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Horiguchi A, Shinchi M, Ojima K, Iijima K, Inoue K, Inoue T, Kaneko N, Kanematsu A, Saito D, Sakae T, Sugihara T, Sekine K, Takao T, Tabei T, Tamura Y, Funabiki T, Yagihashi Y, Yanagi M, Takahashi S, Nakajima Y. The Japanese Urological Association's clinical practice guidelines for urotrauma 2023. Int J Urol 2024; 31:98-110. [PMID: 37929795 DOI: 10.1111/iju.15331] [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: 08/30/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023]
Abstract
The Japanese Urological Association's guidelines for the treatment of renal trauma were published in 2016. In conjunction with its revision, herein, we present the new guidelines for overall urotrauma. Its purpose is to provide standard diagnostic and treatment recommendations for urotrauma, including iatrogenic trauma, to preserve organ function and minimize complications and fatality. The guidelines committee comprised urologists with experience in urotrauma care, selected by the Trauma and Emergency Medicine Subcommittee of the Specialty Area Committee of the Japanese Urological Association, and specialists recommended by the Japanese Association for the Surgery of Trauma and the Japanese Society of Interventional Radiology. The guidelines committee established the domains of renal and ureteral, bladder, urethral, and genital trauma, and determined the lead person for each domain. A total of 30 clinical questions (CQs) were established for all domains; 15 for renal and ureteral trauma and five each for the other domains. An extensive literature search was conducted for studies published between January 1, 1983 and July 16, 2020, based on the preset keywords for each CQ. Since only few randomized controlled trials or meta-analyses were found on urotrauma clinical practice, conducting a systematic review and summarizing the evidence proved challenging; hence, the grade of recommendation was determined according to the 2007 "Minds Handbook for Clinical Practice Guidelines" based on a consensus reached by the guidelines committee. We hope that these guidelines will be useful for clinicians in their daily practice, especially those involved in urotrauma care.
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Affiliation(s)
- Akio Horiguchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
- Division of Trauma Reconstruction, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masayuki Shinchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kenichiro Ojima
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kazuyoshi Iijima
- Department of Urology, Nagano Municipal Hospital, Nagano, Nagano, Japan
| | - Koji Inoue
- Department of Urology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takamitsu Inoue
- Department of Nephrology and Urological Surgery, International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Naoyuki Kaneko
- Trauma and Emergency Center, Fukaya Red Cross Hospital, Fukaya, Saitama, Japan
| | - Akihiro Kanematsu
- Department of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Daizo Saito
- Graduate School of Emergency Medical System, Kokushikan University, Setagaya, Tokyo, Japan
| | - Tatefumi Sakae
- IVR Center, Miyazaki University Hospital, Miyazaki, Japan
| | - Toru Sugihara
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kazuhiko Sekine
- Department of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, Minato, Tokyo, Japan
| | - Tetsuya Takao
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Tadashi Tabei
- Department of Urology, Fujisawa Shonandai Hospital, Fujisawa, Kanagawa, Japan
| | - Yoshimi Tamura
- Department of Urology, Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Tomohiro Funabiki
- Advanced Emergency and Critical Care Center, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Yusuke Yagihashi
- Department of Urology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Masato Yanagi
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
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Roux S, Pettenati C, Dariane C, Sbizzera M, Dominique I, Matillon X, Toinet T, Neuzillet Y, Bessède T, Champy C, Timsit MO, Méjean A. Management of long ureteral stenosis: Alternatives to indwelling ureteral stents. Prog Urol 2021; 31:598-604. [PMID: 33941454 DOI: 10.1016/j.purol.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIF Evaluate kidney autotransplantation (KAT) and ileal ureter substitution (IUS) practice and outcome as alternatives to indwelling ureteral stents for the management of long ureteral stenosis (US). MATERIAL We included all patients treated for US with KAT or IUS in 5 French university urology centers between 2010 and 2018. We excluded US due to urothelial carcinoma. Primary endpoint was the preservation of ipsilateral kidney and renal function without any urinary diversion. RESULTS 22 patients were treated with KAT (n=8, 36.4%) and IUS (n=14, 63.6%). Mean US length was 4.6cm and 6cm (P=0.52) in KAT and IUS groups respectively. US etiologies were lithiasis, iatrogenic, retroperitoneal fibrosis or extrinsic compression. US level was varied. The surgery was described as difficult because of peritoneal adhesions or major peri-ureteral fibrosis. Mean operating time and hospital stay were 336 and 346minutes (P=0.87) and 8 and 15 days respectively (P=0.001). Postoperative complications were mostly Clavien ≤2 (n=17, 77.3%). Revision surgery was required in the KAT group in 3 cases (37.5%), for textiles, renal vein thrombosis and anastomotic leak, none in the IUS group. The mean follow-up was 15.7 months. All but one (in the KAT group) ipsilateral kidneys were preserved, without renal function impairment (Δcreat +2.1 vs. +2.4μmol/l respectively, P=0.67), nor urinary diversion. CONCLUSION KAT and IUS are safe alternatives whose indication depends on surgeons expertise. Our study pointed out the scarcity of this practice suggesting the need to refer patients to expert centers. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- S Roux
- Department of Urology and Transplant surgery, Hôpital Européen Georges-Pompidou, AP-HP, University of Paris Descartes, Paris, France.
| | - C Pettenati
- Department of Urology and Transplant surgery, Hôpital Européen Georges-Pompidou, AP-HP, University of Paris Descartes, Paris, France
| | - C Dariane
- Department of Urology and Transplant surgery, Hôpital Européen Georges-Pompidou, AP-HP, University of Paris Descartes, Paris, France
| | - M Sbizzera
- Hospices Civils de Lyon, HCL, University of Lyon 1, Department of Urology, Lyon, France
| | - I Dominique
- Hospices Civils de Lyon, HCL, University of Lyon 1, Department of Urology, Lyon, France
| | - X Matillon
- Hospices Civils de Lyon, HCL, University of Lyon 1, Department of Urology, Lyon, France
| | - T Toinet
- Hôpital Foch, University of Versailles-Saint-Quentin-En-Yvelynes, Department Of Urology, Suresnes, France
| | - Y Neuzillet
- Hôpital Foch, University of Versailles-Saint-Quentin-En-Yvelynes, Department Of Urology, Suresnes, France
| | - T Bessède
- Hôpital Kremlin-Bicêtre, AP-HP, University of Paris Sud, Department of Urology, Le Kremlin-Bicêtre, France
| | - C Champy
- Hôpital Henri Mondor, AP-HP, University of Paris-Est Créteil, Department Of Urology, Créteil, France
| | - M O Timsit
- Department of Urology and Transplant surgery, Hôpital Européen Georges-Pompidou, AP-HP, University of Paris Descartes, Paris, France
| | - A Méjean
- Department of Urology and Transplant surgery, Hôpital Européen Georges-Pompidou, AP-HP, University of Paris Descartes, Paris, France
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Musquera Felip M, Ajami Fardoun T, Peri Cusi L, Alcaraz Asensio A. Technique Description and Outcomes of Robotic Transvaginal-Assisted Living Donor Kidney Transplantation. Urol Int 2020; 105:148-154. [PMID: 33260186 DOI: 10.1159/000511756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/19/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to describe the surgical technique of totally robotic kidney transplantation with transvaginal insertion and to assess its safety and feasibility. METHODS It is a prospective analysis of the first 5 cases of robotic kidney transplantation with transvaginal insertion. Robotic-assisted kidney transplantation was performed after transvaginal insertion of a living donor kidney graft. Donor's and recipient's characteristics, intraoperative variables, postoperative complications, and surgical outcomes were assessed. RESULTS The median operative time was 220 min. Mean rewarming ischemia time of 53 min, with immediate diuresis. No intraoperative complications were observed. Mean hospitalization period was 9 days, with mean Cr of 1.5 mg/dL at discharge. CONCLUSIONS Robotic kidney transplantation with transvaginal insertion is feasible and safe. A greater number of procedures are required to confirm the results of this new technique.
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Affiliation(s)
| | | | - Lluis Peri Cusi
- Urology Department, Hospital Clinic of Barcelona, Barcelona, Spain
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Li B, Kirshenbaum EJ, Patel P, Gorbonos A. Pushing Boundaries: Robotic Nephrectomy of an Auto-transplanted Kidney for Recurrent Renal Cell Carcinoma. Cureus 2018; 10:e2280. [PMID: 29736363 PMCID: PMC5935431 DOI: 10.7759/cureus.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Advances in robotic technology continue to expand the boundaries of minimally invasive approaches in transplant surgery. A single report has previously described the use of the robotic approach in transplant nephrectomy for a failed allograft. Our objective is to describe our technique and experience for the first reported robotic nephrectomy of an auto-transplanted solitary kidney for a recurrence of renal cell carcinoma (RCC). We highlight technical considerations during allograft mobilization and hilum dissection with the additional demands of a previously operated auto-transplant kidney.
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Affiliation(s)
- Belinda Li
- Urology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Eric J Kirshenbaum
- Urology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Parth Patel
- Urology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Alex Gorbonos
- Urology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
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Alameddine M, Moghadamyeghaneh Z, Yusufali A, Collazo AM, Jue JS, Zheng I, Morsi M, Prakash NS, Gonzalez J. Kidney Autotransplantation: Between the Past and the Future. Curr Urol Rep 2018; 19:7. [PMID: 29399714 DOI: 10.1007/s11934-018-0749-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW The practice of kidney autotransplantation (KAT) has become an increasingly favorable approach in the treatment of certain renovascular, ureteral, and malignant pathologies. Current KAT literature describes conventional open procedures, which are associated with substantial risks. We sought to compare previously reported outcomes, evaluate common surgical indications, and assess associated risks and benefits of current KAT methods. A thorough evaluation and review of the literature was performed with the keywords "autologous transplantation" and "kidney." RECENT FINDINGS Early outcomes of robotic KAT are encouraging and have been associated with fewer complications and shorter hospital stay, but require robotic technique proficiency. KAT is an important method to manage selected complex urological pathologies. Robotic KAT is promising. Nevertheless, future studies should utilize larger patient cohorts to better assess the risks and benefits of KAT and to further validate this approach.
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Affiliation(s)
- Mahmoud Alameddine
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA.
| | - Zhobin Moghadamyeghaneh
- Department of Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Ali Yusufali
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Alexa Marie Collazo
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Joshua S Jue
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Ian Zheng
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Mahmoud Morsi
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | | | - Javier Gonzalez
- Hospital Central de la Cruz Roja, Universidad Alfonso X El Sabio, Madrid, Spain
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Moghadamyeghaneh Z, Hanna MH, Fazlalizadeh R, Obi Y, Foster CE, Stamos MJ, Ichii H. A Nationwide Analysis of Kidney Autotransplantation. Am Surg 2017. [PMID: 28228203 DOI: 10.1177/000313481708300216] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There are limited data regarding outcomes of patients underwent kidney autotransplantation. This study aims to investigate outcomes of such patients. The nationwide inpatient sample database was used to identify patients underwent kidney autotransplantation during 2002 to 2012. Multivariate analyses using logistic regression were performed to investigate morbidity predictors. A total of 817 patients underwent kidney autotransplantation from 2002 to 2012. The most common indication of surgery was renal artery pathology (22.7%) followed by ureter pathology (17%). Overall, 97.7 per cent of operations were performed in urban teaching hospitals. The number of procedures from 2008 to 2012 were significantly higher compared with the number of them from 2002 to 2007 (473 vs 345, P < 0.01). The overall mortality and morbidity of patients were 1.3 and 46.2 per cent, respectively. The most common postoperative complications were transplanted kidney failure (10.7%) followed by hemorrhagic complications (9.7%). Obesity [adjusted odds ratio (AOR): 9.62, P < 0.01], fluid and electrolyte disorders (AOR: 3.67, P < 0.01), and preoperative chronic kidney disease (AOR: 1.80, P = 0.03) were predictors of morbidity in patients. In conclusion, Kidney autotransplantation is associated with low mortality but a high morbidity rate. The most common indications of kidney autotransplantation are renal artery and ureter pathologies, respectively. A kidney transplant failure rate of 10.7 per cent was observed in patients with kidney autotransplantation. The most common postoperative complication was hemorrhagic in nature.
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Ureteral Reconstruction With Ileum: Long-term Follow-up of Renal Function. Urology 2017; 104:225-229. [PMID: 28237532 DOI: 10.1016/j.urology.2017.02.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess long-term renal preservation and surgical outcomes in patients undergoing ureteric substitution with ileum. This has been a mainstay of reconstruction options for lengthy ureteral defects. METHODS Consecutive patients aged 18 or older undergoing ileal ureters at our institution were retrospectively reviewed (from 1989 to June 2013). Patients with <6 months of follow-up were excluded. Demographic, surgical, and renal functional outcomes were reviewed. Renal function was assessed by the Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease Study equations. RESULTS Of the 108 patients meeting the inclusion criteria, 86 (79.6%) had single-renal unit reconstruction and 22 had bilateral reconstruction. Eighty-four (77.8%) had radiation-induced stricture and 24 had iatrogenic or trauma-induced strictures. The median follow-up was 51 months (interquartile range: 22-112). Short-term complications included Clavien grade I (16 [14.8%]), Clavien grade II (3 [2.8%]), Clavien grade III (9 [8.3%]), and Clavien grade IV (3 [2.8%]). Long-term complications included fistula in 6 patients (5.6%), renal failure requiring dialysis in 2 patients (1.9%), hyperchloremic metabolic acidosis in 4 patients (3.7%), and incisional hernia in 11 patients (10.2%). Nine patients (8.3%) had small-bowel obstructions; 3 (2.8%) required adhesiolysis. Four patients (3.7%) had an anastamotic stricture. Nineteen patients (17.6%) had worsening renal function. Cox proportional hazards regression found that those with bilateral repair were at 3.7 times increased risk of worsening renal function (P = .02). CONCLUSION Ureteral substitution with ileum provides an effective and versatile long-term reconstructive option with minimal renal function compromise in properly selected patients. Bilateral reconstruction may contribute to worse long-term renal function.
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8
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EXP CLIN TRANSPLANTExp Clin Transplant 2016; 14. [DOI: 10.6002/ect.2015.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Cheng YT, Flechner SM, Chiang PH. The role of laparoscopy-assisted renal autotransplantation in the treatment of primary ureteral tumor. Ann Surg Oncol 2015; 21:3691-7. [PMID: 25015030 DOI: 10.1245/s10434-013-3382-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND To evaluate the effect and safety of laparoscopy-assisted renal autotransplantation treatment for primary ureteral cancer (PUC). METHODS Medical records of patients undergoing hand-assisted retroperitoneoscopic nephroureterectomy–extracorporeal total ureterectomy–renal autotransplantation–pyelocystostomy (Lap AutoTx) were analyzed. Demographic, intraoperative, and postoperative data were assessed. RESULTS Fifteen patients diagnosed with PUC underwent this novel approach. Three kidneys were abandoned owing to the detection of residual cancer on the renal pelvic junction, surgeon’s judgment on three severe atherosclerotic arteries, and palpable pelvic lymph nodes proven to be evidence of metastatic disease by frozen section analysis. Twelve patients (mean ± SD age 67.5 ± 7.5 years) were treated with Lap AutoTx for PUC successfully. No perioperative mortality occurred. One patient with solitary kidney experienced delayed graft function that required short-term hemodialysis. Three recurrent superficial diseases in three patients were treated with transurethral resection. The mean ± SD follow-up duration was 12.1 ± 6.7 months (range 3–24 months). The renal pelvicaliceal system was easily examined by flexible cystoscopy. CONCLUSIONS Lap AutoTx is less invasive compared with the traditional two-incisional manner and can be performed safely even among elderly patients. Compared with other currently used therapies, this novel treatment can be used to successfully treat PUC with the added advantages of total resection of the ureteral lesion, preservation of the renal function, and simplification of follow-up procedures.Primary ureteral cancer (PUC) is an aggressive disease and has a poor prognosis.1 Studies have shown high prevalence and invasiveness of PUC in Taiwan.2,3 Nephroureterectomy with excision of the bladder cuff is still believed to be the gold standard treatment for PUC.4 Most PUC occurs among individuals aged more than 60 years, and most of these patients are also at high risk of chronic kidney disease (CKD).5,6 Nephroureterectomy not only results in excessive loss of renal function, but also puts the patient at risk of CKD, which contributes to the progression of end-stage renal disease requiring dialysis. In addition, diminished renal function after nephroureterectomy compromises the possible use of adjuvant chemotherapy for advanced disease.Endoscopic surgery (ES) and segmental resection (SR) can be used for renal preservation in PUC cases, but there still are limitations to these approaches, and indefinite invasive ureteroscopy is required during follow-up. Only a few studies have focused on renal autotransplantation (AutoTx) after extracorporeal total ureterectomy (ETU) for PUC. This type of treatment possesses advantages of total resection of malignant ureteral lesions, preservation of renal function, and simplification of follow-up protocols. In two reported case series, all cases involved surgery performed with the traditional 2-incision approach, and only a few cases involved pure PUC.7,8 We have reported that hand-assisted retroperitoneoscopic nephroureterectomy (HARNU) for the treatment of PUC is less invasive and results in better functional outcomes with fewer complications and comparable oncologic control compared with open nephroureterectomy.9 In this study, we report our experience of this treatment combined with ETU and AutoTx for pure PUC.
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Sood A, Jeong W, Ahlawat R, Abdollah F, Sammon JD, Bhandari M, Menon M. Minimally invasive renal autotransplantation. J Surg Oncol 2015; 112:717-22. [PMID: 25995142 DOI: 10.1002/jso.23939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/30/2015] [Indexed: 12/11/2022]
Abstract
Minimally invasive renal allotransplantation techniques have been recently described; reported benefits include reduced morbidity/complications. These benefits have been successfully adapted for minimally invasive renal autotransplantation, however, in a non-oncological setting. We, here, describe a novel alternative robot-assisted renal autotransplantation technique, utilizing GelPOINT, which by permitting ex vivo graft examination and surgery might allow further broadening of indications for minimally-invasive renal autotransplantation, to include complex oncological renal/ureteral lesions. Future studies are needed to evaluate the utility of these techniques.
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Affiliation(s)
- Akshay Sood
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Rajesh Ahlawat
- Kidney and Urology Institute, Medanta-The Medicity, Gurgaon, India
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mahendra Bhandari
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
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Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability. J Urol 2015; 194:738-743. [PMID: 25801764 DOI: 10.1016/j.juro.2015.03.089] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Laparoscopic nephrectomy with autotransplantation is a viable option when renal preservation is required or ureteral reconstruction is impossible. In this study we report on our long-term experience with laparoscopic nephrectomy with autotransplantation. MATERIALS AND METHODS A retrospective review of data from all patients who underwent laparoscopic nephrectomy with autotransplantation since 2000 revealed data for 52 of 59 patients after study exclusions. Indications for laparoscopic nephrectomy with autotransplantation included ureteral stricture disease (41), renal malignancy (7), ptotic kidney (1), chronic flank pain (1), renal artery aneurysm (1) and renovascular hypertension (1). Followup included ultrasonography, nuclear renography and computerized tomography. Complications analyzed were Clavien-Dindo grade III or higher. RESULTS A total of 52 patients (30 women, 57.6%) underwent laparoscopic nephrectomy with autotransplantation at a median age of 48 years (range 12 to 76). At a median followup of 73.5 months 47 patients (90.3%) had long-term function of the autotransplanted renal unit including 3 of 4 (75%) solitary kidneys. There were 5 patients (9.7%) who experienced renal unit failure at a median of 15 months. Of these patients 3 required nephrectomy of autotransplant unit secondary to renal vein thrombosis (1 day), pseudoaneurysm (15 months) and chronic pain (48 months). Overall 4 patients had early complications and 8 had late complications. In the tumor group 4 patients had disease progression and all are alive. CONCLUSIONS Laparoscopic nephrectomy with autotransplantation is an excellent long-term surgical option (greater than 90% success rate with longer than 6-year median followup) for complex ureteral and renal conditions that necessitate preservation of renal parenchyma. However, tumor progression is possible after ex vivo tumor excision. Therefore, careful patient selection and followup are mandatory. This report supports the safety, efficacy and durability of laparoscopic nephrectomy with autotransplantation in experienced hands.
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Abstract
PURPOSE We describe a technique of complete intracorporeal renal autotransplantation with donor nephrectomy and transplantation performed in a minimally invasive fashion without extracting the kidney. MATERIALS AND METHODS We developed this technique of a completely intracorporeal robotic renal autotransplantation and determined the feasibility of this novel procedure. This includes a method of intracorporeal transarterial hypothermic renal perfusion using a perfusion catheter through a laparoscopic port. The procedure was successfully applied in a 56-year-old man with extensive left ureteral loss after failed ureteroscopy for ureterolithiasis. RESULTS Robotic donor nephrectomy was performed with a warm ischemia time of 2.3 minutes. Subsequently cold ischemia was achieved by intracorporeal hypothermic renal perfusion for 95.5 minutes. Vascular anastomoses and ureteroureterostomy in the ipsilateral pelvis were completed after donor nephrectomy with a total overall surgeon console time of 334 minutes. Venous and arterial anastomosis times were 17.3 and 21.3 minutes, respectively. Estimated blood loss was less than 50 ml. There were no complications and the patient was discharged home on postoperative day 1 after normal Doppler transplant renal ultrasound. Postoperative renal scan at 6 weeks, intravenous urogram at 8 weeks and computerized tomography urography at 5 months revealed normal function and successful ureteral reconstruction. CONCLUSIONS We report the feasibility of a technique of a completely intracorporeal robotic renal autotransplantation. This operation may be considered in select patients in the hands of experienced robotic surgeons. However, further refinement is required as this novel procedure is cautiously reproduced and adopted by others.
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Abstract
Pelviureteric junction obstruction (PUJO) of the kidney can lead to a number of different clinical manifestations, which often require surgical intervention. Although the success of pyeloplasty and endopyelotomy are good, there are still a number of patients who fail primary treatment and develop secondary PUJO. These treatment failures can be a challenging cohort to manage. This article aims to provide a comprehensive overview on the surgical options available to the urologist for managing secondary PUJO as well as providing some guidance on assessing factors that will influence management decisions.
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Affiliation(s)
- Alistair Rogers
- Department of Urology, Freeman Hospital, Heaton, Newcastle upon Tyne, NE7 7DN, UK
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Espinosa G, Grochowicz L, Pascual I, Lavilla J, Olavide I, Hernández MD, Landecho MF, Lucena JF, Bastarrika G, Del Pozo JL, Gavira JJ, Alegre F. Renal autotransplant for subsequent endovascular exclusion of the thoracoabdominal aorta. Ann Vasc Surg 2013; 27:974.e1-6. [PMID: 23993115 DOI: 10.1016/j.avsg.2012.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 10/26/2012] [Accepted: 11/14/2012] [Indexed: 10/26/2022]
Abstract
In the last 20 years, endovascular procedures have radically altered the treatment of diseases of the aorta. The objective of endovascular treatment of dissections is to close the entry point to redirect blood flow toward the true lumen, thereby achieving thrombosis of the false lumen. In extensive chronic dissections that have evolved with the formation of a large aneurysm, the dissection is maintained from the end of the endoprosthesis due to multiple orifices, or reentries, that communicate with the lumens. In addition, one of the primary limitations of this technique is when the visceral arteries have disease involvement. In this report we present a case where, despite having treated the entire length of the descending thoracic aorta, the dissection was maintained distally, leading to progression of the diameter of the aneurysm. After reviewing the literature, and to the best of our knowledge, we describe the first case in which renal autotransplant was performed to allow for subsequent exclusion of the aorta at the thoracoabdominal level using a fenestrated endoprosthesis for the celiac trunk and the superior mesenteric artery.
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Affiliation(s)
- Gaudencio Espinosa
- Department of Vascular Surgery, Clínica Universidad de Navarra, Pamplona, Spain
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Basiri A, Majidpour HS, Farrokhi F. Laparoscopy-Assisted Autotransplantation in Child with Renovascular Hypertension. J Endourol 2005; 19:987-9. [PMID: 16253065 DOI: 10.1089/end.2005.19.987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 7-year-old boy with hypertension secondary to intimal hyperplasia of the left renal artery was normotensive after laparoscopic autotransplantation following failed angioplasty. This appears to be the first such case reported.
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Affiliation(s)
- Abbas Basiri
- Urology/Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
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Current World Literature. Curr Opin Urol 2005. [DOI: 10.1097/01.mou.0000160630.81978.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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