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Wu Y, Zhu W, Yang K, Fan S, Guan B, Huang B, Wang J, Wang J, Li Z, Guan H, Huang Y, Li Z, Zhang P, Li X, Zhou L. Terminal augmented ureteroplasty with bladder onlay flap technique for recurrent distal ureteral stricture after ureteroneocystostomy: an initial case series. Transl Androl Urol 2021; 10:3332-3339. [PMID: 34532257 PMCID: PMC8421814 DOI: 10.21037/tau-21-252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Bladder flap has been shown to be a feasible treatment for distal ureteral stenosis; this technique has been improved such that it can be used to address complex urinary tract obstructions. The purpose of the present study was to describe a surgical technique of ureteroplasty with a bladder onlay flap, which consists of a nontransecting and terminal augmented anastomosis, for repairing recurrent distal strictures of the ureter. Methods We retrospectively reviewed 6 patients who underwent this procedure between May 2018 and November 2019. These patients were diagnosed with distal ureteral stenosis and had previously undergone ureteroneocystostomy (one with a Boari flap) but suffered recurrence of flank pain. Patient characteristics, perioperative data and follow-up outcomes were gathered. The success of the operation was judged by symptomatic relief (subjective success) and improved radiographic imaging and renal function (objective success). Results Preoperative computed tomography urography (CTU) showed hydronephrosis in all patients: severe hydronephrosis was observed in 83.3% of patients (5/6), and moderate hydronephrosis was observed in 16.7% (1/6). The mean stricture length was 2 cm. The mean operating time, estimated blood loss and postoperative hospital stays of the six patients were 193.3 min (160–270 min), 41.5 mL (10–58 mL) and 8.2 days (6–11 days), respectively. No serious complications (Clavien-Dindo grade ≥3) occurred during or after the operations. The mean follow-up time was 24.5 months (range, 14 to 29). The objective success rate was 83.3% (5/6), and the subjective success rate was 100%. Conclusions Our technique of ureteroplasty with a bladder onlay flap by nontransecting and terminal augmented anastomosis is feasible and improves the recovery rate after the repair of recurrent distal ureteral stenosis. Patients who have had previous unsuccessful surgeries might benefit from this approach.
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Affiliation(s)
- Yucai Wu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Weijie Zhu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Bao Guan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Bingwei Huang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Jianxin Wang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Yanbo Huang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Zhe Li
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University; National Urological Cancer Centre, Beijing, China.,Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University; Beijing, China
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Xiong SW, Yang KL, Ding GP, Hao H, Li XS, Zhou LQ, Guo YL. [Advances in surgical repair of ureteral injury]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:783-789. [PMID: 31420641 DOI: 10.19723/j.issn.1671-167x.2019.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ureteral injury can be classified as iatrogenic or traumatic, which represents a rare but challenging field of reconstructive urology. Due to their close proximity to vital abdominal and pelvic organs, the ureters are highly susceptible to iatrogenic injury, while ureteral injury caused by external trauma is relatively rare. The signs of ureteric injury are difficult to identify initially and often present after a delay. The treatment of ureteral injury, which is depended on the type, location, and degree of injury, the time of diagnosis and the patient's overall clinical condition, ranges from simple endoscopic management to complex surgical reconstruction. And long defect of the ureter presents much greater challenges to urologists. Ureterotomy under endoscopy using laser or cold-knife is available for the treatment of 2-3 cm benign ureteral injuries or strictures. Pyeloplasty is an effective treatment for ureteropelvic junction obstruction and some improved methods showed the possibility of repairing long-segment (10-15 cm) stenosis. Proximal and mid-ureteral injuries or strictures of 2-3 cm long can often be managed by primary ureteroureterostomy. When not feasible due to ureteral defects of longer segment, mobilization of the kidney should be considered, and transureteroureterostomy is alternative if the proximal ureter is of sufficient length. And autotransplantation or nephrectomy is regarded as the last resorts. Most of the injuries or strictures are observed in the distal ureter, below the pelvic brim, and are usually treated with ureteroneocystostomy. A non-refluxing technique together with a ureteral nipple or submucosal tunnel method, is preferable as it minimizes vesico-ureteral reflux and the risk of infection. In order to cover a longer distance, ureteroneocystostomy in combination with a psoas hitch (covering 6-10 cm of defect) or a Boari flap (covering 12-15 cm) is often adopted. Among various ureteral replacement procedures, only intestinal ureteral substitution, which includes ileal ureter, appendiceal interposition and reconfigured colon substitution, has gained wide acceptance when urothelial tissue is insufficient. Ileal ureter can be used to replace the ureter of >15 cm defect and even to replace the entire unbilateral ureter or bilateral ureter. Laparoscopic and robotic-assisted techniques are increasingly being employed for ureteral reconstruction and adopted with encouraging results.
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Affiliation(s)
- S W Xiong
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - K L Yang
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - G P Ding
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - H Hao
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - X S Li
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - L Q Zhou
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - Y L Guo
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
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Soria J, Guandalino M, Vedrine N, Pereira B, Guy L. [Results of conservative surgical management of ureteral injuries]. Prog Urol 2017; 28:120-127. [PMID: 29162380 DOI: 10.1016/j.purol.2017.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/13/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The ureter is a retroperitoneal organ. Ureteral injuries are rare, with a prevalence of 0.083% of surgical interventions over 10 years. The objective of this study was to evaluate the surgical management of ureteric injuries according to the time of discovery, their size and their location. We also evaluated the results of this management on the renal repercussion as well as the predictive factors of the severity of the ureteric injuries. MATERIAL AND METHODS This was a monocentric retrospective study carried out on the basis of a systematic review of the CHU surgery files. RESULTS The average follow-up was 30 months. The average hospital stay was 8 days. Thirty-four patients (73.9%) underwent initial endoscopic management by attempting a double J probe. Only 20 patients received this double J probe and only 11 patients (55%) did not recidivate the ureteral injury with a median duration of maintenance of the double J probe of 90 days (28-240). Thirty-five patients received open surgical management (76.1%). We found 57% ureterovesical reimplantations (n=20), corresponding to pelvic ureteral injuries (n=32). We also found 20% of nephrectomies. No patient had recurrence of the ureteral injury. Eight patients had secondary dilatation of the pyelocalicious cavities (28.57%). The success of surgical treatment was therefore 57%. CONCLUSION The management of surgically treated ureter injuries provides good results but remains relatively diversified due to the different lesion levels. It was effective in 57% of cases including nephrectomies as failure of treatment. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- J Soria
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - M Guandalino
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - N Vedrine
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - B Pereira
- Service de biostatistique, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - L Guy
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
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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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