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Chen B, Xu L, Fan Y, Zhao L, Sun J, Huang J. Minimally Invasive Surgical Therapies for Ureteral Polyps: A Systematic Review. J Laparoendosc Adv Surg Tech A 2024; 34:313-317. [PMID: 38294894 DOI: 10.1089/lap.2023.0477] [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] [Indexed: 02/02/2024] Open
Abstract
Background: Ureteral polyps are rare benign ureteral tumor. No guideline recommends that open or minimally invasive surgery is best for treating ureteral polyps. This article aims to provide a comprehensive review of the minimally invasive techniques currently available for treating ureteral polyps. Materials and Methods: We performed a comprehensive search of articles published in PubMed, using the keywords "ureteral" and "polyp," or "polyps." Results: A total of 275 studies were obtained from the literature search but 96 articles were excluded. Conclusions: Several minimally invasive approaches were developed with the advancement of medical technology, including endoscopic, laparoscopic, and robotic approaches; however, the best surgical technique was yet to be decided. Due to the advantages and disadvantages of these approaches, the best surgical approach should be tailored to each patient's needs and the surgeon's preferences and experience.
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Affiliation(s)
- Bohong Chen
- Department of Urology, Hangzhou Ninth People's Hospital, Hangzhou, China
| | - Li Xu
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Yi Fan
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Liwei Zhao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Ji Sun
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Jiaguo Huang
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
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Tao CP, Cao YS, Mao CK, Peng B. Laparoscopic treatment of pediatric duplicated kidney with ureteral fibroepithelial polyps: A case report. Asian J Surg 2024; 47:1499-1500. [PMID: 38065739 DOI: 10.1016/j.asjsur.2023.11.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/24/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Cheng-Pin Tao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Yong-Sheng Cao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China.
| | - Chang-Kun Mao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Bo Peng
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
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Robot-assisted excision of partially obstructing ureteral fibroepithelial polyp in a child: A case report and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Griggs-Demmin A, Mudalegundi S, Haney N, Cohen A. Robotic Excision of Large, Multi-Focal Ureteral Fibroepipthelial Polyps. Urology 2022; 167:e3. [PMID: 35728672 DOI: 10.1016/j.urology.2022.06.002] [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: 01/17/2022] [Revised: 05/24/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
Ureteral fibroepithelial polyps (UFP) are benign neoplasms of mesodermal origin. In this report, we describe the rare presentation and robotic surgical management of UFP in an adult female. A 25-year-old female with recurrent bilateral UFP s/p multiple ureteroscopic ablations and right partial ureterectomy with ureto-ureteral anastomosis presented with left flank pain. Four-phase CT with delayed images demonstrated a filling defect in the left ureter. Ureteroscopy confirmed left UFP. The number, size, and multifocality precluded endoscopic management. Creatinine was normal and split function 53%/47%. The patient was recommended for robotic repair. After mobilization of the colon, the ureter was identified and traced up to the hilum. There was an inflammatory rind surrounding the ureter through majority of its length. Care was taken to avoid circumferential dissection of the ureter. Upon longitudinal incision of the ureter, polyps erupted with a release of hydronephrotic urine, despite pre-stenting. Polyps were transected at their base, revealing abnormal underlying urothelium. A ureteroscope was advanced through a robotic port to examine the proximal ureter and renal pelvis. Remaining polyps were removed after which a wire and stent was placed antegrade into the open distal ureter and proximally into the renal pelvis. The anastomosis was performed with 5-0 PDS. ICG and firefly confirmed suitable blood flow to the ureter. Pathology revealed benign fibroepithelial polyps with reactive changes to the urothelium. Retrograde pyelogram two months later revealed a patent ureter. This video demonstrates successful robotic surgical management of large, multifocal UFPs.
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Affiliation(s)
| | - Shwetha Mudalegundi
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205 USA.
| | - Nora Haney
- Brady Urological Institute, Johns Hopkins Medicine, 4940 Eastern Avenue, Baltimore, MD 21224 USA.
| | - Andrew Cohen
- Brady Urological Institute, Johns Hopkins Medicine, 4940 Eastern Avenue, Baltimore, MD 21224 USA.
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Xia W, Chen X, Li B, Chen H, Zhu Z, He Y, Gan Y, Zhang B, Wang K, Li Y, Jiang Z, Long J, Chen Z. Transabdominal Laparoscopic Ureteroureterostomy With the Intraoperative Retrograde Ureteroscopy-Assisted Technique for Multiple Ureteral Polyps: A Single-Center 10 Years Experiences. Front Surg 2022; 9:814290. [PMID: 35284473 PMCID: PMC8913589 DOI: 10.3389/fsurg.2022.814290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe purpose of this study was to report our experience in treating multiple ureteral polyps with transabdominal laparoscopic ureteroureterostomy (LAP-UU) with intraoperative retrograde ureteroscopy (RU)-assisted technique.MethodsThe data of 32 patients who underwent transabdominal LAP-UU with the intraoperative RU-assisted technique due to multiple ureteral polyps between January 2011 and March 2021 were reviewed at our institute. After administration of anesthesia, patients were placed in a passive position and underwent a three-port transabdominal laparoscopy with RU. Detailed data were reviewed, such as demographic characteristics, intraoperative outcomes, postoperative data, complications, and pathology reports.ResultsThirty-two patients were diagnosed with multiple ureteral polyps underwent this surgery method at our institution. The mean duration of symptoms at the time of diagnosis was approximately 7.1 months. The mean age of patients was 42.4 years, with men accounting for 68.8% (22/32), lesion of left for 56.3% (18/32), and the upper ureter for 62.5% (20/32). Furthermore, the median length of the polyps was 3.6 cm, the mean operative time was 174.6 min, and the estimated blood loss (EBL) was about 86.8 ml. The mean time to begin a liquid diet and to be out of bed were 1.7 and 2.3 days, respectively. The average length of hospital stay was 6.3 days. The ureteral stent was removed by cystoscope 2–3 months after surgery. Follow-up duration ranged from 3 to 112 months and none of the patients required another surgery for recurrence.ConclusionTransabdominal LAP-UU combined with the intraoperative RU-assisted technique is an effective, safe, and reliable surgical option for patients with multiple ureteral polyps. Further long-term follow-up is recommended.
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Affiliation(s)
- Weiping Xia
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Bingsheng Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yao He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Gan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Bo Zhang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Kangning Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zexiang Jiang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jin Long
- Department of Urology, The Second Affiliated Hospital, Guizhou Medical University, Kaili, China
| | - Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Zhi Chen
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He M, Li N, Zhang W, Ren Z. Preoperative diagnosis, treatment, and outcomes of FEPs of ureters in children: a 13-year retrospective study based on data at a large pediatric medical center. World J Urol 2020; 39:2239-2243. [PMID: 32844353 PMCID: PMC8217005 DOI: 10.1007/s00345-020-03379-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/20/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose To describe our experience in handling cases of children with fibroepithelial polyps (FEPs) of ureters. We specifically present preoperative diagnosis approaches, provide a clear definition of this entity and its outcomes following treatment. Method Clinical data of children with FEPs who were consecutively treated at Beijing Children's Hospital from January 2006 to May 2019 were retrospectively analyzed in this study. The clinical data reviewed included diagnostic, intraoperative, and follow-up data. Results Of the 2653 children with surgery for hydronephrosis reviewed, 48 (1.8%) cases of FEPs of the ureters were identified, with a mean age of 109 ± 34.7 months. Among them, males accounted for 95.8%, left side for 81.3%, and proximal ureteral polyps for 97.9%. Notably, 70.8% of patients had only 1 polyp and the median size of the polyps was 2.1 ± 1.8 cm. All patients underwent ultrasound before surgery, which revealed the existence of polyps in 29 (60.4%) children. These polyps were completely resected surgically. The mean follow-up was 82 months (range of 6–153 months) and no cases of recurrences of polyps were seen after surgery during follow-up. The rate of other long-term complications was 9.3%. Conclusions In conclusion, FEPs are one of the important causes of hydronephrosis in children. Ultrasound is effective for preoperative diagnosis achieving higher true positive rates than other diagnostic methods. Although the recurrence rate of polyps and symptoms are low after complete resection in children, long-term follow-up is advocated to the adolescence stage to monitor the incidences of urinary tract infections, ureteropelvic junction obstruction and stone formation. Electronic supplementary material The online version of this article (10.1007/s00345-020-03379-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Meng He
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu Street No. 56, Beijing, 100045, China
| | - Ning Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu Street No. 56, Beijing, 100045, China.
| | - Weiping Zhang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu Street No. 56, Beijing, 100045, China.
| | - Zhentao Ren
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu Street No. 56, Beijing, 100045, China
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Bilgutay AN, Kirsch AJ. Robotic Ureteral Reconstruction in the Pediatric Population. Front Pediatr 2019; 7:85. [PMID: 30968006 PMCID: PMC6439422 DOI: 10.3389/fped.2019.00085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/27/2019] [Indexed: 12/17/2022] Open
Abstract
Robot-assisted laparoscopic (RAL) surgery is a safe, minimally invasive technique that has become more widely used in pediatric urology over recent decades. With several advantages over standard laparoscopy, robotic surgery is particularly well-suited to reconstructive surgery involving delicate structures like the ureter. A robotic approach provides excellent access to and visualization of the ureter at all levels. Common applications include upper ureteral reconstruction (e.g., pyeloplasty, ureteropelvic junction polypectomy, ureterocalicostomy, and high uretero-ureterostomy in duplex systems), mid-ureteral reconstruction (e.g., mid uretero-ureterostomy for stricture or polyp), and lower ureteral reconstruction (e.g., ureteral reimplantation and lower ureter-ureterostomy in duplex systems). Herein, we describe each of these robotic procedures in detail.
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Affiliation(s)
- Aylin N Bilgutay
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Andrew J Kirsch
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
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Osbun N, Ellison JS, Lendvay TS. Robot-Assisted Laparoscopic Excision of Ureteral and Ureteropelvic Junction Fibroepithelial Polyps in Children. J Endourol 2017; 30:896-900. [PMID: 27279495 DOI: 10.1089/end.2016.0006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Fibroepithelial polyps of the ureter are a rare cause of asymptomatic and symptomatic upper urinary tract obstruction in children. While these lesions can often be managed endoscopically, large or multifocal polyps may preclude such an approach. OBJECTIVE We aim to describe our institutional experience with robot-assisted laparoscopic treatment of ureteral polyps and show that a robotic approach is an effective alternative for large or multifocal polyps. MATERIALS AND METHODS Four children were identified with ureteral polyps over a 5-year period and underwent transperitoneal robot-assisted laparoscopic excision. Patients presented with flank pain and/or worsening hydronephrosis. All patients were evaluated preoperatively with ultrasound and Tc99m-mercaptoacetyltriglycine (MAG3) diuretic renogram or MR urogram. Retrograde pyelography corroborated the diagnosis of ureteral polyps. We reviewed the charts of these patients and compared the specific robotic approach for each patient, length of hospitalization, surgical complications, need for additional procedures, and resolution of symptoms and hydronephrosis. RESULTS In one patient, more than 20 polyps were identified over a long ureteral segment and all were excised; for the remaining three patients, 1 to 2 polyps were found. Mean postoperative length of stay was 1.5 days. One patient developed a ureteral stricture requiring repeat ureteroureterostomy, and another patient required repeat retrograde pyelography for gross hematuria that occurred several months after surgery. No polyps or obstruction was observed on retrograde pyelography in these patients. Mean duration of follow-up was 29 months (9-62 months). Symptoms and degree of hydronephrosis have improved in the three patients who have been followed for at least 12 months. CONCLUSIONS Robot-assisted laparoscopy is a safe and feasible alternative to endoscopic treatment of fibroepithelial ureteral polyps. The robotic platform may be preferred in cases of multifocal or large ureteral polyps, or in cases in which a concomitant ureteropelvic junction narrowing may be present.
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Affiliation(s)
- Nathan Osbun
- 1 Department of Urology, University of Washington , Seattle, Washington
| | - Jonathan S Ellison
- 2 Division of Pediatric Urology, Seattle Children's Hospital , Seattle, Washington
| | - Thomas S Lendvay
- 2 Division of Pediatric Urology, Seattle Children's Hospital , Seattle, Washington
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Cai Y, Zhang Z, Yue X. Rare giant primary ureteral polyp: A case report and literature review. Mol Clin Oncol 2017; 6:327-330. [PMID: 28451407 PMCID: PMC5403350 DOI: 10.3892/mco.2017.1146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 01/31/2017] [Indexed: 12/03/2022] Open
Abstract
Primary ureteral fibroepithelial polyps (UFPs) are rare benign tumors of mesodermal origin. The majority UFPs are observed in the proximal part of the ureter and most commonly on the left side. The mean diameter of UFP is reported to be <5 cm. We herein present a rare case of a long primary ureteral polyp originating from the lower ureter in a 53-year-old woman. Following computed tomography, magnetic resonance imaging, retrograde pyelography and ureteroscopic examination, a preliminary diagnosis of giant primary lower ureteral polyp protruding into the bladder was obtained. Polyp resection and resection of the narrow ureteral segment with a V-shaped end-to-end anastomosis were performed. The length of this polyp was 15.0 cm, and the final pathological diagnosis was UFP. No recurrence or ureteral stenosis were observed at the 12-month follow-up. A supplementary review of previously published cases and related literature is also included.
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Affiliation(s)
- Yunlin Cai
- Department of Urology, The Second Clinical Hospital of North Sichuan Medical College (Nanchong Central Hospital), Nanchong, Sichuan 637000, P.R. China
| | - Zongping Zhang
- Department of Urology, The Second Clinical Hospital of North Sichuan Medical College (Nanchong Central Hospital), Nanchong, Sichuan 637000, P.R. China
| | - Xiaofeng Yue
- Department of Urology, The Second Clinical Hospital of North Sichuan Medical College (Nanchong Central Hospital), Nanchong, Sichuan 637000, P.R. China
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