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Fan S, Han G, Li Z, Wang X, Li X, Xiong S, Li D, Zhang J, Meng C, Zhang P, Yang K, Li X, Zhou L. Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series. BMC Surg 2022; 22:435. [PMID: 36544120 PMCID: PMC9773509 DOI: 10.1186/s12893-022-01885-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Complete intracorporal robotic ileal ureteric replacement is challenging. We aimed to present the surgical technique of robotic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures. METHODS From March 2019 to March 2021, 18 patients underwent robotic ileal ureter replacement with extracorporeal ileal segment preparation by one experienced surgeon. The demographic, perioperative, and follow-up data were recorded. Success was defined as the resolution of the presenting symptom, a stable estimated glomerular filtration rate and unobstructive drainage on imaging examination. RESULTS All 18 surgeries were successfully completed without conversion. The median length of the intestinal tube used was 20 (12-30) cm. The median operative time was 248 (170-450) min, the median estimated blood loss was 50 (10-200) ml, and the median postoperative hospital stay was 7 (5-27) days. At a median follow-up of 16 (13-28) months, all patients were symptom-free. No or mild hydronephrosis was confirmed in 17 patients; 1 patient had moderate hydronephrosis without peristalsis of the ileal ureter. The renal function was stable in all patients. The overall success rate was 100%. Postoperative complications, including 4 cases of urinary infections (Grade I), 1 case of an incision hernia (Grade I), 4 cases of kidney stone formation (Grade I), 6 cases of metabolic acidosis (Grade I), 4 cases of incomplete ileus (Grade II), and 1 case of an incision infection (Grade IIIb). CONCLUSIONS Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation is safe, feasible, and effective for the treatment of long ureteral strictures, especially in high-volume tertiary referral centers with extensive robotic surgery experience capable of managing severe peri-operative complications.
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Affiliation(s)
- Shubo Fan
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - GuanPeng Han
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Zhihua Li
- grid.411472.50000 0004 1764 1621Nursing Department, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Xiang Wang
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Xinfei Li
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Shengwei Xiong
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Dan Li
- grid.411472.50000 0004 1764 1621Nursing Department, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Jun Zhang
- grid.411472.50000 0004 1764 1621Nursing Department, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Chang Meng
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Peng Zhang
- grid.414252.40000 0004 1761 8894Department of Urology, Emergency General Hospital, No. 29, Xibahenanli, Chaoyang District, Beijing, 100028 China
| | - Kunlin Yang
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Xuesong Li
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
| | - Liqun Zhou
- grid.11135.370000 0001 2256 9319Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034 China
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Koszutski T, Smyczek Krakowczyk D, Pastuszka A, Tobor S, Kudela G, Hyla-Klekot L. 28 years of functioning of the ileal ureter - own experience and systematic review. J Pediatr Urol 2021; 17:692-699. [PMID: 34162519 DOI: 10.1016/j.jpurol.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
A SHORT INTRODUCTION Irreversible ureteral damage is a rare and challenging problem for pediatric urologists. Ileal replacement has become one of the limited surgical options for ureteral reconstruction. Only a few papers have examined the results of the ileal ureter and renal function outcomes. Furthermore, there are even fewer papers showing patients with the intestinal ureter, which is used to drain urine from a solitary kidney in early childhood. AN OBJECTIVE To perform a systematic review and analyze available cases of the long-term function of the "neoureter" and differences in the surgical approach. To present the case of a 29-year-old female with a history of ileal replacement of the ureter in a solitary kidney which was performed in this patient at the age of 14 months. STUDY DESIGN PubMed and Scopus were used to search for eligible articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were strictly followed. Based on the titles, abstracts, and full-text reviews, 77 articles were analyzed, of which only 23 were directly related to pediatric cases of our interest. Medical records of the female patient, who has been treated in our center since 1991, were retrospectively described and reviewed. RESULTS Of 23 papers, we identified 75 cases of children who underwent ureteral substitution. The outcomes of the procedure are satisfactory and acceptable. The presented case of the female patient shows a good therapeutic option. CONCLUSION Ileal ureteral reconstruction is a safe and effective therapeutic option (even in a long-term follow-up). Despite many problems and complications, it allows preservation of renal and bladder function and social dryness.
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Affiliation(s)
- T Koszutski
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| | - D Smyczek Krakowczyk
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland.
| | - A Pastuszka
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| | - Sz Tobor
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| | - G Kudela
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| | - L Hyla-Klekot
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
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Grosso AA, DI Maida F, Mari A, Campi R, Crisci A, Vignolini G, Masieri L, Carini M, Minervini A. Totally intracorporeal robotic ileal ureter replacement: focus on surgical technique and outcomes. Minerva Urol Nephrol 2021; 73:532-539. [PMID: 33439579 DOI: 10.23736/s2724-6051.20.04191-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of the present study was to describe our totally intracorporeal robotic ileal ureter replacement technique, reporting perioperative and mid-term results and compare it with previous similar experiences, specifically focusing on technical considerations. METHODS Three patients were submitted to robotic ileal ureter substitution for long ureteral defects in our institution during 2019. The procedures were carried out fully intracorporeally. Two patients received a complete replacement of the urinary tract using an ileal segment, while in one patient the lower ureteral stump was maintained, and an ileal-ureter anastomosis was performed distally. Patients' baseline characteristics, as well as perioperative and mid-term results were collected. A detailed description of the technique is reported and compared with prior similar experiences. RESULTS Median operative time was 270 (range 240-300) min. No Clavien-Dindo complication >2 was collected. All patients experienced a fast return to oral intake and canalization. Antegrade pyelography, performed a 1-month follow-up, revealed full passage of the medium contrast in those patients submitted to complete ileal ureter replacement while, in the third one, stenosis at the level of ileal-ureter anastomoses was found. CONCLUSIONS Robotic ileal ureter replacement can be performed completely intracorporeal with optimal results and limited complication rate, in selected cases. According to our considerations, specific surgical steps are needed to reduce the risks related to this procedure, including avoiding partial ileal substitution.
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Affiliation(s)
- Antonio A Grosso
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy -
| | - Fabrizio DI Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Alfonso Crisci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Masieri
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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Zhu W, Xiong S, Fang D, Hao H, Zhang L, Xiong G, Yang K, Zhang P, Zhu H, Cai L, Li X, Zhou L. Minimally invasive ileal ureter replacement: Comparative analysis of robot-assisted laparoscopic versus conventional laparoscopic surgery. Int J Med Robot 2021; 17:e2230. [PMID: 33533169 DOI: 10.1002/rcs.2230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/22/2020] [Accepted: 01/15/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND This study is an initial comparative analysis of perioperative and intermediate-term functional outcomes between patients who underwent robot-assisted laparoscopic (RALS) or conventional laparoscopic surgery (LS). MATERIALS AND METHODS A total of 25 patients who underwent ileal ureter replacement (10 RALS and 15 LS) were followed by functional cine magnetic resonance urography (MRU) combined with a modified Whitaker test. Also, the characteristics, perioperative data and functional outcomes of the patients were compared. RESULTS The estimated blood loss, postoperative hospital stay and time to oral intake were significantly lower in the RALS group. At the median 14-month follow-up, all the patients showed improved renal function and were symptom-free, with no signs of leakage or stenosis observed by cine MRU combined with a modified Whitaker test. CONCLUSIONS RALS with an extracorporeal bowel resection is feasible and appears to be safe, with quick postoperative recovery and encouraging outcomes.
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Affiliation(s)
- Weijie Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Dong Fang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Gengyan Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Lin Cai
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
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Seetharam Bhat KR, Moschovas MC, Patel VR, Ko YH. The robot-assisted ureteral reconstruction in adult: A narrative review on the surgical techniques and contemporary outcomes. Asian J Urol 2020; 8:38-49. [PMID: 33569271 PMCID: PMC7859418 DOI: 10.1016/j.ajur.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/30/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022] Open
Abstract
Despite the rapid increase in the use of robotic surgery in urology, the majority of ureteric reconstruction procedures are still performed using laparoscopic or open approaches. This is primarily due to uncertainty regarding the advantages of robotic approaches over conventional ones, and the unique difficulty in identifying the specific area of interest due to the lack of tactile feedback from the current robotic systems. However, with the potential benefits of minimal invasiveness, several pioneering reports have been published on robotic surgery in urology. By reviewing the literature on this topic, we aimed to summarize the techniques, considerations, and consistent findings regarding robotic ureteral reconstruction in adults. Robotic applications for ureteral surgery have been primarily reported for pediatric urology, especially in the context of relieving a congenital obstruction in the ureteral pelvic junction. However, contemporary studies have also consistently demonstrated that robotic surgery could be a reliable option for malignant, iatrogenic, and traumatic conditions, which generally occur in adult patients. Nevertheless, the lack of comparative studies on heterogeneous hosts and disease conditions make it difficult to determine the benefit of the robotic approach over the conventional approach in the general population; thus, qualified prospective trials are needed for wider acceptance. However, contemporary reports have demonstrated that the robotic approach could be an alternative option for ureteral construction, even in the absence of haptic feedback, which can be compensated by various surgical techniques and enhanced three-dimensional visualization.
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Affiliation(s)
| | - Marcio Covas Moschovas
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
| | - Vipul R Patel
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
| | - Young Hwii Ko
- Department of Urology, Yeungnam University, Daegu, Republic of Korea
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A Case Report of an Obstructing Ureteral Nephrogenic Adenoma in a Child Managed With Open Ileal Ureter. Urology 2020; 143:231-233. [PMID: 32439556 DOI: 10.1016/j.urology.2020.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 11/22/2022]
Abstract
Nephrogenic adenoma is a rare, benign lesion that can be encountered anywhere along the urinary tract. It is associated with genitourinary trauma, chronic inflammation, genitourinary surgery, renal transplant, urolithiasis, and radiation. In children, these lesions are almost exclusively found in the bladder. However, we report an unusual case of a 15-year-old boy with no prior urologic history who presented with an obstructing right ureteral nephrogenic adenoma that required an ileal ureter interposition and right ureterectomy.
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Common and uncommon features of nephrogenic adenoma revisited. Pathol Res Pract 2019; 215:152561. [PMID: 31358481 DOI: 10.1016/j.prp.2019.152561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 11/24/2022]
Abstract
Nephrogenic adenoma is a common diagnosis in urological pathology that may be challenging for general pathologists. Due to its polymorphic appearance under the microscope, some cases can be misdiagnosed as malignancy and then unnecessarily overtreated. Aside from the typical tubules, cysts and papillae, nephrogenic adenoma may display a broad spectrum of histologic appearances and locations, some of them atypical or unexpected. These unusual and concerning features will have special consideration in this description. The goal of the review is to increase awareness of general pathologists of the varied histology of nephrogenic adenoma.
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Babbar P, Yerram N, Sun A, Hemal S, Murthy P, Bryk D, Nandanan N, Nyame Y, Caveney M, Nelson R, Berglund R. Robot-assisted ureteral reconstruction - current status and future directions. Urol Ann 2018; 10:7-14. [PMID: 29416268 PMCID: PMC5791461 DOI: 10.4103/ua.ua_94_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Robotic surgery in the treatment in certain urological diseases has become a mainstay. With the increasing use of the robotic platform, some surgeries which were historically performed open have transitioned to a minimally invasive technique. Recently, the robotic approach has become more utilized for ureteral reconstruction. In this article, the authors review the surgical techniques for a number of major ureteral reconstuctive surgeries and briefly discuss the outcomes reported in the literature.
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Affiliation(s)
- Paurush Babbar
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Nitin Yerram
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Andrew Sun
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Sij Hemal
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Prithvi Murthy
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Darren Bryk
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Naveen Nandanan
- Division of Urology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Yaw Nyame
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Maxx Caveney
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Ryan Nelson
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Ryan Berglund
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
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