplanted, joining the proximal and distal ends of the remaining the ureter (n=9). Control animals underwent the same procedure except that the transplant was achieved with a bilayered acellular-gelatin sheet (n=9). At 4 and 8 weeks after transplantation, the proximal regions of ureters treated with the control bilayered acellular-gelatin sheets exhibited flexures and dilations, which are not characteristic of unoperated ureters. In contrast, the bilayered AMC-gelatin sheet transplanted rabbits did not have ureteral flexures or dilations. About midway between the proximal and distal ends, both the control and experimental reconstructed ureteral walls had smooth muscle layers; however, those in the experimental reconstructed ureteral walls were significantly thicker and better organized than those in the control reconstructed ureteral walls. Some AMCs differentiated into smooth muscle marker-positive cells. The experimental ureteral walls contained smooth muscle cells derived from the PKH26-labeled AMCs and others that were derived through migration and differentiation of cells from the remaining proximal and distal ends of the original ureter. In addition, the lumina of the 8-week reconstructed ureteral tissues in experimental rabbits did not show histological strictures as seen in the control ureters. These results suggest that the bilayered AMC-gelatin sheets have the potential to replace defective tissues and/or reconstruct damaged ureters.
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Affiliation(s)
- Noriyuki Ogawa
- Shinshu University Graduate School of Medicine School of Medicine, 34808, Department of Urology, 3-1-1, Asahi, Matsumoto, Japan, 390-8621;
| | - Tetsuya Imamura
- Shinshu University Graduate School of Medicine School of Medicine, 34808, Department of Urology, Matsumoto, Nagano, Japan;
| | - Tomonori Minagawa
- Shinshu University Graduate School of Medicine School of Medicine, 34808, Department of Urology, Matsumoto, Nagano, Japan;
| | - Teruyuki Ogawa
- Shinshu University Graduate School of Medicine School of Medicine, 34808, Department of Urology, Matsumoto, Nagano, Japan;
| | - Osamu Ishizuka
- Shinshu University Graduate School of Medicine School of Medicine, 34808, Department of Urology, Matsumoto, Nagano, Japan;
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Yuan C, Li Z, Wang J, Zhang P, Meng C, Li D, Gao J, Guan H, Zhu W, Lu B, Zhang Z, Feng N, Yang K, Li X, Zhou L. Ileal ureteral replacement for the management of ureteral avulsion during ureteroscopic lithotripsy: a case series. BMC Surg 2022; 22:262. [PMID: 35799183 PMCID: PMC9264655 DOI: 10.1186/s12893-022-01690-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/14/2022] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION To describe our initial experience with ileal ureteral replacement (IUR) for the management of ureteral avulsion (UA) during ureteroscopic lithotripsy. METHODS Between September 2010 and April 2021, ten patients received ileal ureteral replacement for ureteral avulsion during ureteroscopic lithotripsy. Anterograde urography and computed tomography urography (CTU) were applied to evaluate the lesion. Follow-up was performed with magnetic resonance urography and renal ultrasound as well as clinical assessment of symptoms. We retrospectively analysed the clinical data of ten patients treated with ileal ureteral replacement for the treatment of ureteral avulsion. RESULTS Four patients underwent open ileal ureteral replacement, two underwent laparoscopic ileal ureteral replacement, and four underwent robotic-assisted ileal ureteral replacement. The mean operative time (OT) was 310 min (range 191-530). The mean estimated blood loss (EBL) was 193 mL (range 10-1000). The mean length of the ileal graft was 21 cm (range 12-25). The median postoperative hospital time was 13 days (range 7-19). All surgeries were effectively completed, and no case required open conversion in laparoscopic and robotic-assisted surgeries. There was no obvious hydronephrosis according to contrast-enhanced computed tomography 3-dimensional reconstruction images without serious complications or progressive hydronephrosis during a median follow-up duration of 51 months (range 5-131), and the success rate was 100%. CONCLUSIONS Our initial results and experience showed that ileal ureteral replacement for the management of ureteral avulsion during ureteroscopic lithotripsy is safe and feasible.
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Affiliation(s)
- Changwei Yuan
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Zhihua Li
- Department of Nursing, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, No. 29, Xibahenanli St, Chaoyang District, Beijing, 100028, China
| | - Chang Meng
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Dan Li
- Department of Nursing, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Jingjing Gao
- Department of Nursing, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Hua Guan
- Department of Nursing, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Weijie Zhu
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Boyu Lu
- Department of Urology, Panjin Liaohe Oilfield Gem Flower Hospital, No. 26, YingBin St, Xinglongtai District, Panjin, 124010, China
| | - Zhichao Zhang
- Department of Urology, Qinhuangdao Jungong Hospital, No. 15, YuFeng St, Haigang District, 066001, Qinhuangdao, China
| | - Ninghan Feng
- Department of Urology, Affiliated Wuxi No. 2 Hospital, Nanjing Medical University, No. 68, Zhongshan St, Liangxi District, Wuxi, 214001, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
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Gonzalez AN, Mishra K, Zhao LC. Buccal Mucosal Ureteroplasty for the Management of Ureteral Strictures: Patient Selection and Considerations. Res Rep Urol 2022; 14:135-140. [PMID: 35433528 PMCID: PMC9007613 DOI: 10.2147/rru.s291950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/19/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ashley N Gonzalez
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
- Correspondence: Ashley N Gonzalez, Email
| | - Kirtishri Mishra
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
- University Hospitals Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lee C Zhao
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
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12
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Li X, Qiao J, Xiong S, Wang J, Wang Q, Li Z, Guan H, Huang Y, Yang K, Li X, Zhou L. The surgical outcomes of reconstruction for the treatment of ureteral stricture after holmium laser lithotripsy: The comprehensive experience. Asian J Surg 2022; 45:2713-2718. [DOI: 10.1016/j.asjsur.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/17/2021] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
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Yang K, Fan S, Wang J, Yin L, Li Z, Xiong S, Han G, Meng C, Zhang P, Li X, Zhou L. Robotic-assisted Lingual Mucosal Graft Ureteroplasty for the Repair of Complex Ureteral Strictures: Technique Description and the Medium-term Outcome. Eur Urol 2022; 81:533-540. [PMID: 35101303 DOI: 10.1016/j.eururo.2022.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/07/2021] [Accepted: 01/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Robot-assisted autologous graft ureteroplasty provides another treatment option for complex ureteral strictures, circumventing ileal ureter or renal autotransplantation. OBJECTIVE To report the medium-term outcome of robotic ureteroplasty with a lingual mucosal graft (RU-LMG) for managing complex ureteral strictures. DESIGN, SETTING, AND PARTICIPANTS Between June 2019 and September 2020, 12 patients underwent RU-LMG. The perioperative variables were prospectively collected, and the outcomes were assessed. SURGICAL PROCEDURE After ureteral stricture dissection, the narrow segment was cut longitudinally, and a lingual mucosal graft (LMG) of the required length was harvested, followed by double-J stent placement and LMG ventral onlay anastomosis. If the diseased ureter required transection, posteriorly augmented ureteral anastomosis could be performed before LMG harvest. Finally, the anastomotic area was wrapped by the omental flap. MEASUREMENTS A descriptive statistical analysis was performed. The criteria for complete success included the absence of both clinical symptoms and obstruction on radiography. RESULTS AND LIMITATIONS Seven patients (58%) had a history of failed ureteral reconstruction. The mean (range) stricture length was 4.7 (3-6.5) cm, LMG length was 4.4 (3-7) cm, LMG width was 1.5 (1-2) cm, operative duration was 197.1 (130-346) min, estimated blood loss was 49.2 (10-200) ml, and the duration of postoperative hospitalization was 6 (4-14) d. No open conversions and intraoperative complications occurred. The median follow-up time was 15 mo (range: 13-27 mo). The overall success rate was 92% (11/12). CONCLUSIONS These medium-term follow-up results demonstrate that RU-LMG is a safe and feasible technique for repairing ureteral strictures. PATIENT SUMMARY Our study proves that robotic ureteroplasty with a lingual mucosal graft is a safe and feasible technique for ureteral reconstruction that can serve as another choice for managing long, complex ureteral strictures.
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Affiliation(s)
- Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Lu Yin
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Chang Meng
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, 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, Beijing, China; National Urological Cancer Center, Beijing, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
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Wang J, Fan S, Guan H, Xiong S, Zhang D, Huang B, Wang X, Zhu H, Li Z, Xiong G, Zhang Z, Yang K, Li X, Zhou L. Should ureteroscopy be performed for patients after ureteral reconstruction with autologous onlay flap/graft? Transl Androl Urol 2021; 10:3737-3744. [PMID: 34804817 PMCID: PMC8575567 DOI: 10.21037/tau-21-583] [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: 07/02/2021] [Accepted: 08/26/2021] [Indexed: 11/06/2022] Open
Abstract
Background To analyze the safety and clinical significance of performing ureteroscopy after ureteral reconstruction with autologous onlay/graft. To describe the ureteroscopic appearances of the appendiceal onlay flap and lingual mucosa graft. Methods Beginning in August 2018, we conducted a prospective cohort study of autologous onlay/graft techniques to repair ureteral strictures. The perioperative data of 42 patients who had undergone surgery more than 6 months prior were collected prospectively. During the postoperative follow-up, ureteroscopy was performed in 27 patients (64.3%) after surgery (group A), and ureteroscopy was not performed in the other 15 patients (35.7%) (group B). We carried out a comparative study of these two groups of patients. Analyses were conducted mainly on complications related to ureteroscopy and the success rate of ureteral reconstruction surgery. Results There were no significant differences in patient demographic data or the length of ureteral reconstruction between the two groups (P>0.05). For the ureteroscopy group, the median time from repair surgery to ureteroscopy was 3 (range, 2-7) months, there was no poor healing of the anastomosis, and the ureteral lumen of all patients was unobstructed. Some expected observations can be found in the ureteral lumen, such as mucosa edema, stones, follicles and granulation tissue. Among the 27 patients, one patient (3.7%) developed bleeding intraoperatively and 7 patients (25.9%) were found to have low-grade (Clavien-Dindo I and II) postoperative complications, including 5 cases of fever and 2 cases of bleeding. The mean follow-up times of patients in group A and group B were 16.7±6.4 and 19.0±10.1 months, respectively. The objective success (imaging showed hydronephrosis ease) rate of the two groups was 100%. The subjective success (symptom relief) rates of group A and group B were 96.3% and 100%, respectively. Conclusions Patients after autologous onlay flap/graft ureteroplasty do not need to undergo routine ureteroscopy unless there is aggravation of hydronephrosis or other indications for ureteroscopy, such as stones.
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Affiliation(s)
- Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Dengxiang Zhang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Bingwei Huang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Xiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Gengyan Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhongyuan Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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15
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O'Rourke TK, Gn M, Patel HV, Fakes C, Jones N, Cancian M, Elsamra SE. The Urologist and the Appendix: A Review of Appendiceal Use in Genitourinary Reconstructive Surgery. Urology 2021; 159:10-15. [PMID: 34695504 DOI: 10.1016/j.urology.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022]
Abstract
Recently, genitourinary reconstruction has experienced a renaissance. Over the past several years, there has been an expansion of the literature regarding the use of buccal mucosa for the repair of complex ureteral strictures and other pathologies. The appendix has been an available graft utilized for the repair of ureteral stricture disease and has been infrequently reported since the early 1900s. This review serves to highlight the use of the appendix for reconstruction in urology, particularly focusing on the anatomy and physiology of the appendix, historical use, and current applications, particularly in robotic upper tract reconstruction.
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Affiliation(s)
- Timothy K O'Rourke
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Martus Gn
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Hiren V Patel
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Christina Fakes
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nyasia Jones
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Madeline Cancian
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sammy E Elsamra
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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16
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Wang J, Zhang B, Fan J, Cheng S, Fan S, Yin L, Li Z, Guan H, Yang K, Li X. The application of the "omental wrapping" technique with autologous onlay flap/graft ureteroplasty for the management of long ureteral strictures. Transl Androl Urol 2021; 10:2871-2878. [PMID: 34430389 PMCID: PMC8350257 DOI: 10.21037/tau-21-305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022] Open
Abstract
Background To present our experience with the "omental wrapping" technique in laparoscopic and robotic ureteroplasty using onlay flaps or grafts for the management of long proximal or middle ureteral strictures. Methods This is a retrospective review of 25 patients with long proximal or middle ureteral strictures who underwent laparoscopic and robotic onlay flaps or grafts ureteroplasty using an omental flap to reinforce an anastomosis site between August 2018 and November 2019. Perioperative and follow-up data were collected. Results Sixteen laparoscopic procedures and nine robotic procedures were performed successfully. Sixteen patients underwent ureteroplasty with lingual mucosal graft (LMG), and nine patients with appendiceal onlay flap (AOF). The median stricture length was 4 cm (range, 2-6 cm). The mean operative time (OT) was 220.5±50.6 min, the estimated blood loss (EBL) was 66.0±38.9 mL, and the length of hospital stay (LHS) was 8.0±3.6 days. In the LMG group, four patients had tongue numbing and one had an oral ulcer, which relieved itself gradually without intervention. Two patients in the LMG group and four patients in the AOF group experienced urinary tract infection, and all responded well to antibiotic treatment. There were no complications attributed to "omental wrapping". The mean follow-up was 16.3±4.8 months. According to the standards regarding improvement in clinical symptoms, relief of obstruction radiologically and a stable estimate glomerular filtration rate, our surgical success rate was 100%. Conclusions The "omental wrapping" technique in laparoscopic and robotic onlay flaps or grafts ureteroplasty for long proximal or middle ureteral strictures is an efficient, safe, reproducible and simple technique.
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Affiliation(s)
- Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Baiyu Zhang
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Sida Cheng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Lu Yin
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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17
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Elbers JR, Rodríguez Socarrás M, Rivas JG, Autran AM, Esperto F, Tortolero L, Carrion DM, Sancha FG. Robotic Repair of Ureteral Strictures: Techniques and Review. Curr Urol Rep 2021; 22:39. [PMID: 34105032 DOI: 10.1007/s11934-021-01056-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW To provide an overview and description of the different surgical techniques for the robotic repair of ureteral strictures. RECENT FINDINGS The robotic repair of ureteral stenosis has emerged as a useful option for treating strictures unsuitable for endoscopic resolution with good results, lower morbidity, and faster recovery than open techniques. Depending on the stricture's length and location, the reconstructive options are reimplantation, psoas hitch, Boari flap, ureteroureterostomy, appendiceal onlay flap, buccal mucosa graft (BMG) ureteroplasty, ileal replacement, or renal autotransplantation. The robotic approach offers a magnified vision and the possibility of adding near-infrared fluorescence (NIRF) imaging, indocyanine green (ICG), and FireflyTM to facilitate the technique. Multicenter studies with extended follow-up still have to confirm the good results obtained in published case series. Robotic reconstructive techniques are useful for repairing ureteral strictures, obtaining good functional results with less morbidity and faster recovery than open procedures.
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Affiliation(s)
- Javier Reinoso Elbers
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| | - Moises Rodríguez Socarrás
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain.
| | - Juan Gómez Rivas
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| | - Ana Maria Autran
- Oficina de Investigacion CAU (Confederacion Americana de Urologia), Madrid, Argentina
| | | | | | - Diego M Carrion
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| | - Fernando Gómez Sancha
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
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Chu H, Cao Y, Deng Q. Laparoscopic approach for intermittent hydronephrosis caused by primary ureteral fibroepithelial polyps in children. WORLD JOURNAL OF PEDIATRIC SURGERY 2021; 4:e000243. [DOI: 10.1136/wjps-2020-000243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo summarize the diagnosis and treatment experience of children with intermittent hydronephrosis caused by ureteral fibroepithelial polyp (UFP).MethodsFrom 2017 to 2020, cases of hydronephrosis caused by ureteral polyp in Anhui Provincial Children’s Hospital were retrospectively enrolled for investigation. Demographic data, clinical manifestations, operation details, pathology and outcomes were collected from patients’ medical data for analysis.ResultsAll seven cases of UFP were boys, including six cases on the left side of the ureter and one case on the right side, at the median age of 7.1 years (3–14 years), with abdominal intermittent pain as the first symptom. All cases underwent laparoscopic pyeloureteroplasty. All the operations were completed successfully; postoperative pathology indicated the presence of primary UFP. Postoperative follow-ups of 1–30 months showed satisfactory recovery and relief from hydronephrosis.ConclusionsLaparoscopic pyeloureteroplasty or ureteroureterostomy is one of the optimal treatments for ureteral polyp at present. The surgical method should be determined according to the number of polyps, the length and the diameter of the affected ureter, and also the status of renal function of the patients.
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19
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Zhu W, Xiong S, Wu Y, Zhang D, Huang C, Hao H, Zhang L, Yang K, Zhang P, Zhu H, Li X, Zhou L. Indocyanine green fluorescence imaging for laparoscopic complex upper urinary tract reconstructions: a comparative study. Transl Androl Urol 2021; 10:1071-1079. [PMID: 33850742 PMCID: PMC8039610 DOI: 10.21037/tau-20-1261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background To describe our technique for using an intraureteral injection of indocyanine green (ICG) and visualization under near-infrared fluorescence (NIRF) to facilitate challenging upper urinary tract reconstructions (UUTRs) and to present the comparative outcomes. Methods We collected 36 patients who underwent laparoscopic UUTRs between April 2019 and March 2020, and we divided the patients into two groups based on the use of ICG (ICG group and non-ICG group). Demographic characteristics, perioperative outcomes, and functional outcomes were compared between the two groups. Results There were 18 cases in the ICG group and 18 cases in the non-ICG group, respectively. There were no differences in the baseline characteristics between the two groups. The intraoperative time to identification of the ureter (TIU; 20.9±11.7 vs. 30.0±14.6 min, P=0.03) and length of postoperative hospital stay (LPHS; 11.1±3.0 vs. 16.6±10.0 days, P=0.03) were significantly shorter in the ICG group. There was also a trend for lesser time for locating the stricture (43.0±27.9 vs. 55.4±18.6 min, P=0.14) and lower estimated blood loss (EBL) in the ICG group patients (88.3±75.4 vs. 91.7±46.2 mL, P=0.22). During the mean 3.8-month follow-up for the ICG group and the 6.2-month for the non-ICG group, there was a trend for more severe complications in the non-ICG group. Conclusions Visualizing intraureteral ICG under NIRF is useful in challenging UUTRs, allows for rapid ureteral identification and accurate real-time delineation of the ureteral stricture margins, and provides encouraging follow-up outcomes compared with those in the non-ICG group.
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Affiliation(s)
- Weijie Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Yucai Wu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Dengxiang Zhang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Chen Huang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
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Cheng S, Li X, Yang K, Xiong S, Li Z, Zhu H, Zhang P, Li X, Guan H, Li Z, Hao H, Zhang L, Li X, Zhou L. Modified Laparoscopic and Robotic Flap Pyeloplasty for Recurrent Ureteropelvic Junction Obstruction with a Long Proximal Ureteral Stricture: The "Wishbone" Anastomosis and the "Ureteral Plate" Technique. Urol Int 2021; 105:642-649. [PMID: 33567431 DOI: 10.1159/000512994] [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: 09/11/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of the study was to present our modified flap pyeloplasty techniques for recurrent ureteropelvic junction obstruction (UPJO) with a long proximal ureteral stricture and compare outcomes of laparoscopic and robotic procedures. MATERIALS AND METHODS Between March 2018 and January 2020, 21 patients underwent modified laparoscopic or robotic flap pyeloplasty for recurrent UPJO with a long proximal ureteral stricture. Our surgical modifications included the "wishbone" anastomosis and "ureteral plate" technique. Demographic, perioperative, and follow-up data were recorded and compared retrospectively between the groups. Success was defined as subjective pain alleviation and hydronephrosis improvement. RESULTS Thirteen modified laparoscopic flap pyeloplasty (mLFP) and 8 modified robotic flap pyeloplasty (mRFP) were performed successfully without conversion. mRFP tended to have shorter overall operative time (142.4 vs. 179.1 min, p = 0.122) and anastomosis time (43.1 vs. 61.0 min, p = 0.093) than mLFP. No difference was found in estimated blood loss (p = 0.723) and pararenal draining time (p = 0.175) between the groups. The mean postoperative hospital stay of mRFP was significantly shorter than that of mLFP (5.0 vs. 8.2 days, p = 0.015). No major complications occurred. During the mean follow-up of 17.9 months, the overall success rate was 90.5%, and there was no significant difference between 2 groups. CONCLUSIONS The modified flap pyeloplasty could be considered a practical and effective treatment option with a high success rate for recurrent UPJO with a long proximal ureteral stricture, and the robotic procedures showed advantages of higher efficiency and faster recovery.
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Affiliation(s)
- Sida Cheng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Ziao Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Xuechao Li
- Department of Urology, The Fifth Medical Center, Chinese People's Liberation Army General Hospital/People's Liberation Army Medical School, Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China,
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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21
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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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22
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Burns ZR, Sawyer KN, Selph JP. Appendiceal Interposition for Ureteral Stricture Disease: Technique and Surgical Outcomes. Urology 2020; 146:248-252. [PMID: 32961223 DOI: 10.1016/j.urology.2020.07.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To report our initial experience with ureteral appendiceal interposition (UAI) in a series of adult patients undergoing ureteral reconstruction for ureteral stricture. METHODS We retrospectively collected data of patients who underwent UAI for ureteral stricture disease from December 2015 to March of 2020. Success of surgery was defined as one that required no subsequent procedural intervention for recurrent ureteral stricture disease, or loss of kidney function. RESULTS Eleven patients underwent UAI for ureteral stricture. Etiologies for stricture disease included radiation exposure, nephrolithiasis, and iatrogenic injury. Median follow-up was 363 days. Three patients had Clavien-Dindo class III complications during their hospitalization. No patient required repeat intervention due to recurrent ureteral stricture disease. On imaging, 9 patients had no obstruction on Lasix renal scan postoperatively, or improvement in hydronephrosis on CT scan. Two patients with poor renal function preop continued to show poor function after surgery. CONCLUSION The use of the appendix is a safe and feasible option for ureteral reconstruction in appropriately selected adult patients when primary ureteral repair is not possible.
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Affiliation(s)
| | | | - John Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
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23
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Onlay Repair Technique for the Management of Ureteral Strictures: A Comprehensive Review. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6178286. [PMID: 32775430 PMCID: PMC7407031 DOI: 10.1155/2020/6178286] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 01/12/2023]
Abstract
Ureteroplasty using onlay grafts or flaps emerged as an innovative procedure for the management of proximal and midureteral strictures. Autologous grafts or flaps used commonly in ureteroplasty include the oral mucosae, bladder mucosae, ileal mucosae, and appendiceal mucosae. Oral mucosa grafts, especially buccal mucosa grafts (BMGs), have gained wide acceptance as a graft choice for ureteroplasty. The reported length of BMG ureteroplasty ranged from 1.5 to 11 cm with success rates of 71.4%-100%. However, several studies have demonstrated that ureteroplasty using lingual mucosa grafts yields better recipient site outcomes and fewer donor site complications than that using BMGs. In addition, there is no essential difference in the efficacy and complication rates of BMG ureteroplasty using an anterior approach or a posterior approach. Intestinal graft or flap ureteroplasty was also reported. And the reported length of ileal or appendiceal flap ureteroplasty ranged from 1 to 8 cm with success rates of 75%-100%. Moreover, the bladder mucosa, renal pelvis wall, and penile/preputial skin have also been reported to be used for ureteroplasty and have achieved satisfactory outcomes, but each graft or flap has unique advantages and potential problems. Tissue engineering-based ureteroplasty through the implantation of patched scaffolds, such as the small intestine submucosa, with or without cell seeding, has induced successful ureteral regeneration structurally close to that of the native ureter and has resulted in good functional outcomes in animal models.
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