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Ziewers S, Dotzauer R, Thomas A, Brandt MP, Haferkamp A, Frees S, Zugor V, Kajaia D, Labanaris A, Kouriefs C, Radu C, Radavoi D, Jinga V, Mirvald C, Sinescu I, Surcel C, Tsaur I. Robotic-assisted vs. open ureteral reimplantation: a multicentre comparison. World J Urol 2024; 42:194. [PMID: 38530438 DOI: 10.1007/s00345-024-04875-9] [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: 05/02/2023] [Accepted: 02/09/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE Open ureteral reimplantation is considered the standard surgical approach to treat distal ureteral strictures or injuries. These procedures are increasingly performed in a minimally invasive and robotic-assisted manner. Notably, no series comparing perioperative outcomes and safety of the open vs. robotic approach are available so far. METHODS In this retrospective multi-center study, we compared data from 51 robotic ureteral reimplantations (RUR) with 79 open ureteral reimplantations (OUR). Both cohorts were comparatively assessed using different baseline characteristics and perioperative outcomes. Moreover, a multivariate logistic regression for independent predictors was performed. RESULTS Surgery time, length of hospital stay and dwell time of bladder catheter were shorter in the robotic cohort, whereas estimated blood loss, postoperative blood transfusion rate and postoperative complications were lower than in the open cohort. In the multivariate linear regression analysis, robotic approach was an independent predictor for a shorter operation time (coefficient - 0.254, 95% confidence interval [CI] - 0.342 to - 0.166; p < 0.001), a lower estimated blood loss (coefficient - 0.390, 95% CI - 0.549 to - 0.231, p < 0.001) and a shorter length of hospital stay (coefficient - 0.455, 95% CI - 0.552 to - 0.358, p < 0.001). Moreover, robotic surgery was an independent predictor for a shorter dwell time of bladder catheter (coefficient - 0.210, 95% CI - 0.278 to - 0.142, p < 0.001). CONCLUSION RUR represents a safe alternative to OUR, with a shorter operative time, decreased blood loss and length of hospital stay. Prospective research are needed to further define the extent of the advantages of the robotic approach over open surgery.
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Affiliation(s)
- Stefanie Ziewers
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Maximilian P Brandt
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sebastian Frees
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Vahudin Zugor
- Clinic for Urology, Pediatric Urology and Robot-Assisted Minimally Invasive Urology, Clinical Center Bamberg, Bamberg, Germany
| | - David Kajaia
- Clinic for Urology, Pediatric Urology and Robot-Assisted Minimally Invasive Urology, Clinical Center Bamberg, Bamberg, Germany
| | | | | | - Cosmin Radu
- "Prof. Dr. Theodor Burghele" Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Daniel Radavoi
- "Prof. Dr. Theodor Burghele" Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Viorel Jinga
- "Prof. Dr. Theodor Burghele" Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Cristian Mirvald
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Ioanel Sinescu
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Cristian Surcel
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Igor Tsaur
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
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John J, Bhana K, Lazarus J, Kesner K. Pseudodiverticulum: A rare late complication of the Boari flap procedure for lower ureteric repair. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/2051415820964977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Boari bladder flap is a vital tool in the armamentarium of the urologist. It is used to maintain continuity of the urinary system when dealing with diseased segments of the mid and lower ureter. It is, however, associated with long-term complications. We present the case of a 46-year-old woman who developed a rare pseudodiverticulum as a consequence of the procedure. This patient had undergone a right-sided laparoscopic Boari bladder flap for a right distal ureteric stricture secondary to pelvic endometriosis, and presented 10 years later at our urology department with long-standing irritative voiding symptoms and a feeling of incomplete voiding. Radiological and endoscopic investigation revealed the presence of a capacious pseudodiverticulum which was seen on ultrasound to retain a significant amount of urine post micturition and then to empty back into her bladder, strongly suggesting that this was the cause of her sensation of incomplete bladder emptying. She had minimal symptom bother and no recurrent urinary tract infections, calculi or tumour, and it was decided that no further operative management was necessary and that her condition could be managed her conservatively. To the best of our knowledge, this is only the second case describing this rare, long-term complication of a Boari flap. Level of evidence: Level 5.
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Affiliation(s)
- Jeff John
- Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, South Africa
| | - Kerisha Bhana
- Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, South Africa
| | - John Lazarus
- Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, South Africa
| | - Ken Kesner
- Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, South Africa
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Groen VH, Lock MTWT, Angst IB, Verhagen PCMS, Horenblas S, Dik P, Bosch JLHR. Psoas hitch procedure in 166 adult patients: The largest cohort study before the laparoscopic era. BJUI COMPASS 2021; 2:331-337. [PMID: 35474876 PMCID: PMC8988742 DOI: 10.1002/bco2.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 01/12/2023] Open
Affiliation(s)
- V. H. Groen
- Department of Urology University Medical Centre Utrecht Utrecht The Netherlands
| | - M. T. W. T. Lock
- Department of Urology University Medical Centre Utrecht Utrecht The Netherlands
| | - I. B. Angst
- Department of Urology Erasmus University Medical Centre Rotterdam Rotterdam The Netherlands
| | - P. C. M. S. Verhagen
- Department of Urology Erasmus University Medical Centre Rotterdam Rotterdam The Netherlands
| | - S. Horenblas
- Department of Urology The Netherlands Cancer Institute Amsterdam The Netherlands
| | - P. Dik
- Department of Pediatric Urology University Medical Centre Utrecht Utrecht The Netherlands
- Department of Pediatric Urology Sechenov University Moscow Russia
| | - J. L. H. R. Bosch
- Department of Urology University Medical Centre Utrecht Utrecht The Netherlands
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Adamowicz J, Kuffel B, Van Breda SV, Pokrwczynska M, Drewa T. Reconstructive urology and tissue engineering: Converging developmental paths. J Tissue Eng Regen Med 2019; 13:522-533. [DOI: 10.1002/term.2812] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/23/2018] [Accepted: 12/17/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Jan Adamowicz
- Chair of Urology, Department of Regenerative MedicineCollegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
| | - Blazej Kuffel
- Chair of Urology, Department of Regenerative MedicineCollegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
| | | | - Marta Pokrwczynska
- Chair of Urology, Department of Regenerative MedicineCollegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
| | - Tomasz Drewa
- Chair of Urology, Department of Regenerative MedicineCollegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
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Ota Y, Andou M, Ota I. Laparoscopic surgery with urinary tract reconstruction and bowel endometriosis resection for deep infiltrating endometriosis. Asian J Endosc Surg 2018; 11:7-14. [PMID: 29444547 DOI: 10.1111/ases.12464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/10/2018] [Indexed: 01/11/2023]
Abstract
Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis. It causes chronic pelvic pain, severe dysmenorrhea, deep dyspareunia, dyschezia, and dysuria, markedly impairing the quality of life of women of reproductive age. A number of randomized controlled trials on surgical and medical treatments to reduce the pain associated with endometriosis have been reported, but few have focused on this in DIE. DIE causes not only pain but also functional invasion to the urinary organs and bowel, such as hydronephrosis and bowel stenosis. In addition to DIE resection, surgical treatment involves adhesion separation as well as resection and reconstruction of the urinary organs and bowel; high-level skills are required. The severity of DIE should be evaluated preoperatively as accurately as possible. Using ENZIAN in conjunction with the AFS (The revised American Fertility Society classification of endometriosis) classification makes a more detailed assessment of DIE possible. The operative procedures used for laparoscopic resection of urinary DIE and reconstruction of the urinary organs are chosen based on the type of lesion (intrinsic/extrinsic) and length of stenosis. In addition to ureteroneocystostomy, the psoas bladder hitch and Boari bladder flap procedures are applied when necessary to extend the urinary tract. Bowel resection for bowel endometriosis is classified into classic segmental resection and conservative approaches (shaving/discoid). When these procedures are employed, it is advisable to work in consultation with urologists and gastroenterologists and to inform the patients of the associated risks and outcomes. Furthermore, postoperative medication is essential because it is difficult to conduct repeated surgeries.
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Affiliation(s)
| | | | - Ikuko Ota
- Kurashiki Heisei Hospital, Kurashiki, Japan
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Zhong W, Du Y, Yang K, Meng S, Lin R, Li X, Zhuang L, Cai L, Cui H, He Z, Zhou L. Ileal Ureter Replacement Combined With Boari Flap-Psoas Hitch to Treat Full-Length Ureteral Defects: Technique and Initial Experience. Urology 2017; 108:201-206. [PMID: 28739403 DOI: 10.1016/j.urology.2017.07.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/17/2017] [Accepted: 07/11/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the feasibility of ileal ureter replacement combined with Boari flap-psoas hitch procedure for the management of full-length ureteral defects (>20 cm). METHODS Three patients diagnosed with full-length ureteral defect were treated with our technique performed by a single surgeon between January 2015 to January 2016. All the patients had borderline renal function preoperatively. In each case, the ureteral reconstruction was performed by combining ileal ureter replacement with Boari flap-psoas hitch. Data on indications for surgery, intraoperative and postoperative outcomes, and changes in renal function were collected. RESULTS Surgery was performed successfully with an operation duration between 210 and 250 minutes. The mean estimated blood loss was 230 mL. The mean length of hospital stay was 11 days, and no major complications (grade ≥3) occurred. Postoperative follow-up showed radiological resolution of hydronephrosis and improved renal function in all 3 patients. CONCLUSION Ileal ureter replacement combined with Boari flap-psoas hitch is a feasible option for bridging full-length ureteral defects. This technique minimizes the length of ileal graft required as well as limitations concerning patient selection. Larger series with longer follow-up to confirm the value of the technique are warranted.
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Affiliation(s)
- Wenlong Zhong
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Yicong Du
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Steven Meng
- Department of Urology, Children's Hospital Boston, Boston
| | - Rongcheng Lin
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, 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.
| | - Liyan Zhuang
- Department of Urology, Tufts Medical Center, Boston
| | - Lin Cai
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Haoran Cui
- Peking University Health Science Center, Beijing, China
| | - Zhisong He
- 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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Radtke JP, Korzeniewski N, Huber J, Alt CD, Pahernik S, Hadaschik BA, Hohenfellner M, Teber D. Ureterocystoneostomy in complex oncological cases with an “Uebelhoer” modified Boari bladder flap. Langenbecks Arch Surg 2017; 402:1271-1278. [DOI: 10.1007/s00423-017-1554-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/05/2017] [Indexed: 11/25/2022]
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8
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Packiam VT, Cohen AJ, Nottingham CU, Pariser JJ, Faris SF, Bales GT. Open Vs Minimally Invasive Adult Ureteral Reimplantation: Analysis of 30-day Outcomes in the National Surgical Quality Improvement Program (NSQIP) Database. Urology 2016; 94:123-8. [DOI: 10.1016/j.urology.2016.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/09/2016] [Accepted: 05/12/2016] [Indexed: 11/28/2022]
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9
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Functional Outcomes of Bladder Reconstruction Secondary to Trauma and Ureteral Injury. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Gambachidze D, Phé V, Drouin SJ, Wolff B, Parra J, Mozer P, Renard-Penna R, Chartier-Kastler E, Rouprêt M. [Functional outcomes obtained after vesicoureteral reimplantation surgery in adults: A review]. Prog Urol 2015; 25:683-91. [PMID: 26184044 DOI: 10.1016/j.purol.2015.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 05/31/2015] [Accepted: 06/12/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Vesico-ureteral reimplantations (VUR) for adults are complex procedures, often practicing for distal ureteral lesions. Our goal was to synthesis the main indications for VUR, different techniques and their functional outcomes. MATERIAL AND METHODS A literature review in English by Medline, Embase and Google scholar was performed using the following keywords: ureter; laparoscopy; robotics, reimplantation; surgery; obstruction; morbidity; complications; psoas hitch; Boari flap; ureteroneocystostomy. RESULTS In more than half of the cases, aetiology was a iatrogenic ureteral lesion. When the ureteral defect was less than 2 cm, direct or non-refluxing VUR was the technique of choice. If defect was superior than 2 cm the Boari flap or vesicopsoas hitch were preferred. Several surgical approaches were feasible: open, laparoscopic only, robot assisted laparoscopic. Estimated blood loss, pain and mean hospital stay seemed better with conventional or robotic coelioscopy. Nevertheless, complications, pre-/post-operative renal function and mean operative time seemed similar. The most frequent major complication was the anastomotic urine leakage. CONCLUSIONS The VUR techniques are well codified now even if it's a rare procedure. Functional outcomes are satisfied according to literature and morbidity is more and more decreasing but the level of evidence of the studies is low.
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Affiliation(s)
- D Gambachidze
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - V Phé
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S J Drouin
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - B Wolff
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Parra
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Mozer
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - R Renard-Penna
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - E Chartier-Kastler
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Rouprêt
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Chen CL, Tang SH, Cha TL, Meng E, Tsao CW, Sun GH, Yu DS, Chang SY, Wu ST. Combined Y-shaped common channel transureteroureterostomy with Boari flap to treat bilateral long-segment ureteral strictures. BMC Res Notes 2014; 7:550. [PMID: 25138268 PMCID: PMC4150947 DOI: 10.1186/1756-0500-7-550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 08/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ureteral stricture is a complication of several etiologies including idiopathic retroperitoneal fibrosis, infection, radiotherapy, instrumentation, and surgical procedures. A variety of techniques have been reported for management. The transureteroureterostomy and bladder flap have been the standard procedures for repairing distal ureteral defects of unilateral ureter. Bilateral ureteral stricture is an uncommon condition that challenges usual reconstructive procedures. It is a difficult task to reconstruct the complex situation of bilateral ureteral strictures. CASE PRESENTATION A 54-year-old female underwent concurrent chemoradiotherapy for stage IVB squamous cell carcinoma of cervix. Subsequently, she had stricture of bilateral distal ureters with bilateral hydroureteronephrosis which was found by computed tomography. The renal function deteriorated during the follow-up period. She had periodic change of double-J stents and percutaneous nephrostomy. However, the renal function still deteriorated. We performed a combined Y-shaped common channel transureteroureterostomy with Boari flap to reconstruct bilateral long-segment ureteral strictures. The patient recovered uneventfully. CONCLUSION Reconstruction of bilateral ureteral strictures is a difficult treatment. We developed a modified technique for the complex situation of bilateral ureteral strictures. To our knowledge, this has not been previously reported in the scientific literature and it is a feasible procedure to treat bilateral long-segment ureteral strictures.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sheng-Tang Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No,325, Section 2, Cheng-Kung Road, Taipei 114, Taiwan.
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Lazica DA, Brandt AS, Roth S. [Avoidance and management of complications in open surgical ureter reconstruction]. Urologe A 2014; 53:968-75. [PMID: 24934377 DOI: 10.1007/s00120-014-3499-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Open surgical reconstruction of the ureter is a urological procedure with a potentially high risk of complications. The correct selection of patients and time of operation are important aspects regarding the treatment strategy. Position and length of the affected ureter segment to be reconstructed determine the surgical intervention possibilities. The psoas hitch procedure is a well-established technique for distal reconstruction of the ureter where most iatrogenic injuries occur. In more proximal or complex defects, several procedures are available. Partial or complete replacement of the ureter with bowel is still considered the standard for bridging long ureteral defects but is accompanied with higher intra- and postoperative complication rates. In specific patients and situations, autotransplantation of the kidney and subcutaneous pyelovesical bypasses are clinical options. Using mucosal grafts or tissue engineering may be new therapeutic prospects to cover ureteral defects but the clinical impact still needs to be clarified. All therapeutic strategies share the fact that great surgical expertise and experience are necessary as the operative technique must be mastered to avoid severe complications.
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Affiliation(s)
- D A Lazica
- Klinik für Urologie und Kinderurologie, HELIOS Klinikum Wuppertal, Lehrstuhl der Universität Witten/Herdecke, Heusnerstraße 40, 42283, Wuppertal, Deutschland,
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Knight RB, Hudak SJ, Morey AF. Strategies for open reconstruction of upper ureteral strictures. Urol Clin North Am 2013; 40:351-61. [PMID: 23905933 DOI: 10.1016/j.ucl.2013.04.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article presents a review of the literature regarding surgical techniques and outcomes for reconstruction of strictures involving the upper ureter. The preoperative assessment for proximal ureteral stricture is briefly reviewed, followed by a discussion of ureteroureterostomy, transureteroureterostomy, ureterocalicostomy, bladder flaps, downward nephropexy, bowel interposition grafts, onlay or tubular grafting, renal autotransplantation, and nephrectomy. The future direction for reconstruction of the proximal ureter is proposed.
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Affiliation(s)
- Richard B Knight
- Department of Urology, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, TX 78234, USA.
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15
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Wenske S, Olsson CA, Benson MC. Outcomes of distal ureteral reconstruction through reimplantation with psoas hitch, Boari flap, or ureteroneocystostomy for benign or malignant ureteral obstruction or injury. Urology 2013; 82:231-6. [PMID: 23642933 DOI: 10.1016/j.urology.2013.02.046] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 02/23/2013] [Accepted: 02/26/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess functional outcomes and complications of ureteroneocystotomies (UNCs) with or without psoas hitch or Boari flap in the reconstruction and repair of the ureter. METHODS We reviewed a consecutive series of patients that underwent open ureteral reconstruction for ureteral obstruction or injury. Underlying ureteral disorder, preoperative and postoperative estimated glomerular filtration rate (eGFR), and imaging studies regarding resolution of hydronephrosis were assessed. RESULTS A total of 100 ureteral reimplantations performed at our institution from November 1986 to August 2012 were identified: 24 primary ureteroneocystotomies, 58 with psoas hitch, and 18 with Boari flap. Median follow-up was 48.7 months (range 12.3-253 months). The most common underlying disorder was ureteral transitional cell cancer (TCC). Men were found to have more frequent underlying chronic ureteral disorders with chronic renal failure when compared to women. Ureteral stents were placed in 81% and were removed after a median of 33 days (range 2-161 days). Resolution of hydronephrosis was noted in 81% of the patients. The eGFR deteriorated significantly over time only in male patients (P = .001). Postoperative complications included stent-related dysuria, urinary tract infection, and contrast-extravasation on cystogram necessitating prolonged urethral and ureteral catheter drainage. CONCLUSION Excellent functional outcome without significant morbidity associated with ureteral reimplantation/reconstruction was achieved. Despite resolution of hydronephrosis in the vast majority of patients, those with chronic underlying ureteral disorder and renal failure did not show improvement of their eGFR.
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Affiliation(s)
- Sven Wenske
- Department of Urology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA.
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16
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Central Role of Boari Bladder Flap and Downward Nephropexy in Upper Ureteral Reconstruction. J Urol 2011; 186:1345-9. [DOI: 10.1016/j.juro.2011.05.086] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Indexed: 12/27/2022]
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17
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Azioni G, Bracale U, Scala A, Capobianco F, Barone M, Rosati M, Pignata G. Laparoscopic ureteroneocystostomy and vesicopsoas hitch for infiltrative ureteral endometriosis. MINIM INVASIV THER 2011; 19:292-7. [PMID: 20868303 DOI: 10.3109/13645706.2010.507345] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aim of the study was to assess the safety and efficacy of laparoscopic treatment of distal infiltrative ureteral endometriosis with segmental ureteral resection, ureteroneocystostomy, and vesicopsoas hitch. We performed a retrospective analysis of perioperative data and looked at follow-up outcomes of patients with deep endometriosis with ureteral involvement treated by laparoscopic vesicopsoas hitch. Six patients were treated for left ureteral endometriosis in the study period. Four of those were diagnosed during previous laparoscopies. A ureteroneocystostomy (Lich-Gregoir reimplantation procedure) with vesicopsoas hitch was fashioned laparoscopically in all cases, and a double-J stent was applied intraoperatively. There were no intraoperative or postoperative complications and no cases of extravasation of contrast at cystogram one week after surgery. The median follow-up time was 38 months (range 12-56). All patients had normal renal ultrasound or intravenous pyelogram results at one year follow-up. This study confirmed that laparoscopic ureteroneocystostomy and vesicopsoas hitch is a safe and effective option in the management of distal ureteral endometriosis. In view of the small size of this series, multicenter studies are needed to confirm these conclusions.
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Affiliation(s)
- Guglielmo Azioni
- Department of Obstetrics and Gynecology, San Camillo Hospital, Via Giovanelli 19, Trento, Italy
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Abstract
Ureteral injuries are caused by iatrogenic reasons in about 75% of cases. Among urological procedures ureterorenoscopy (URS) is mainly described as the reason for ureteral injury, although complication rates of URS are generally low. Injuries of the ureter are divided into five grades by the AAST. Grades I-II are referred to as partial and grades III-V as complex ureteral injuries. To avoid higher complication rates there should be no delay in confirmation of diagnosis and initiation of therapy. Correct therapy depends on grade of injury. Partial ureteral injuries are treated by endoscopic inlay of a ureteral stent for approximately 14-21 days. In complex injuries endoscopic ureteroureterostomy could be attempted but leads to rather poor long-term results depending on the length of devascularization of the injured ureter.Procedures with and without use of bowel for ureteral reconstruction and replacement have been described. The type of operative procedure should be selected based on location and degree of ureteral injury. Besides ureteral reconstruction, autotransplantation of the affected kidney can be required in individual cases.
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Allaparthi S, Ramanathan R, Balaji K. Robotic Distal Ureterectomy with Boari Flap Reconstruction for Distal Ureteral Urothelial Cancers: A Single Institutional Pilot Experience. J Laparoendosc Adv Surg Tech A 2010; 20:165-71. [DOI: 10.1089/lap.2009.0269] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Satya Allaparthi
- Division of Urology, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Rajan Ramanathan
- Division of Urology, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - K.C. Balaji
- Division of Urology, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
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Rutigliano DN, Georges A, Wolden SL, Kayton ML, Meyers P, La Quaglia MP. Ureteral reconstruction for retroperitoneal tumors in children. J Pediatr Surg 2007; 42:355-8. [PMID: 17270548 DOI: 10.1016/j.jpedsurg.2006.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Removal of solid tumors of the pelvis and abdominal cavity may require resection of an involved ureteral segment. Ureteral stricture can also be a result of intense therapy. We present our experience with urinary reconstruction in this situation. METHODS A retrospective review of pediatric oncology patients with solid abdominal/pelvic tumors who underwent a ureteral reconstructive procedure was done. Institutional review board wavier was obtained for the review. Patient data were collected on diagnosis, procedures performed, renal function, and follow-up. RESULTS Thirteen patients were identified: 8 male and 5 female. The mean age at surgery was 10.1 years. The most common reason for surgery was en bloc tumor resection (n = 8) followed by ureteral strictures (n = 3). The Boari flap, Leadbetter-Politano reimplantation, and psoas hitch were the most common procedures preformed. Follow-up studies included measurements of serum urea nitrogen/creatinine levels as well as renal scans to assess functional status; 2 patients had elevated serum urea nitrogen/creatinine levels at follow-up. The mean follow-up time was 18 months; 4 patients died-none was secondary to renal complications. There were no local tumor recurrences. CONCLUSIONS Abdominal and pelvic tumors frequently involve the ureter, and their removal should not necessitate acceptance of poor surgical margins. Complete surgical resection of tumor including involved ureteral segments can prolong survival in patients with extensive abdominopelvic cancers. In another group of patients, ureteral strictures arise secondary to therapy and reconstruction may preserve renal function.
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Affiliation(s)
- Daniel N Rutigliano
- Division of Pediatric Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
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Ureteral reimplantation for management of ureteral strictures: a retrospective comparison of laparoscopic and open techniques. Eur Urol 2006; 51:512-22; discussion 522-3. [PMID: 16949730 DOI: 10.1016/j.eururo.2006.08.004] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 08/01/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare the results of laparoscopic ureteral reimplantation with a previous series of open surgery. MATERIALS AND METHODS We compared ten patients who underwent laparoscopic vesicopsoas-hitch with (n=4) or without Boari-flap (n=6) technique for ureteral obstructions with ten patients treated by open ureteroneocystostomy for similar pathologies. Patient demographics, preoperative symptoms, radiologic imaging, and postoperative outcomes were analyzed. Postoperative observation time averaged 17 mo (range: 9-23) in the laparoscopic and 65 mo (range: 18-108) in the open group. Success was defined as relief of obstruction in postoperative imaging studies and relief of pain. RESULTS Mean length of stricture (28.5 vs. 25 mm) was comparable in both groups. In laparoscopy versus open surgery, mean operative time (228 vs. 187 min) was longer, blood loss (370 vs. 610 ml) and analgesic requirement (4.9 vs. 21.5mg) were significantly lower, and mean time to oral intake (1.5 vs. 2.9 d), hospital stay (9.2 vs. 19.1 d), and convalescence time (2.3 vs. 4.2 wk) were significantly shorter. Success rates yielded 10 of 10 after laparoscopy and 8 of 10 after open surgery. No intra- or postoperative major complications occurred in the laparoscopic series. After open surgery, two patients had major postoperative complications, including urinary extravasation with abdominal haematoma and anastomostic stricture, respectively. CONCLUSIONS Laparoscopic ureteroneocystostomy is feasible, providing functional outcomes comparable to open surgery while offering the advantages of a minimal invasive technique (e.g., less postoperative analgesics, and shorter hospitalization and convalescence). Nevertheless, it requires a high level of laparoscopic expertise and should be carried out only in specialist centers.
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Braslis KG. Use of a posterior Boari flap in ureteral replacement. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:301-3. [PMID: 9572345 DOI: 10.1111/j.1445-2197.1998.tb02090.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schoeneich G, Winter P, Albers P, Fröhlich G, Müller SC. Management of complete ureteral replacement. Experiences and review of the literature. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1997; 31:383-8. [PMID: 9290171 DOI: 10.3109/00365599709030625] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The common treatment for patients with extensive damage to the ureter is complete ureteral replacement, combining Boari flap-psoas bladder hitch and downward mobilization of the involved kidney, with complete ideal replacement of the ureter, renal autotransplantation, of elective nephrectomy. Three case reports serve to describe two options of reconstructive treatment for complete ureteral replacement. The operative techniques, their limits, their postoperative results, and the treatment alternatives are discussed with due regard to recent literature. In the case of ileal replacement we have used a very short ileal segment to reduce the absorption surface of the ileal mucosa. Reflux prevention of the ileal segment was performed by creating an invaginated distal ileum nipple which was additionally fixed at the Boari flap by a third stapler row (auto suture TASS) to prevent potential nipple-gliding.
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Affiliation(s)
- G Schoeneich
- Department of Urology, University of Bonn, Germany
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Dénes FT, Brito AH, Cutait R. Transureterocalicostomy: an alternative internal diversion technique. J Urol 1995; 153:404-6. [PMID: 7815599 DOI: 10.1097/00005392-199502000-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report a case of an infiltrating retroperitoneal tumor that completely enveloped and obstructed the mid third of the left ureter. After resection of the tumor, including a 10 cm. long segment of ureter, the upper left ureter was successfully diverted to the upper calix of the right ectopic kidney (transureterocalicostomy). To our knowledge our report represents the first case of such surgery.
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Affiliation(s)
- F T Dénes
- Department of Urology, Hospital Sírio-Libanes, São Paulo, Brazil
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Cormio L, Crovace A, Lacalandra G, Di Bellò A, Selvaggi FP. Bladder Z-plasty for the repair of ureteric injuries. Experimental study in sheep. BRITISH JOURNAL OF UROLOGY 1993; 71:667-71. [PMID: 8343891 DOI: 10.1111/j.1464-410x.1993.tb16062.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
There is general acceptance that the best substitute for a damaged distal ureter is an elongated bladder and that the bladder psoas hitch is the most reliable procedure. Nevertheless, it is not always sufficient to bridge a long ureteric gap. In order to obtain an equally safe but wider bladder elongation than the psoas hitch can provide, we have previously studied the effect of several Z-shaped incisions on isolated pig bladders. The aim of the present study was to verify, in vivo, the efficacy and safety of the new technique. Five sheep underwent the psoas hitch procedure and 6 the Z-plasty procedure. The results showed that Z-plasty provides an equally safe but longer bladder elongation than the psoas hitch procedure.
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Affiliation(s)
- L Cormio
- Division of Surgical Nephrology, School of Medicine, University of Bari, Italy
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Benson MC, Ring KS, Olsson CA. Ureteral reconstruction and bypass: experience with ileal interposition, the Boari flap-psoas hitch and renal autotransplantation. J Urol 1990; 143:20-3. [PMID: 2294254 DOI: 10.1016/s0022-5347(17)39852-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A total of 18 patients underwent an operation for extensive ureteral loss from 1980 to 1986. The indications included recurrent calculi, retroperitoneal fibrosis, surgical trauma and tumor. Of the patients 10 had construction of an ileal ureter (4 had bilateral reconstruction), 6 had creation of a psoas hitch with a Boari bladder tube and 2 were treated by autotransplantation. Mean duration of followup was 4.8 years. The procedure was successful in 17 patients. There were no apparent differences among the groups. Selection criteria and potential complications are discussed with regard to each technique. These procedures provide an excellent means for reconstruction of the urinary tract in patients who have failed other treatments.
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Affiliation(s)
- M C Benson
- Department of Urology, Columbia University College of Physicians and Surgeons, J. Bentley Squier Urologic Clinic, Columbia Presbyterian Medical Center, New York, New York
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