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Lee M, Lee Z, Houston N, Strauss D, Lee R, Asghar AM, Corse T, Zhao LC, Stifelman MD, Eun DD. Robotic ureteral reconstruction for recurrent strictures after prior failed management. BJUI COMPASS 2023; 4:298-304. [PMID: 37025480 PMCID: PMC10071084 DOI: 10.1002/bco2.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 02/19/2023] Open
Abstract
Objectives To describe our multi-institutional experience with robotic ureteral reconstruction (RUR) in patients who failed prior endoscopic and/or surgical management. Materials and Methods We retrospectively reviewed our Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database for all consecutive patients who underwent RUR between 05/2012 and 01/2020 for a recurrent ureteral stricture after having undergone prior failed endoscopic and/or surgical repair. Post-operatively, patients were assessed for surgical success, defined as the absence of flank pain and obstruction on imaging. Results Overall, 105 patients met inclusion criteria. Median stricture length was 2 (IQR 1-3) centimetres. Strictures were located at the ureteropelvic junction (UPJ) (41.0%), proximal (14.3%), middle (9.5%) or distal (35.2%) ureter. There were nine (8.6%) radiation-induced strictures. Prior failed management included endoscopic intervention (49.5%), surgical repair (25.7%) or both (24.8%). For repair of UPJ and proximal strictures, ureteroureterostomy (3.4%), ureterocalicostomy (5.2%), pyeloplasty (53.5%) or buccal mucosa graft ureteroplasty (37.9%) was utilized; for repair of middle strictures, ureteroureterostomy (20.0%) or buccal mucosa graft ureteroplasty (80.0%) was utilized; for repair of distal strictures, ureteroureterostomy (8.1%), side-to-side reimplant (18.9%), end-to-end reimplant (70.3%) or appendiceal bypass (2.7%) was utilized. Major (Clavien >2) post-operative complications occurred in two (1.9%) patients. At a median follow-up of 15.1 (IQR 5.0-30.4) months, 94 (89.5%) cases were surgically successful. Conclusions RUR may be performed with good intermediate-term outcomes for patients with recurrent strictures after prior failed endoscopic and/or surgical management.
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Affiliation(s)
- Matthew Lee
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Ziho Lee
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Nicklaus Houston
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - David Strauss
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Randall Lee
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Aeen M. Asghar
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Tanner Corse
- Department of Urology Hackensack Meridian School of Medicine Nutley New Jersey USA
| | - Lee C. Zhao
- Department of Urology New York University Grossman School of Medicine at New York University Langone Medical Center New York New York USA
| | - Michael D. Stifelman
- Department of Urology Hackensack Meridian School of Medicine Nutley New Jersey USA
| | - Daniel D. Eun
- Department of Urology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
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Elaarag M, Alashi H, Aldeeb M, Khalil I, Al-Qudimat AR, Mansour A, Al-Ansari AA, Aboumarzouk OM. Salvage minimally invasive robotic and laparoscopic pyeloplasty in adults: a systematic review. Arab J Urol 2022; 20:204-211. [DOI: 10.1080/2090598x.2022.2082208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Mai Elaarag
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hind Alashi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Maya Aldeeb
- Hamad General Hospital, Hamad Medical Corporation, Qatar, Doha
| | - Ibrahim Khalil
- Hamad General Hospital, Hamad Medical Corporation, Qatar, Doha
| | - Ahmad R. Al-Qudimat
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Hamad General Hospital, Hamad Medical Corporation, Qatar, Doha
| | | | - Abdulla A Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Hamad General Hospital, Hamad Medical Corporation, Qatar, Doha
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Hamad General Hospital, Hamad Medical Corporation, Qatar, Doha
- College of Medicine, Qatar University, Doha, Qatar
- Dentistry and Nursing, the University of Glasgow, Glasgow, UK
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Du T, Qi P, He L, Yang S, Zhang B, Shang P. Comparison of Secondary and Primary Minimally Invasive Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2022; 32:871-883. [PMID: 35319279 DOI: 10.1089/lap.2021.0771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To compare the outcomes of secondary minimally invasive pyeloplasty (MIP) versus primary MIP for the patients with ureteropelvic junction obstruction (UPJO). Materials and Methods: We searched all the literature of PubMed, Web of Science, EMBASE, and Cochrane Library comparing secondary MIP and primary MIP and performed a systematic review and meta-analysis. Results: We included 15 studies involving 1637 patients with 1371 in the primary MIP group and 266 in the secondary MIP group. There were no significant differences in length of hospital stays, and the risk of hematuria, urinary tract infection, intestinal obstruction, stent complications, and overall complications (P > .05). Comparing with the secondary MIP group, the primary MIP group has shorter operative time (mean difference [MD] = -36.91 minutes, 95% confidence interval [CI]: -50.21 to -23.62, P < .00001), less estimated blood loss (MD = -16.70 mL, 95% CI: -31.60 to -1.80, P = .03), lower risk of urinary leakage and injury of blood vessel (relative risk [RR] = 0.32, 95% CI: 0.11-0.93, P = .04) (RR = 0.10, 95% CI: 0.02-0.61, P = .01), and higher success rate (RR = 1.07, 95% CI: 1.02-1.11, P = .003). The robot-assisted pyeloplasty is superior to the laparoscopic pyeloplasty in controlling the amount of blood loss in the secondary operation. Conclusions: Considering the poorer outcomes of secondary surgery, we believe that special attention should be paid to not missing crossing vessels, and it would be more prudent to perform a more definitive procedure with pyeloplasty instead of endopyelotomy for primary UPJO.
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Affiliation(s)
- Tianci Du
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Peng Qi
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Liangzhi He
- Department of Pediatric Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Shujun Yang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Biao Zhang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Panfeng Shang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
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Li X, Zhang J, Shi W, Yang T, Lu R, Zhao X, Chen L. Application of three-dimensional image reconstruction technology based on high-resolution CT in pyeloplasty. Transl Androl Urol 2021; 10:1314-1320. [PMID: 33850765 PMCID: PMC8039617 DOI: 10.21037/tau-21-202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Three-dimensional (3D) image reconstruction technology is widely used in surgical operations for its intuitive visualization. Pyeloplasty requiresprecise cutting and suturing. The reconstruction technology can accurately determine the location and scope of the stenosis at the junction of the renal pelvis and ureter and the relationship with the surrounding vasculature. The purpose of this article is to retrospective evaluate the application value of image reconstruction technology in pyeloplasty based on high-resolution 3D CT images. Methods A total of 20 patients with renal pelvic ureteral junction obstruction admitted to our hospital from August 2019 to August 2020 were selected. In this group, left pyeloplasty was performed in 8 patients and right pyeloplasty in 12 patients. In terms of conditions, there was 1 case with secondary pyeloplasty, 6 cases of patients with kidney stones, 2 cases with renal ectopic blood vessels, 1 case with renal prolapse, 1 case with horseshoe kidney, and 1 case with ureteral polyps. There were 12 males and 8 females, with an average age of 34.65±10.67 years and an average body mass index (BMI) of 22.48±3.03 kg/m2. In all patients, 3D CT reconstruction technology was used to guide the formulation of robot-assisted laparoscopic pyeloplasty plans; verify the consistency between the actual operation and the preoperative planning; and observe the operation time, blood loss, postoperative exhaust time, indwelling drainage tube time, and follow-up for comorbidities. Results The operation was successful in all 20 patients. The actual operation was 100% consistent with the preoperative planning, the operative time was 160.80±63.26 min, the intraoperative blood loss was 47±30.45 mL, the postoperative exhaust time was 1.15±0.37 days, the drainage tube indwelling time was 4.35±1.50 days, and the average follow-up time was 7.95±3.41 months. There were no complications. Conclusions Three-dimensional image reconstruction technology based on high-resolution CT has high clinical application value in the treatment of ureteropelvic junction obstruction (UPJO), which simplifies the operation process and shortens the operation time, and is a valuable tool for auxiliary surgeons in devising the operation plan.
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Affiliation(s)
- Xuechao Li
- Medical School of Chinese PLA, Beijing, China.,Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Jingyun Zhang
- Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Weiqing Shi
- Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Tao Yang
- Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Rongjian Lu
- Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Zhao
- Cheerland Clinical Laboratory Co., Ltd., Beijing, China
| | - Lijun Chen
- Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
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Lee Z, Lee M, Lee R, Koster H, Cheng N, Siev M, Jun M, Munver R, Ahmed M, Zhao LC, Stifelman MD, Eun DD. Ureteral Rest is Associated With Improved Outcomes in Patients Undergoing Robotic Ureteral Reconstruction of Proximal and Middle Ureteral Strictures. Urology 2021; 152:160-166. [PMID: 33639184 DOI: 10.1016/j.urology.2021.01.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To evaluate the effect of ureteral rest on outcomes of robotic ureteral reconstruction. METHODS We retrospectively reviewed all patients who underwent robotic ureteral reconstruction of proximal and/or middle ureteral strictures in our multi-institutional database between 2/2012-03/2019 with ≥12 months follow-up. All patients were recommended to undergo ureteral rest, which we defined as the absence of hardware (ie. double-J stent or percutaneous nephroureteral tube) across a ureteral stricture ≥4 weeks prior to reconstruction. However, patients who refused percutaneous nephrostomy tube placement did not undergo ureteral rest. Perioperative outcomes were compared after grouping patients according to whether or not they underwent ureteral rest. Continuous and categorical variables were compared using Mann-Whitney U and 2-tailed chi-squared tests, respectively; P <.05 was considered significant. RESULTS Of 234 total patients, 194 (82.9%) underwent ureteral rest and 40 (17.1%) did not undergo ureteral rest prior to ureteral reconstruction. Patients undergoing ureteral rest were associated with a higher success rate compared to those not undergoing ureteral rest (90.7% versus 77.5%, respectively; P = .027). Also, patients undergoing ureteral rest were associated with lower estimated blood loss (50 versus 75 milliliters, respectively; p<0.001) and less likely to undergo buccal mucosa graft ureteroplasty (20.1% versus 37.5%, respectively; p=0.023). CONCLUSIONS Implementing ureteral rest prior to ureteral reconstruction may allow for stricture maturation and is associated higher surgical success rates, lower estimated blood loss, and decreased utilization of buccal mucosa graft ureteroplasty.
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Affiliation(s)
- Ziho Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
| | - Matthew Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Randall Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Helaine Koster
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Nathan Cheng
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Michael Siev
- New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Min Jun
- New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Ravi Munver
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Mutahar Ahmed
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Lee C Zhao
- New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Michael D Stifelman
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Daniel D Eun
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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