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Hamamoto S, Taguchi K, Kawase K, Unno R, Isogai M, Torii K, Iwatsuki S, Etani T, Naiki T, Okada A, Yasui T. Efficacy of Robot-Assisted Ureteroureterostomy in Patients with Complex Ureteral Stricture after Ureteroscopic Lithotripsy. J Clin Med 2023; 12:7726. [PMID: 38137795 PMCID: PMC10743600 DOI: 10.3390/jcm12247726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Ureteral stricture (US) postureteroscopic lithotripsy (URSL) has emerged as a severe complication with the widespread use of laser technology. Furthermore, managing a complex US is challenging. Therefore, this study evaluated the efficacy of robot-assisted ureteroureterostomy (RAUU) in addressing US post-URSL and analyzed the pathology of transected ureteral tissues to identify the risk factors for US. METHODS we conducted a prospective cohort study on patients who underwent RAUU for URSL-induced US from April 2021 to May 2023. RESULTS A total of 14 patients with a mean age of 49.8 years were included in this study. The mean stricture length on radiography was 22.66 ± 7.38 mm. Nine (64.2%) patients had experienced failure with previous interventions. The overall success rate was 92.9%, both clinically and radiographically, without major complications, at a mean follow-up of 12.8 months. The pathological findings revealed microcalcifications and a loss of ureteral mucosa in 57.1% and 28.6% of patients, respectively. CONCLUSIONS The RAUU technique shows promise as a viable option for US post-URSL in appropriately selected patients despite severe pathological changes in the ureter. Therefore, the migration of microcalcifications to the site of ureteral perforation may be a significant factor contributing to US development.
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Affiliation(s)
- Shuzo Hamamoto
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan; (K.T.); (K.K.); (R.U.); (M.I.); (K.T.); (S.I.); (T.E.); (T.N.); (A.O.); (T.Y.)
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Rossanese M, Giannarini G, Scalia R, Macchione L, Crestani A, Simonato A, Ficarra V. Outcomes and treatment failure after open or robotic ureteral reconstruction for iatrogenic injuries. BJUI Compass 2023; 4:673-679. [PMID: 37818024 PMCID: PMC10560615 DOI: 10.1002/bco2.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/28/2023] [Accepted: 06/04/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives The aim of this study is to assess the aetiology, perioperative outcomes and treatment failure of contemporary patients undergoing open or robot-assisted ureteral reconstruction for iatrogenic injuries. Patients and methods We retrospectively analysed consecutive patients who underwent ureteral reconstruction for iatrogenic injuries at two academic centres 07/2013 and 06/2022. A variety of open or robot-assisted procedures were performed, including uretero-cystoneostomy, Boari bladder flap, uretero-ureterostomy, ileal replacement and pyelo-ureteroplasty. All procedures were performed by a single surgeon with extensive experience in open and robot-assisted surgery and preference-based management. Outcome measures were aetiology, estimated blood loss, length of stay, postoperative complications and treatment failure, defined as upper tract obstruction requiring permanent urinary drainage. We also planned a subgroup analysis comparing the outcomes between open and robot-assisted procedures. Results Fifty-nine patients were included. Most injuries were consequent to endourological procedures (44%). The most frequently performed procedures were uretero-cystoneostomy (49.2%) and Boari bladder flap (32.2%). Forty (67.8%) were open, and 19 (32.2%) were robot-assisted procedures. Major postoperative complications were recorded in seven (11.9%) patients. After a median follow-up of 42 months (interquartile range 12-24), treatment failure was observed in seven (11.9%) cases. Robot-assisted versus open procedures were associated with decreased estimated blood loss (p = 0.01), length of stay (p < 0.001) and treatment failure (0/19 vs. 7/36, p = 0.04). Conclusion In our series of iatrogenic ureteral lesions requiring reconstructive surgery, endourological procedures were the most frequent cause. Major postoperative complications were infrequent, and treatment failure rate was low. The robot-assisted approach was associated with improved perioperative outcomes and lower failure rate compared with open.
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Affiliation(s)
- Marta Rossanese
- Gaetano Barresi Department of Human and Paediatric Pathology, Section of UrologyUniversity of MessinaMessinaItaly
| | | | - Riccardo Scalia
- Department of Surgical Oncological and Stomatological Sciences, Section of UrologyUniversity of PalermoPalermoItaly
| | - Luciano Macchione
- Gaetano Barresi Department of Human and Paediatric Pathology, Section of UrologyUniversity of MessinaMessinaItaly
| | | | - Alchiede Simonato
- Department of Surgical Oncological and Stomatological Sciences, Section of UrologyUniversity of PalermoPalermoItaly
| | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Section of UrologyUniversity of MessinaMessinaItaly
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Yang W, Tang W, Zheng X, Zhang M, Lu X, Chen Z, Ji C, Guo H. Combination of robot-assisted laparoscopy and ureteroscopy for the management of complex ureteral strictures. BMC Urol 2023; 23:161. [PMID: 37828507 PMCID: PMC10571485 DOI: 10.1186/s12894-023-01333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND To summarize the efficacy of combined robot-assisted laparoscopy and ureteroscopy in treating complex ureteral strictures. METHODS Eleven patients underwent combined robot-assisted laparoscopy and ureteroscopy for ureteral strictures between January 2020 and August 2022. Preoperative B-ultrasound, glomerular filtration rate measurement, and intravenous pyelography showed different degrees of hydronephrosis in the affected kidney and moderate to severe stenosis in the corresponding part of the ureter. During the operation, stricture segment resection and end-to-end anastomosis were performed using the da Vinci robot to find the stricture point under the guidance of a ureteroscopic light source in the lateral or supine lithotomy position. RESULTS All the patients underwent robot-assisted laparoscopy and ureteroscopy combined with end-to-end ureterostenosis. There were no conversions to open surgery or intraoperative complications. Significant ureteral stricture segments were found in all patients intraoperatively; however, stricture length was not significantly different from the imaging findings. Patients were followed up for 3-27 months. Two months postoperatively, the double-J stent was removed, a ureteroscopy was performed, the ureteral mucosa at the end-to-end anastomosis grew well, and the lumen was patent in all patients. Furthermore, imaging examination showed that hydronephrosis was significantly improved in all patients, with grade I hydronephrosis in three cases and grade 0 hydronephrosis in eight cases. No recurrence of ureteral stricture was observed in patients followed up for > 1 year. CONCLUSION Robot-assisted laparoscopy combined with ureteroscopy is an effective method for treating complex ureteral strictures and can achieve accurate localization of the structured segment.
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Affiliation(s)
- Wenjin Yang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China
| | - Weinan Tang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210008, China
| | - Xi Zheng
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Mengjie Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Xinyi Lu
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China
| | - Zeqing Chen
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Changwei Ji
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China.
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China.
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Yang K, Pang KH, Fan S, Li X, Osman NI, Chapple CR, Zhou L, Li X. Robotic ureteral reconstruction for benign ureteral strictures: a systematic review of surgical techniques, complications and outcomes : Robotic Ureteral Reconstruction for Ureteral Strictures. BMC Urol 2023; 23:160. [PMID: 37828505 PMCID: PMC10571348 DOI: 10.1186/s12894-023-01313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 08/29/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Robotic ureteral reconstruction (RUR) has been widely used to treat ureteral diseases. To summarize the surgical techniques, complications, and outcomes following RUR, as well as to compare data on RUR with open and laparoscopic ureteral reconstruction. METHODS Our systematic review was registered on the PROSPERO (CRD42022309364) database. The PubMed, Cochrane and Embase databases were searched for publications in English on 06-Feb-2022. Randomised-controlled trials (RCTs) or non-randomised cohort studies with sample size ≥ 10 cases were included. RESULTS A total of 23 studies were included involving 996 patients and 1004 ureters from 13 non-comparative, and 10 retrospective comparative studies. No RCT study of RUR was reported. The success rate was reported ≥ 90% in 15 studies. Four studies reported 85-90% success rate. Meta-analyses for comparative studies showed that RUR had significantly lower estimated blood loss (EBL) (P = 0.006) and shorter length of stay (LOS) (P < 0.001) than the open approach. RUR had shorter operative time than laparoscopic surgery (P < 0.001). CONCLUSIONS RUR is associated with lower EBL and shorter LOS than the open approach, and shorter operative time than the laparoscopic approach for the treatment of benign ureteral strictures. However, further studies and more evidence are needed to determine whether RUR is more superior.
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Affiliation(s)
- Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Karl H Pang
- Division of Urology, Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
- Division of Urology, Queen Mary Hospital, Hong Kong, China
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Nadir I Osman
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christopher R Chapple
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China.
- Institute of Urology, Peking University, Beijing, China.
- National Urological Cancer Center, Beijing, China.
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Heo JE, Kang SK, Lee J, Koh D, Kim MS, Lee YS, Ham WS, Jang WS. Outcomes of single-port robotic ureteral reconstruction using the da Vinci SP ® system. Investig Clin Urol 2023; 64:373-379. [PMID: 37417562 DOI: 10.4111/icu.20230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/19/2023] [Accepted: 04/23/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE The da Vinci SP® robotic system enables three double-jointed wristed instruments and a fully wristed three-dimensional camera to be placed through a single port. This study presents our experience with robot-assisted ureteral reconstruction using the SP system and reports its outcomes. MATERIALS AND METHODS Between December 2018 and April 2022, a single surgeon performed robotic ureteral reconstruction using the SP system in 39 patients: 18 underwent pyeloplasty and 21 received ureteral reimplantation. Demographic and perioperative patient data were collected and analyzed. Radiographic and symptomatic improvements were assessed 3 months after surgery. RESULTS In pyeloplasty group, 12 patients (66.7%) were female and two patients (11.1%) had undergone previous surgery for ureteral obstruction. The median operative time was 152 minutes, the median blood loss was 8 mL, and the median length of stay in hospital was 3 days. There was one case of a complication involving postoperative percutaneous nephrostomy (PCN). In ureteral reimplantation group, 19 patients (90.5%) were female and ten patients (47.6%) had undergone gynecological surgery that caused ureteral obstruction. The median operative time was 152 minutes, the median blood loss was 10 mL, and the median length of stay in hospital was 4 days. We observed one case of open conversion and two cases of complications (colonic serosal tearing and postoperative PCN after ileal ureter replacement). The radiographic results and symptoms successfully improved following both surgeries. CONCLUSIONS Despite adhesion-related complications, the SP system appears to be safe and effective for use in robot-assisted ureteral reconstruction.
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Affiliation(s)
- Ji Eun Heo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ku Kang
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jongsoo Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Koh
- Department of Urology, Konyang University College of Medicine, Daejeon, Korea
| | - Min Seok Kim
- Department of Urology, Chosun University School of Medicine, Gwangju, Korea
| | - Yong Seung Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
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Territo A, Bravo-Balado A, Andras I, Campi R, Pecoraro A, Hevia V, Prudhomme T, Baboudjian M, Gallioli A, Verri P, Charbonnier M, Boissier R, Breda A. Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration. World J Urol 2023; 41:1951-1957. [PMID: 37340277 PMCID: PMC10352153 DOI: 10.1007/s00345-023-04455-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/22/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Ureteral stenosis (US) in kidney transplant (KT) recipients is associated with poorer long-term graft survival. Surgical repair is the standard of care, and endoscopic treatment represents an alternative for stenosis < 3 cm. We aimed to determine the effectiveness and safety of endourological management of US in KT patients and predictors of failure. METHODS A retrospective multicenter study was conducted in four European referral centers, including all KT patients with US managed endoscopically between 2009 and 2021. Clinical success was defined as the absence of upper urinary tract catheterization, surgical repair or transplantectomy during follow-up. RESULTS A total of 44 patients were included. The median time to US onset was 3.5 months (IQR 1.9-10.8), the median length of stricture was 10 mm (IQR 7-20). Management of US involved balloon dilation and laser incision in 34 (79.1%) and 6 (13.9%) cases, respectively, while 2 (4.7%) received both. Clavien-Dindo complications were infrequent (10%); only one Clavien ≥ III complication was reported. Clinical success was 61% at last follow-up visit (median = 44.6 months). In the bivariate analysis, duckbill-shaped stenosis (vs. flat/concave) was associated with treatment success (RR = 0.39, p = 0.04, 95% CI 0.12-0.76), while late-onset stenosis (> 3 months post KT) with treatment failure (RR = 2.00, p = 0.02, 95% CI 1.01-3.95). CONCLUSIONS Considering the acceptable long-term results and the safety of these procedures, we believe that the endoscopic treatment should be offered as a first-line therapy for selected KT patients with US. Those with a short and duckbill-shaped stenosis diagnosed within 3 months of KT seem to be the best candidates.
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Affiliation(s)
- Angelo Territo
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
| | - Alejandra Bravo-Balado
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain.
| | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
| | - Riccardo Campi
- Unit of Urologic Robotic, Minimally-Invasive Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Unit of Urologic Robotic, Minimally-Invasive Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
| | - Vital Hevia
- Hospital Universitario Ramón y Cajal. Alcalá University. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Thomas Prudhomme
- Department of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France
| | - Michael Baboudjian
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
- Department of Urology and Kidney Transplantation, APHM, CHU de La Conception Hospital, 146, Boulevard Baille, 13005, Marseille, France
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
| | - Paolo Verri
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
| | - Mathieu Charbonnier
- Department of Urology and Kidney Transplantation, APHM, CHU de La Conception Hospital, 146, Boulevard Baille, 13005, Marseille, France
| | - Romain Boissier
- Department of Urology and Kidney Transplantation, APHM, CHU de La Conception Hospital, 146, Boulevard Baille, 13005, Marseille, France
| | - Alberto Breda
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
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Veredgorn Y, Savin Z, Herzberg H, Masarwa I, Yossepowitch O, Sofer M. Long-term Indwelling Tandem Polymeric Ureteral Stents for Benign Ureteral Obstruction. J Endourol 2023; 37:516-520. [PMID: 36976787 DOI: 10.1089/end.2022.0798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Objective: To assess the outcome of tandem polymeric internal stents (TIS) for benign ureteral obstruction (BUO). Material and Methods: We conducted a retrospective study that included all consecutive patients treated for BUO by means of TIS in a single tertiary center. Stents were replaced routinely every 12 months or earlier, when indicated. The primary outcome was permanent stent failure, and the secondary outcomes included temporary failure, adverse events, and renal function status. Kaplan-Meier and regression analyses were used to estimate outcomes, and logistic regression was used to assess the association between clinical variables and outcomes. Results: Between July 2007 and July 2021, 26 patients (34 renal units) underwent a total of 141 stent replacements, with median follow-up of 2.6 years (interquartile range [IQR] 0.75-5). Retroperitoneal fibrosis was the leading cause of TIS placement (46%). Permanent failures occurred in 10 (29%) renal units, and the median time to permanent failure was 728 days (IQR 242-1532). There was no association between preoperative clinical variables and permanent failure. Temporary failure occurred in four renal units (12%), which were treated by nephrostomy and eventually returned to TIS. Urinary infection and kidney injury rates were one event for every four and eight replacements, respectively. There was no significant alteration in serum creatinine levels throughout the study (p = 0.18). Conclusion: TIS provides long-term relief for patients with BUO and offers a safe and effective solution for urinary diversion, while avoiding the need for external tubes.
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Affiliation(s)
- Yotam Veredgorn
- Tel-Aviv Sourasky Medical Center, Urology, Weitzman 6 Tel Aviv, Tel-Aviv, Israel, 6423906
| | - Ziv Savin
- Tel-Aviv Sourasky Medical Center, Urology, 6th Weizman street, Tel Aviv, Tel Aviv, Israel, 64239,
| | - Haim Herzberg
- Tel-Aviv Sourasky Medical Center, Urology, Waizman 6 Tel Aviv Israel, Tel-Aviv, Israel, 66389
- Tel Aviv Ichilov-Sourasky Medical Center, 26738, Tel Aviv, Israel, 64239
| | - Ismail Masarwa
- Tel-Aviv Sourasky Medical Center, Urology, Tel-Aviv, Israel
| | | | - Mario Sofer
- Tel Aviv Sourasky Medical Center, 26738, Urology, 6 Weizman St., Tel Aviv, Israel, 64239
- Tel Aviv University Sackler Faculty of Medicine, 58408, Surgery, Tel Aviv, Israel
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Holmes-Martin K, Zhu M, Xiao S, Arab Hassani F. Advances in Assistive Electronic Device Solutions for Urology. Micromachines 2022; 13:mi13040551. [PMID: 35457855 PMCID: PMC9028141 DOI: 10.3390/mi13040551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022]
Abstract
Recent technology advances have led urology to become one of the leading specialities to utilise novel electronic systems to manage urological ailments. Contemporary bladder management strategies such as urinary catheters can provide a solution but leave the user mentally and physically debilitated. The unique properties of modern electronic devices, i.e., flexibility, stretchability, and biocompatibility, have allowed a plethora of new technologies to emerge. Many novel electronic device solutions in urology have been developed for treating impaired bladder disorders. These disorders include overactive bladder (OAB), underactive bladder (UAB) and other-urinary-affecting disorders (OUAD). This paper reviews common causes and conservative treatment strategies for OAB, UAB and OUAD, discussing the challenges and drawbacks of such treatments. Subsequently, this paper gives insight into clinically approved and research-based electronic advances in urology. Advances in this area cover bladder-stimulation and -monitoring devices, robot-assistive surgery, and bladder and sphincter prosthesis. This study aims to introduce the latest advances in electronic solutions for urology, comparing their advantages and disadvantages, and concluding with open problems for future urological device solutions.
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Bausch K, Sauter R, Subotic S, Halbeisen FS, Seifert HH, Feicke A. Long-term outcome of non-antireflux robotic-assisted laparoscopic ureter reimplantation in ureteral obstruction. J Endourol 2022; 36:1183-1191. [PMID: 35262405 DOI: 10.1089/end.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Although robotic-assisted laparoscopic ureter reimplantation (RALUR) is a recognized alternative to open and laparoscopic ureter reimplantation in treating distal ureteral obstruction, there are limited data on long-term efficacy and safety outcomes of non-antireflux RALUR. We assessed patients undergoing RALUR, evaluating operative, functional and safety determinants. MATERIALS AND METHODS All consecutive patients undergoing non-antireflux RALUR between April 2015 and January 2020 were included in this retrospective cohort study. The primary outcome endpoint was recurrent distal ureteral obstruction. RESULTS Mean follow-up was 41.3 months (CI 95%, 33.3-49.2). Among the 26 included patients, none developed recurrent distal ureteral obstruction. Kidney function in terms of serum creatinine level (72.0 vs. 71.0 µmol/L, p=0.988) and glomerular filtration rate (92.0 vs. 91.0 mL/min, p=0.831) was stable between the preoperative period and the last follow-up. Renal pelvis dilatation decreased significantly postoperatively, from grade 2 to grade 0 (p<0.001). Most patients (73.1%) remained free from any clinical symptoms of reflux during the follow-up. The rate of postoperative complications (Clavien-Dindo grade ≥II) was 23.1%. All complications resolved without sequelae. No recurring urinary tract infections were reported. CONCLUSIONS Non-antireflux RALUR appears to be safe and effective in the management of distal ureteral obstruction. There was no recurrent ureteral obstruction after RALUR in our cohort during a mean follow-up of more than 3 years. Non-antireflux reimplantation did not seem to have any notable impact on renal function during the follow-up period.
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Affiliation(s)
- Kathrin Bausch
- University Hospital Basel, 30262, Department of Urology, Spitalstrasse 21, Basel, BS, Switzerland, 4031.,University Hospital Basel, 30262, Urology , Basel, Switzerland, 4031;
| | - Raphael Sauter
- Cantonal Hospital Basel-Landschaft, 367307, Liestal, Basel-Landschaft, Switzerland;
| | - Svetozar Subotic
- Cantonal Hospital Basel-Landschaft, 367307, Urology, Liestal, Basel-Landschaft, Switzerland;
| | | | - Hans H Seifert
- Universitätsspital Basel, 30262, Urology, Basel, Switzerland;
| | - Antje Feicke
- University Hospital Basel, 30262, Department of Urology, Basel, BS, Switzerland;
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Carbonara U, Crocerossa F, Mehrazin R, Campi R, Marchioni M, Morlacco A, Pagliarulo V, Wu Z, Autorino R, Stein RJ, Eun D, Ditonno P, Dal Moro F. Robotic ureteral reimplantation: systematic review and pooled analysis of comparative outcomes in adults. Minerva Urol Nephrol 2022; 74:161-168. [PMID: 35147383 DOI: 10.23736/s2724-6051.21.04558-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The surgical treatment of ureteral strictures in adults represents a challenging procedure for the variability of location, extension, and etiology of the disease. Open ureteral reimplantation (OUR) offered high success rates even when considering complex ureteral disease. The debate for defining the role of robotic in the treatment of adult ureteral disease is still ongoing. The aim of the current systematic review is to provide an updated analysis of the comparative outcomes of robot-assisted UR (RAUR) versus OUR based on the available literature. EVIDENCE ACQUISITION An independent systematic review of the literature was performed from 2010 to 2021. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design search strategies, selection criteria, and evidence reports. The quality of the included studies was determined using the Newcastle-Ottawa scale for nonrandomized controlled trials. Pooled analysis of demographics and clinical characteristics, as well as surgical and postoperative outcomes, was performed. EVIDENCE SYNTHESIS After an initial screening and full-text review, 5 studies published between 2002 and 2021 were identified and included in the analysis. All the studies were observational retrospective case-control studies. Among the 225 patients included in the pooled analysis, 94 (41.8%) and 131 (58.2%) were RAUR and OUR, respectively. There was no difference between groups in terms of baseline characteristics. No differences in surgical approach and operative time were reported among the groups. Estimated blood loss was lower for robotic approach (WMD: -121.71ml; p=0.0006). There were no significant differences between groups in overall (OR: 0.85; p=0.69) and major (OR:0.69; p=0.52) complication. RAUR group reported shorter length of stay (WMD: -2.39day; p<0.00001), catheter (WMD: -5.26day; p=0.004) and stent (WMD: -11.9day; p=0.001) time. CONCLUSIONS Available evidence shows that RAUR offers similar surgical outcomes if compared to OUR, and potential advantages in terms of lower blood loss, shorter hospital stay, catheter, and stent time. The adoption of one approach over the other is likely to be mainly dictated by the surgeon's preference and expertise.
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Affiliation(s)
- Umberto Carbonara
- Division of Urology, VCU Health, Richmond, VA, USA - u.carbonaragmail.com.,Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy - u.carbonaragmail.com
| | - Fabio Crocerossa
- Division of Urology, VCU Health, Richmond, VA, USA.,Department of Urology, Magna Graecia University, Catanzaro, Italy
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Chieti, Italy
| | - Alessandro Morlacco
- Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Vincenzo Pagliarulo
- Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China 11 Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Robert J Stein
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | | | - Pasquale Ditonno
- Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Fabrizio Dal Moro
- Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
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11
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Kostakopoulos NA, Kastora S, Dimitropoulos K, Athanasiadis G. A novel tattooing technique for ureteric strictures in Robotic Ureteroureterostomy. A non inferiority analysis. BJU Int 2022; 129:460-462. [PMID: 35044084 PMCID: PMC9306818 DOI: 10.1111/bju.15687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/04/2021] [Accepted: 01/02/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Nikolaos A Kostakopoulos
- Aberdeen Royal Infirmary Department of Urology NHS Grampian Aberdeen United Kingdom
- University of Aberdeen School of Medicine and Medical Sciences
| | | | - Konstantinos Dimitropoulos
- Aberdeen Royal Infirmary Department of Urology NHS Grampian Aberdeen United Kingdom
- University of Aberdeen School of Medicine and Medical Sciences
| | - Grigorios Athanasiadis
- Aberdeen Royal Infirmary Department of Urology NHS Grampian Aberdeen United Kingdom
- University of Aberdeen School of Medicine and Medical Sciences
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12
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Zhu W, Zhu Z, Li Z, Li X, Zhang J, Xu Y, Wang X, Zhang P, Huang B, Huang C, Zhang D, Zhu H, Li X, Lin J, Zhou L. A ureteral stricture disease score and classification system: correlation with upper urinary tract reconstructive surgery complexity. Transl Androl Urol 2021; 10:3745-3755. [PMID: 34804818 PMCID: PMC8575562 DOI: 10.21037/tau-21-575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/02/2021] [Indexed: 11/15/2022] Open
Abstract
Background To develop an original and standardized ureteral stricture disease (USD) score and classification system for quantifying ureter stricture characteristics, assessing complexity of the minimally invasive upper urinary tract reconstructive (UUTR) surgical procedure, formulating preoperative plans, and offering objective comparisons of surgical techniques between different institutions and surgeons. Methods We retrospectively reviewed a test set of 64 patients and a validation set of 170 patients who underwent minimally invasive UUTR surgery from January 2018 to January 2021. Three factors were selected to be included in the USD score and classification system: (I) stricture etiology (E, 1–2 points); (II) stricture segment (S, 0–3 points); and (III) length of stricture (L, 1–5 points). The UUTR surgery involves low-complex surgeries (cystoscopy with ureteral dilation and stent placement, ureteropyeloplasty, end to end repair, ureteral reimplantation) and high-complex surgeries (onlay repair (buccal mucosae, lingual mucosae, appendix mucosae), Boari flap repair and ileal ureter replacement). Estimated blood loss and operative time were used as surrogate indicators of surgical complexity. Results The interrater reliability of the USD score and classification system was 0.908. A linear relationship between the USD score and estimated blood loss was observed (rs =0.676, P<0.001). The USD score was also correlated with operative time (rs =0.638, P<0.001). A significant difference in USD scores was found between the high and low complexity surgery groups (4 vs. 7, P<0.001). Variability of UUTR surgery is based on USD classification system, but with regularity to conform to. Conclusions The USD score and classification system is a concise, easily applicable, and validated scale to delineate the clinically significant features of ureter stricture that correlate with the complexity of the UUTR surgical procedure. The use of this score and classification system can facilitate preoperative plan and comparison of USD treatments in clinical practice and urological literature. Research with large sample is needed to further examine and modify the use of the system.
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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
| | - Zhenpeng Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Jianye Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Yangyang Xu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Xiang Wang
- 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
| | - Bingwei Huang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Chen Huang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Dengxiang Zhang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Jian Lin
- 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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13
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O'Rourke TK, Gn M, Patel HV, Fakes C, Jones N, Cancian M, Elsamra SE. The Urologist and the Appendix: A Review of Appendiceal Use in Genitourinary Reconstructive Surgery. Urology 2021; 159:10-15. [PMID: 34695504 DOI: 10.1016/j.urology.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022]
Abstract
Recently, genitourinary reconstruction has experienced a renaissance. Over the past several years, there has been an expansion of the literature regarding the use of buccal mucosa for the repair of complex ureteral strictures and other pathologies. The appendix has been an available graft utilized for the repair of ureteral stricture disease and has been infrequently reported since the early 1900s. This review serves to highlight the use of the appendix for reconstruction in urology, particularly focusing on the anatomy and physiology of the appendix, historical use, and current applications, particularly in robotic upper tract reconstruction.
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Affiliation(s)
- Timothy K O'Rourke
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Martus Gn
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Hiren V Patel
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Christina Fakes
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nyasia Jones
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Madeline Cancian
- Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sammy E Elsamra
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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14
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Liu Y, Wu M, Wang W, Zhan X, Peng J, An N. Retrospective Analysis of the Efficacy of Da Vinci Robot-Assisted Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction in Children. J Healthc Eng 2021; 2021:5398858. [PMID: 34659688 DOI: 10.1155/2021/5398858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/24/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
Ureteropelvic junction obstruction (UPJO) is one of the common causes of hydronephrosis in children, and the purpose of this study was to observe the application effect of da Vinci robot-assisted laparoscopic treatment of UPJO and to investigate the safety, feasibility, and advantages of da Vinci robot-assisted laparoscopic surgery. 13 patients who underwent robot-assisted pyeloplasty (RAP) for UPJO admitted from May 2020 to March 2021 were retrospectively analyzed in our study. The clinical data among them revealed the intraoperative and postoperative indicators and complications as follows. UPJO was found on the left side in 9 patients and on the right side in 4 patients. The average operative time, blood loss, and hospital stay were 227.3 (175-310) min, 9.2 (5-30) mL, and 9.2 (6-14) days, respectively. Two cases of gross hematuria and two cases of minor urinary tract infection occurred after surgery, and the rest had no perioperative complications. The clinical treatment efficiency at postoperative follow-up was 100%. Our initial analysis showed that da Vinci robot-assisted laparoscopic surgery is a highly effective and safe option for the treatment of UPJO in children.
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15
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Hebert KJ, Linder BJ, Gettman MT, Ubl D, Habermann EB, Lyon TD, Ziegelmann MJ, Viers BR. Contemporary Analysis of Ureteral Reconstruction 30-Day Morbidity Utilizing the National Surgical Quality Improvement Program (NSQIP) Database: Comparison of Minimally Invasive Versus Open Approaches. J Endourol 2021; 36:209-215. [PMID: 34663084 DOI: 10.1089/end.2021.0242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To characterize 30-day morbidity of upper ureteral reconstruction (UUR) and lower ureteral reconstruction (LUR) surgery by comparing open and minimally invasive surgery (MIS) approaches using a national surgical outcomes registry. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent UUR and LUR between 2007-2017. Primary endpoints included 30-day complications, transfusion, readmission, return to operating room (ROR), and prolonged postoperative length of stay (LOS). Multivariable logistic regression was performed to observe the association of MIS approach on 30-day outcomes. RESULTS 3042 patients were identified with 2116 undergoing UUR and 926 undergoing LUR. Of 2116 patients undergoing UUR, 1733 (82%) were performed via MIS approach. On multivariable analysis, open approach for UUR was associated with increased odds of any 30-day complication (odds ratio (OR) 1.6 [1.1-2.4]; p=0.014), major complication (OR 1.8 [1.04-3.0]; p=0.034), transfusion (OR 3.7 [1.2- 11.5]; p=0.025), ROR (OR 2.0 [1.0-3.9]; p=0.047), and prolonged LOS (OR 5.4 [3.9-7.6]; p<0.001). Of the 926 patients undergoing LUR, 458 (49%) were performed via a MIS approach. On multivariable analysis, open approach for LUR was associated with increased odds of any 30-day complication (OR 1.5 [1.1-2.1]; p=0.028), minor complication (OR 1.7 [1.1-2.6]; p=0.02), transfusion (OR 8.1 [2.7-23.7]; p<0.001), and prolonged LOS (OR 4.2 [2.4-7.3]; p<0.001). CONCLUSION Utilization of a national surgical database revealed an open approach was associated with increased 30-day morbidity across multiple postoperative outcome measures. These findings suggest a MIS approach should be considered, when feasible, for upper and lower ureteral reconstruction.
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Affiliation(s)
- Kevin J Hebert
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian J Linder
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel Ubl
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Department of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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16
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Wang J, Zhang B, Fan J, Cheng S, Fan S, Yin L, Li Z, Guan H, Yang K, Li X. The application of the "omental wrapping" technique with autologous onlay flap/graft ureteroplasty for the management of long ureteral strictures. Transl Androl Urol 2021; 10:2871-2878. [PMID: 34430389 PMCID: PMC8350257 DOI: 10.21037/tau-21-305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022] Open
Abstract
Background To present our experience with the "omental wrapping" technique in laparoscopic and robotic ureteroplasty using onlay flaps or grafts for the management of long proximal or middle ureteral strictures. Methods This is a retrospective review of 25 patients with long proximal or middle ureteral strictures who underwent laparoscopic and robotic onlay flaps or grafts ureteroplasty using an omental flap to reinforce an anastomosis site between August 2018 and November 2019. Perioperative and follow-up data were collected. Results Sixteen laparoscopic procedures and nine robotic procedures were performed successfully. Sixteen patients underwent ureteroplasty with lingual mucosal graft (LMG), and nine patients with appendiceal onlay flap (AOF). The median stricture length was 4 cm (range, 2-6 cm). The mean operative time (OT) was 220.5±50.6 min, the estimated blood loss (EBL) was 66.0±38.9 mL, and the length of hospital stay (LHS) was 8.0±3.6 days. In the LMG group, four patients had tongue numbing and one had an oral ulcer, which relieved itself gradually without intervention. Two patients in the LMG group and four patients in the AOF group experienced urinary tract infection, and all responded well to antibiotic treatment. There were no complications attributed to "omental wrapping". The mean follow-up was 16.3±4.8 months. According to the standards regarding improvement in clinical symptoms, relief of obstruction radiologically and a stable estimate glomerular filtration rate, our surgical success rate was 100%. Conclusions The "omental wrapping" technique in laparoscopic and robotic onlay flaps or grafts ureteroplasty for long proximal or middle ureteral strictures is an efficient, safe, reproducible and simple technique.
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Affiliation(s)
- Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Baiyu Zhang
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Sida Cheng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Lu Yin
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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17
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Kosber RL, Ha AS, Kurtzman JT, Blum R, Brandes SB. Hospital Ownership, Geographic Region, Patient Age, Comorbidities and Insurance Status Appear to Influence Patient Selection Robotic-Assisted Ureteral Reimplantation for Benign Disease: A Population-Based Analysis. J Endourol 2021; 36:224-230. [PMID: 34278805 DOI: 10.1089/end.2021.0415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Robotic-assisted ureteral reimplantation (RAUR) is a relatively new minimally-invasive surgery. As such, research is lacking, and the largest adult cohort studies include fewer than 30 patients. Our aim was to be the first population-based study to report on national utilization trends, factors associated with patient selection, inpatient outcomes, and the relative cost of RAUR for adults with benign ureteral disease (BUD). MATERIALS AND METHODS The National Inpatient Sample (2010-2015) was queried to identify all elective, non-transplant related, open and robotic-assisted reimplants for adult BUD. Survey-weighted logistic regression using Akaike Information Criterion identified patient-/hospital-level factors associated with robotic surgery. Survey-weighted regression models examined the association of robotic surgery with outcomes and charges. RESULTS A weighted-total of 9,088 cases were included: 1,688 (18.6%) robotic-assisted and 7,400 (81.4%) open. There were significantly increased odds of RAUR across consecutive years (OR 3.0, p < 0.001) and among patients operated on at private for-profit hospitals (OR 2.1; p = 0.01), but significantly decreased odds among older patients (OR 0.98, p < 0.001), those with Medicaid (OR 0.5, p = 0.02), those with 2+ comorbidities (OR 0.6, p = 0.009) and those operated on in Western (OR 0.5; p = 0.005) states. RAUR was significantly associated with a reduced length-of-stay (IRR: 0.60; p <0.001), decreased odds of blood transfusion (OR: 0.40; p <0.001) and a lower mean ratio of total hospital charges (Ratio: 0.71; p = 0.006). CONCLUSIONS This is the first population-based study to report on the utilization and clinical benefits of RAUR for adult BUD. Open reimplantation remains the most common surgical technique utilized, despite the potential benefits of RAUR. Future research is needed to explore the mechanisms behind patient-/hospital-level factors and surgical selection. Work to investigate potential barriers in access to robotic surgery can help us provide equitable care across patient populations.
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Affiliation(s)
- Rashed L Kosber
- Columbia University Irving Medical Center, 21611, Urology, New York, New York, United States;
| | - Albert Sangji Ha
- Columbia University Irving Medical Center, 21611, Urology, Herbert Irving Pavilion, 11th floor, 161 Fort Washington Avenue, New York, New York, New York, United States, 10032-3784;
| | - Jane T Kurtzman
- Columbia University Irving Medical Center, 21611, Urology, 161 Fort Washington Avenue, 11th Floor, New York, New York, New York, United States, 10032-3784;
| | - Ruth Blum
- Columbia University Irving Medical Center, 21611, Urology, New York, New York, United States;
| | - Steven B Brandes
- Columbia University Irving Medical Center, 21611, Urology, New York, New York, United States;
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18
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Carbonara U, Branche B, Cisu T, Crocerossa F, Guruli G, Grob MB, Roseman T, Hampton LJ, Autorino R. ROBOT-ASSISTED URETERAL REIMPLANTATION: A SINGLE CENTER COMPARATIVE STUDY. J Endourol 2021; 35:1504-1511. [PMID: 34098751 DOI: 10.1089/end.2021.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To report a single-center experience with robot-assisted ureteral reimplantation (RAUR) and to compare its outcomes with those of open ureteral reimplantation (OUR). MATERIALS AND METHODS Patients who underwent RAUR or OUR for ureteral disease between 2016 and 2020 were identified. Data collected included baseline, pathological, perioperative and postoperative features. The RAUR outcomes were compared with those of OUR. RESULTS Overall, twenty-one (42.8%) patients underwent RAUR, and 28 (57.2%) underwent OUR. The two groups were similar in terms of baseline and pathological characteristics. There was a statistically significant difference in favor of RAUR for median operative time (216 vs. 317min, p=0.01) and median blood loss (35 vs. 175ml, p=0.001). No difference was observed in overall complication rate (33.3 vs. 46.4%, p=0.9), as well as major complications (Clavien-Dindo≥III grade) rate between RAUR and OUR groups. Median LOS was shorter for RAUR (2 vs. 6 days; p=0.001), as well as median catheterization time (16 vs. 28 days; p=0.005). CONCLUSIONS RAUR is a safe and effective minimally invasive surgical procedure for the management of mid to distal ureteral strictures. It can recapitulate the success rate of the gold standard OUR while offering a benefit in terms of lower surgical morbidity and faster postoperative recovery.
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Affiliation(s)
- Umberto Carbonara
- Virginia Commonwealth University Health System, 6887, Department of Urology, 11200 E BROAD ST, RICHMOND, Richmond, Virginia, United States, 23233.,Università degli Studi di Bari Aldo Moro, 9295, Department of Urology, Bari, Puglia, Italy;
| | | | - Theodore Cisu
- VCU Health, 6887, Richmond, Virginia, United States;
| | - Fabio Crocerossa
- Virginia Commonwealth University Health System, 6887, Department of Urology, 1200 E Broad St., Richmond, Virginia, United States, 23298;
| | - Georgi Guruli
- VCU Health, 6887, Richmond, Virginia, United States;
| | - Mayer B Grob
- VCU Health, 6887, Richmond, Virginia, United States;
| | - Tyler Roseman
- VCU Health, 6887, Richmond, Virginia, United States;
| | | | - Riccardo Autorino
- Virginia Commonwealth University Health System, 6887, Surgery (Urology), 1200 East Broad st, Richmond, Virginia, United States, 23298;
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19
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Gn M, Sterling J, Sinkin J, Cancian M, Elsamra S. The Expanding Use of Buccal Mucosal Grafts in Urologic Surgery. Urology 2021; 156:e58-e65. [PMID: 34097942 DOI: 10.1016/j.urology.2021.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/07/2021] [Accepted: 05/27/2021] [Indexed: 12/21/2022]
Abstract
The advent and success of buccal mucosal grafts as a substitution material in the urinary tract has changed the landscape of reconstructive urology. Due to its ease to harvest, low morbidity, and advantageous properties, there has been a growing number of applications for buccal mucosal grafts in upper and lower urinary tract reconstruction as well as genital reconstruction. In this article, we review the historical application and the evolution of buccal mucosal grafts and provide an up-to-date review on its utilization in urologic procedures.
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Affiliation(s)
- Martus Gn
- Department of Urology, Warren Alpert Medical School, Providence, RI.
| | - Joshua Sterling
- Department of Urology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jeremy Sinkin
- Department of Plastic Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Madeline Cancian
- Department of Urology, Warren Alpert Medical School, Providence, RI
| | - Sammy Elsamra
- Department of Urology, Robert Wood Johnson Medical School, New Brunswick, NJ
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20
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Dell'Oglio P, Palagonia E, Wisz P, Andras I, De Groote R, Poelaert F, Beato S, Goossens M, Schatteman P, D'Hondt F, De Naeyer G, Mazzone E, Mottrie A. Robot-assisted Boari flap and psoas hitch ureteric reimplantation: technique insight and outcomes of a case series with ≥1 year of follow-up. BJU Int 2021; 128:625-633. [PMID: 33829630 DOI: 10.1111/bju.15421] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe step-by-step surgical techniques and report outcomes of the largest single-centre series of patients with distal ureteric disease exclusively treated with robot-assisted ureteric reimplantation with Boari flap (RABFUR) and psoas hitch (RAPHUR), with a minimum follow-up of 1 year and complete postoperative data. PATIENTS AND METHODS A total of 37 patients with distal ureteric disease were treated between 2010 and 2018. Of these, 81% and 19% underwent RAPHUR and RABFUR, respectively. Intra-, peri- and postoperative outcomes were assessed. The 90-day postoperative complications were reported according to the standardised methodology proposed by the European Association of Urology Ad Hoc Panel. Functional outcomes (creatinine, estimated glomerular filtration rate [eGFR]) and postoperative symptoms (visual analogue pain scale) were assessed. RESULTS The median operating time and blood loss were 180 min and 100 mL, respectively. There were no conversions to open surgery and no intraoperative transfusions. The median length of stay, bladder catheter indwelling time and stent removal were 4, 7 and 30 days, respectively. The median follow-up was 24 months. Overall, 10 patients (27%) had postoperative complications and of these, eight (22%) and two (5.4%) were Clavien-Dindo Grade I-II and III, respectively. At the last follow-up, the median postoperative creatinine level and eGFR were 0.9 mg/dL and 73.5 mL/min/1.73 m2 , respectively. At the last follow-up, five (13.5%) and three (8%) patients had Grade 1 hydronephrosis and mild urinary symptoms, respectively. The study limitations include its retrospective nature. CONCLUSION In the present study, we present our RABFUR and RAPHUR techniques. We confirm the feasibility and safety profile of both approaches in patients with distal ureteric disease relying on the largest single-centre series with ≥1 year of follow-up.
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Affiliation(s)
- Paolo Dell'Oglio
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erika Palagonia
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Department of Urology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Pawel Wisz
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | | | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Filip Poelaert
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | | | - Marijn Goossens
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Peter Schatteman
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Elio Mazzone
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
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Kapogiannis F, Spartalis E, Fasoulakis K, Tsourouflis G, Dimitroulis D, Nikiteas NI. Laparoscopic and Robotic Management of Ureteral Stricture in Adults. In Vivo 2021; 34:965-972. [PMID: 32354881 DOI: 10.21873/invivo.11864] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM The aim of this review was to provide an update on the status of minimal invasive treatment of ureteral stricture either with a laparoscopic or robotic surgery. MATERIALS AND METHODS Eligible studies, published until November 2019 were retrieved through Medline, Cochrane and Pubmed databases. Predetermined inclusion and exclusion criteria were used as selection method for data synthesis and acquisition. The study was performed in accordance with the PRISMA statement. RESULTS A total of 19 retrospective studies met the inclusion criteria. All of them demonstrated the safety, feasibility and success of both laparoscopic and robotic ureteral reconstruction. Individual case series or cumulative comparison analysis of the available studies showed at least equivalent success rates and a trend favoring laparoscopic and robotic groups in terms of estimated blood loss and length of hospital stay to the detriment of longer operative times and possibly higher cost. CONCLUSION Current evidence suggests the effectiveness, safety and increasing incorporation of minimally invasive techniques for complex stricture repair and reconstruction.
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Affiliation(s)
- Filippos Kapogiannis
- Department of Urology, Hippokrateion Hospital, Athens, Greece .,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gerasimos Tsourouflis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos I Nikiteas
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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23
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Lee M, Lee Z, Koster H, Jun M, Asghar AM, Lee R, Strauss D, Patel N, Kim D, Komaravolu S, Drain A, Metro MJ, Zhao L, Stifelman M, Eun DD. Intermediate-term outcomes after robotic ureteral reconstruction for long-segment (≥4 centimeters) strictures in the proximal ureter: A multi-institutional experience. Investig Clin Urol 2020; 62:65-71. [PMID: 33258325 PMCID: PMC7801167 DOI: 10.4111/icu.20200298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/24/2020] [Accepted: 08/06/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose To report our intermediate-term, multi-institutional experience after robotic ureteral reconstruction for the management of long-segment proximal ureteral strictures. Materials and Methods We retrospectively reviewed our Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database to identify all patients who underwent robotic ureteral reconstruction for long-segment (≥4 centimeters) proximal ureteral strictures between August 2012 and June 2019. The primary surgeon determined the specific technique to reconstruct the ureter at time of surgery based on the patient's clinical history and intraoperative findings. Our primary outcome was surgical success, which we defined as the absence of ureteral obstruction on radiographic imaging and absence of obstructive flank pain. Results Of 20 total patients, 4 (20.0%) underwent robotic ureteroureterostomy (RUU) with downward nephropexy (DN), 2 (10.0%) underwent robotic ureterocalycostomy (RUC) with DN, and 14 (70.0%) underwent robotic ureteroplasty with buccal mucosa graft (RU-BMG). Median stricture length was 4 centimeters (interquartile range [IQR], 4–4; maximum, 5), 6 centimeters (IQR, 5–7; maximum, 8), and 5 centimeters (IQR, 4–5; maximum, 8) for patients undergoing RUU with DN, RUC with DN, and RU-BMG, respectively. At a median follow-up of 24 (IQR, 14–51) months, 17/20 (85.0%) cases were surgically successful. Two of four patients (50.0%) who underwent RUU with DN developed stricture recurrences within 3 months. Conclusions Long-segment proximal ureteral strictures may be safely and effectively managed with RUC with DN and RU-BMG. Although RUU with DN can be utilized, this technique may be associated with a higher failure rate.
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Affiliation(s)
- Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
| | - Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Helaine Koster
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Minsuk Jun
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY, USA
| | - Aeen M Asghar
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Randall Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - David Strauss
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Neel Patel
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Daniel Kim
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Sreeya Komaravolu
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Alice Drain
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY, USA
| | - Michael J Metro
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Lee Zhao
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY, USA
| | - Michael Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Diana P, Buffi NM, Lughezzani G, Dell’Oglio P, Mazzone E, Porter J, Mottrie A. The Role of Intraoperative Indocyanine Green in Robot-assisted Partial Nephrectomy: Results from a Large, Multi-institutional Series. Eur Urol 2020; 78:743-749. [DOI: 10.1016/j.eururo.2020.05.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/27/2020] [Indexed: 12/23/2022]
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26
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Cheng S, Fan S, Wang J, Xiong S, Li X, Xu Y, Li Z, Guan H, Zhang P, Zhu H, Huang C, Zhang L, Yang K, Li X, Zhou L. Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy. Int Urol Nephrol 2020; 53:479-488. [PMID: 33037521 DOI: 10.1007/s11255-020-02679-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios. METHODS From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2-6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures. RESULTS A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2-6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time (P = 0.008), shorter postoperative hospital stay (P = 0.011) but higher hospital cost (P < 0.001). At a mean follow-up of 12.8 months, the overall success rate was 94.3%. There was no difference in postoperative complications or the success rate between the approaches. CONCLUSION Laparoscopic and robotic onlay flap/graft ureteroplasty can be safe and feasible to repair long proximal/middle ureteral strictures while robotic procedures showed higher efficiency, faster recovery but higher cost. Our algorithmic strategies may provide beneficial references for their standardization and dissemination into clinical care.
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Affiliation(s)
- Sida Cheng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Jie Wang
- Department 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
- Department 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
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Yangyang Xu
- Department 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
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Hua Guan
- Department 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
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Chen Huang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kunlin Yang
- Department 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
- Department 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
- Department 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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Ficarra V, Rossanese M, Crestani A, Caloggero S, Alario G, Novara G, Giannarini G, Valotto C. A Contemporary Case Series of Complex Surgical Repair of Surgical/Endoscopic Injuries to the Abdominal Ureter. Eur Urol Focus 2020; 7:1476-1484. [PMID: 32814683 DOI: 10.1016/j.euf.2020.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/14/2020] [Accepted: 07/24/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Iatrogenic ureteral injuries are devastating complications potentially resulting in irreversible impairment of renal function and/or infectious sequelae. Only few data are available on the management of such injuries to the abdominal ureter. OBJECTIVE To report the etiology, perioperative outcomes, and treatment failure rate of different reconstructive surgical interventions for iatrogenic injuries to the abdominal ureter in a contemporary case series. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed consecutive patients who underwent reconstructive surgery for iatrogenic injuries to the abdominal ureter at our academic centers between July 2013 and April 2019. All interventions were performed via either an open or a robot-assisted approach by a single expert surgeon. SURGICAL PROCEDURE Different surgical reconstructive procedures, such as Boari bladder flap, ureteroureterostomy, ileal replacement, and pyeloureteroplasty, have been adopted. MEASUREMENTS Outcome measures were the etiology of iatrogenic injuries, rate of postoperative complications, and rate of treatment failure, defined as upper urinary tract obstruction requiring permanent urinary drainage. RESULTS AND LIMITATIONS Nineteen patients were included. Injuries were consequent to endourological procedures in nine (47.4%), gynecological procedures in two (10.5%), colonic surgery in two (10.5%), vascular surgery in two (10.5%), and other surgeries in four (21.1%) cases. Boari bladder flap was performed in 12 (63.2%), ureteroureterostomy in two (10.5%), ileal substitution in two (10.5%), and pyeloureteroplasty in three (15.8%) cases. Only four (21.1%) procedures were performed robotically. Major postoperative complications were recorded in three (15.8%) patients. After a median follow-up of 16 (interquartile range 12-24) mo, treatment failure was observed in two (15.8%) cases. We accept the limitations of a small retrospective single-surgeon series with preference-based management choice. CONCLUSIONS In our series, endourological procedures were the most frequent cause of iatrogenic injuries to the abdominal ureter requiring reconstructive surgery. A Boari bladder flap was the preferred option to bridge extensive ureteral defects. Despite the complexity of such procedures, major postoperative complications were infrequent and treatment failure rate was low. PATIENT SUMMARY We report on a contemporary series of patients with disparate iatrogenic injuries to the abdominal ureter requiring complex reconstructive surgery. Despite the difficulty of such procedures, we found that major postoperative complications were infrequent and treatment failure rate was low.
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Affiliation(s)
- Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy.
| | - Marta Rossanese
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | | | | | - Giuseppe Alario
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology and Gastroenterology, Urology Unit, University of Padua, Padua, Italy
| | - Gianluca Giannarini
- Urology Unit, "Santa Maria della Misericordia" Academic Medical Centre, Udine, Italy
| | - Claudio Valotto
- Urology Unit, "Santa Maria della Misericordia" Academic Medical Centre, Udine, Italy
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Lee Z, Lee M, Koster H, Lee R, Cheng N, Jun M, Slawin J, Zhao LC, Stifelman MD, Eun DD. A Multi-Institutional Experience With Robotic Ureteroplasty With Buccal Mucosa Graft: An Updated Analysis of Intermediate-Term Outcomes. Urology 2020; 147:306-310. [PMID: 32798516 DOI: 10.1016/j.urology.2020.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To update our prior multi-institutional experience with robotic ureteroplasty with buccal mucosa graft and analyze our intermediate-term outcomes. Although our previous multi-institutional report provided significant insight into the safety and efficacy associated with robotic ureteroplasty with buccal mucosa graft, it was limited by small patient numbers. METHODS We retrospectively reviewed our multi-institutional database to identify all patients who underwent robotic ureteroplasty with buccal mucosa graft between October 2013 and March 2019 with ≥12 months follow up. Indication for surgery was a complex proximal and/or middle ureteral stricture not amenable to primary excision and anastomosis secondary to stricture length or peri-ureteral fibrosis. Surgical success was defined as the absence of obstructive flank pain and ureteral obstruction on functional imaging. RESULTS Of 54 patients, 43 (79.6 %) patients underwent an onlay, and 11 (20.4%) patients underwent an augmented anastomotic robotic ureteroplasty with buccal mucosa graft. Eighteen of 54 (33.3%) patients previously failed a ureteral reconstruction. The median stricture length was 3.0 (IQR 2.0-4.0, range 1-8) centimeters. There were 3 of 54 (5.6%) major postoperative complications. The median length of stay was 1.0 (IQR 1.0-3.0) day. At a median follow-up of 27.5 (IQR 21.3-38.0) months, 47 of 54 (87.0%) cases were surgically successful. Stricture recurrences were diagnosed ≤2 months postoperatively in 3 of 7 (42.9%) patients, and ≥10 months postoperatively in 4 of 7 (57.1%) patients. CONCLUSION Robotic ureteroplasty with buccal mucosa graft is associated with low peri-operative morbidity and excellent intermediate-term outcomes.
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Affiliation(s)
- Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
| | - Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Helaine Koster
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Randall Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Nathan Cheng
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Min Jun
- Department of Urology, Grossman School of Medicine at New York University Langone Health, New York, NY
| | - Jeremy Slawin
- Department of Urology, Grossman School of Medicine at New York University Langone Health, New York, NY
| | - Lee C Zhao
- Department of Urology, Grossman School of Medicine at New York University Langone Health, New York, NY
| | - Michael D Stifelman
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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Xiong S, Wang J, Zhu W, Yang K, Ding G, Li X, Eun DD. Onlay Repair Technique for the Management of Ureteral Strictures: A Comprehensive Review. Biomed Res Int 2020; 2020:6178286. [PMID: 32775430 DOI: 10.1155/2020/6178286] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 01/12/2023]
Abstract
Ureteroplasty using onlay grafts or flaps emerged as an innovative procedure for the management of proximal and midureteral strictures. Autologous grafts or flaps used commonly in ureteroplasty include the oral mucosae, bladder mucosae, ileal mucosae, and appendiceal mucosae. Oral mucosa grafts, especially buccal mucosa grafts (BMGs), have gained wide acceptance as a graft choice for ureteroplasty. The reported length of BMG ureteroplasty ranged from 1.5 to 11 cm with success rates of 71.4%-100%. However, several studies have demonstrated that ureteroplasty using lingual mucosa grafts yields better recipient site outcomes and fewer donor site complications than that using BMGs. In addition, there is no essential difference in the efficacy and complication rates of BMG ureteroplasty using an anterior approach or a posterior approach. Intestinal graft or flap ureteroplasty was also reported. And the reported length of ileal or appendiceal flap ureteroplasty ranged from 1 to 8 cm with success rates of 75%-100%. Moreover, the bladder mucosa, renal pelvis wall, and penile/preputial skin have also been reported to be used for ureteroplasty and have achieved satisfactory outcomes, but each graft or flap has unique advantages and potential problems. Tissue engineering-based ureteroplasty through the implantation of patched scaffolds, such as the small intestine submucosa, with or without cell seeding, has induced successful ureteral regeneration structurally close to that of the native ureter and has resulted in good functional outcomes in animal models.
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Porpiglia F, Checcucci E, Piramide F, Amparore D, Fiori C, Hemal A. Subtotal ureteral substitution with ileum for patients with multiple ureteral stenosis. Transl Androl Urol 2020; 9:971-976. [PMID: 32420213 PMCID: PMC7215022 DOI: 10.21037/tau.2019.12.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The use of small bowel for ureteral substitution in patients with ureteral stenosis can, nowadays, be safely performed with a laparoscopic or robotic mini-invasive approach. To date, this technique required a complete substitution of the ureter with ileum. In this work we present our robotic intracorporeal sub-total ureteral substitution preserving the distal part of the ureter with the aim to reduce the risk of vescico-ureteral reflux. We report the case of a 65-years old male with a “functional” right single kidney and multiple recurrent stenosis. Our technique seems to be feasible and safe, no intra or postoperative complication were recorded. At 3 months of follow-up the trans-nephrostomic enhanced CT showed a completely opacification of ileal ureter, thus the nephrostomic tube was removed. At 6 and 12 months the patient was asymptomatic and with a level of serum creatinine 1.9 and 1.6 mg/dL, respectively. In conclusion the sub-total ureteral substitution with ileum can be a safety and effective procedure for patients who require a mandatory preservation of homolateral renal function.
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Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Ashok Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Wang Q, Lu Y, Hu H, Zhang J, Qin B, Zhu J, Dirie NI, Zhang Z, Wang S. Management of recurrent ureteral stricture: a retrospectively comparative study with robot-assisted laparoscopic surgery versus open approach. PeerJ 2019; 7:e8166. [PMID: 31824773 PMCID: PMC6898986 DOI: 10.7717/peerj.8166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/05/2019] [Indexed: 12/11/2022] Open
Abstract
Background Management of recurrent ureteral stricture is challenging. Consensus on the best surgical choice has not been demonstrated. In this study, we aim to report our experience in treating recurrent ureteral stricture and demonstrate whether robot-assisted procedure for redo ureteral surgery is as effective as open procedure while remaining less invasive. Methods We retrospectively assessed 41 patients (22 robot-assisted surgeries and 19 open surgeries) who underwent consecutive robot-assisted and open procedures for redo ureteral surgery from January 2014 to 2018 in our institution. Perioperative outcomes, including demographics, operative time, estimated blood loss, complications, pain scores, success rate and cost, were compared between two groups. Results There was no significant intergroup difference in terms of age, body mass index, gender composition and American Society of Anesthesiologists scores. A total of 31 patients underwent redo pyeloplasty and ten underwent redo uretero-ureterostomy. Compared with open group, robot-assisted group showed shorter operative time (124.55 min vs. 185.11 min, p < 0.0001), less estimated blood loss (100.00 mL vs. 182.60 mL, p = 0.008) and higher cost (61161.77¥ vs. 39470.79¥, p < 0.0001). Complication rate and pain scores were similar between two groups. Median follow-up periods were 30 and 48 months for robot-assisted and open group respectively. Success rate in the robot-assisted (85.71%) and the open group (82.35%) was not significantly different. Conclusions Robot-assisted surgery for recurrent stricture after previous ureteral reconstruction is as effective as open procedure and is associated with shorter operative time and less estimated blood loss.
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Affiliation(s)
- Qing Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuchao Lu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Henglong Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiaqiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Baolong Qin
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianning Zhu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Najib Isse Dirie
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zongbiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Dirie NI, Wang S. Robot-assisted laparoscopic ureteroneocystostomy in adults: A single surgeon experience and literature review. Asian J Urol 2019; 7:37-44. [PMID: 31970070 PMCID: PMC6962745 DOI: 10.1016/j.ajur.2019.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/19/2019] [Accepted: 06/25/2019] [Indexed: 11/09/2022] Open
Abstract
Objective To present our experience and technique with robot-assisted ureteroneocystostomy (RAUN) procedure in adults. Methods Between February 2015 and August 2018, a total of 30 (34 ureters) patients who underwent RAUN surgery under a single surgeon were retrospectively reviewed. Perioperative data such as age, sex, body mass index (BMI), American society of anesthesiologists score, estimated blood loss, surgical technique, operative time, complications, length of hospital stay, and stent removal time were recorded. During the follow-up, patients underwent renal function test, urinalysis, and renal ultrasound examination for evaluation. Success was defined as symptomatic and radiologic relieve. Lastly, a literature search was conducted to review all published articles regarding RAUN surgery in adults. Results The patients’ mean age, BMI, EBL, operative time, and follow-up period were 45.4 years, 23.1 kg/m2, 65.6 mL, 182.9 min, and 21.3 months, respectively. The two most common indications for the surgery were benign ureteral strictures and ureteric injuries secondary to a previous radical hysterectomy. Of the 34 cases, 26 (76.5%) and 8 (23.5%) patients received primary RAUN and RAUN with psoas hitch technique, respectively. Refluxing RAUN method was performed in all cases. No intraoperative complications were found. Two patients had a radiologic and symptomatic recurrence; one was managed with a repeat surgery while the other received ureteral dilatation treatment. Conclusion Both our study and the published literature showed that RAUN is a safe, less invasive, and effective surgical technique that can easily replicate the open ureteroneocystostomy for managing lower ureteral diseases.
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Affiliation(s)
- Najib Isse Dirie
- Department of Urology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Masieri L, Sforza S, Di Maida F, Grosso AA, Mari A, Rosi EM, Tellini R, Carini M, Minervini A. Robotic correction of iatrogenic ureteral stricture: preliminary experience from a tertiary referral centre. Scand J Urol 2019; 53:356-360. [PMID: 31469016 DOI: 10.1080/21681805.2019.1651390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Iatrogenic stenosis is a relatively common complication and it could happen after urological procedures in the entire course of the ureter. The aim of this study is to report the surgical outcomes of 36 consecutive patients (period April 2013-November 2018) submitted to robot-assisted correction of benign stricture with previous urological surgery in a tertiary referral center.Methods: Elective criteria were to have had a benign ureteral stricture development after at least one urological procedure. Patients were classified as failures in the event of post-operative ultrasound demonstrating persistent hydronephrosis with or without symptoms or persistent symptoms with renal scan evidence of obstruction or redo procedures.Results: Eighteen patients (50%) were treated for calculosis, seven (19.4%) patients were submitted to double J ureteral stenting and previous pyeloplasty was performed in 11 (30.5%) patients. Overall median operative time was 160 min (IQR = 120-180). Five (13.8%) complications with three (8.3%) surgical post-operative complications occurred. Length of stay was 6 (IQR = 5-7) days. At last follow-up, ranging between 7-60 months, the overall success rate was 86.1% (31/36): three of them (8.3%) were submitted to retrograde holmium laser endopyelotomy, while two (5.5%) underwent a redo robot-assisted correction.Conclusions: Robot-assisted correction procedures can be done safely with good perioperative outcomes and a high post-operative success rate in a tertiary referral center. Further randomized clinical trials are mandatory to confirm the safety of this procedure.
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Affiliation(s)
- L Masieri
- Department of Pediatric Urology, University of Florence, Meyer Hospital, Florence, Italy.,Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - S Sforza
- Department of Pediatric Urology, University of Florence, Meyer Hospital, Florence, Italy.,Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - F Di Maida
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Andrea Grosso
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - A Mari
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Emma Maria Rosi
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - R Tellini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - M Carini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - A Minervini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
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Masieri L, Sforza S, Mari A, Morselli S, Tellini R, Di Maida F, Vignolini G, Serni S, Carini M, Minervini A. Robot-assisted pyeloplasty for ureteropelvic junction obstruction: experience from a tertiary referral center. MINERVA UROL NEFROL 2019; 71:168-173. [DOI: 10.23736/s0393-2249.19.03328-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Kaouk JH, Garisto J, Eltemamy M, Bertolo R. Robot-assisted surgery for benign distal ureteral strictures: step-by-step technique using the SP ® surgical system. BJU Int 2019; 123:733-739. [PMID: 30499629 DOI: 10.1111/bju.14635] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the step-by-step techniques for robot-assisted ureteric reimplantation performed using the Vinci SP® surgical system (Intuitive Surgical, Sunnyvale, CA, USA), including different case scenarios with an educational purpose. MATERIALS AND METHODS Three consecutive patients diagnosed with distal benign ureteric strictures were counselled for ureteric reimplantation and consented to undergo surgery performed using the da Vinci SP surgical system. Demographics and peri-operative outcomes were collected after institutional review board approval (IRB 13-780). Patients provided informed consent having received an explanation for the adoption of the novel platform. The first patient was a woman referred to our institution for a left distal ureteric stricture after total hysterectomy for uterine fibroids with ureteric injury. The second patient was a man with BPH and recurrent UTIs, who was diagnosed with a 1.5-cm bladder stone and a large bladder diverticulum compressing the left distal ureter. The third patient was a man diagnosed with bilateral uretero-enteric anastomoses stricture status after radical cystectomy with orthotopic ileal neobladder urinary diversion for bladder cancer. RESULTS The procedures were successfully completed. An extra port through a separate skin incision for the bedside assistant was placed for the first two procedures. In such cases, this additional port was used electively from the start of the procedure and did not represent a change in the treatment plan. Moreover, the port wound was used to accommodate the drainage. The bilateral ureteric reimplantation, however, was completed according to a pure single-site approach (no extra ports were placed out of the GelSeal cap). The mean operating times were 165, 150 and 180 min, respectively. Blood loss was 50 mL in all cases. No intra-operative complications occurred. Patients were discharged on postoperative days 1, 1 and 2, respectively, with normal serum creatinine levels. Neither transfusions nor major complications occurred. CONCLUSION Robot-assisted reconstructive surgery for benign distal ureteric strictures is feasible and safe using the da Vinci SP surgical system.
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Affiliation(s)
- Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Lee Z, Sterling ME, Keehn AY, Lee M, Metro MJ, Eun DD. The use of indocyanine green during robotic ureteroenteric reimplantation for the management of benign anastomotic strictures. World J Urol 2018; 37:1211-1216. [PMID: 30229414 DOI: 10.1007/s00345-018-2493-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE We describe our technique for using intraureteral and intraurinary diversion indocyanine green (ICG) during robotic ureteroenteric reimplantation and report our outcomes. METHODS We retrospectively reviewed eight patients who underwent ten robotic ureteroenteric reimplantations between August 2013 and July 2017. ICG was injected antegrade and/or retrograde into the lumen of the ureter, and retrograde into the lumen of the urinary diversion. All patients consented to off-label use of ICG. Postoperatively, all patients were assessed for: clinical success: the absence of flank pain; and radiological success: the absence of obstruction on renal scan and/or loopogram. RESULTS Visualization of ICG under near-infrared fluorescence allowed for precise identification of the strictured ureter and urinary diversion, which fluoresced green; and localization the ureteroenteric stricture margins, which poorly fluoresced green. The median operative time was 208 min (IQR 191-299), estimated blood loss was 125 ml (IQR 69-150), and length of stay was 6 days (IQR 1-8). Three of eight (37.5%) patients suffered a minor (Clavien ≤ 2), and 2/8 (25.0%) patients suffered a major (Clavien > 2) post-operative complication. There were no complications related to ICG use. At a median follow-up of 29 months (IQR 21-38), 8/10 (80.0%) ureteroenteric reimplantations were clinically and radiologically successful. CONCLUSIONS Intraureteral and intraurinary diversion ICG may be utilized as a real-time contrast agent during robotic ureteroenteric reimplantation to assist with identification of the strictured ureter and urinary diversion, and delineation of the ureteroenteric stricture margins. Despite this, RUER remains a technically difficult and morbid procedure.
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Affiliation(s)
- Ziho Lee
- Department of Urology, Temple University School of Medicine, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA.
| | - Matthew E Sterling
- Department of Urology, Temple University School of Medicine, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Aryeh Y Keehn
- Department of Urology, Temple University School of Medicine, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Matthew Lee
- Department of Urology, Temple University School of Medicine, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Michael J Metro
- Department of Urology, Temple University School of Medicine, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA
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Garisto JD, Dagenais J, Arora H, Bertolo R, Kaouk JH. Concurrent Robotic Pyelolithotomy and Partial Nephrectomy: Tips and Tricks. Urology 2018; 118:243. [DOI: 10.1016/j.urology.2018.03.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/17/2018] [Accepted: 03/22/2018] [Indexed: 11/19/2022]
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Mari A, Sforza S, Morselli S, Campi R, Masieri L, Carini M, Minervini A. Surgical outcome of 100 consecutive robot-assisted pyeloplasty cases with no drainage placement for ureteropelvic junction obstruction. Int J Urol 2018; 25:700-701. [DOI: 10.1111/iju.13700] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Andrea Mari
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Simone Sforza
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Simone Morselli
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
- Department of Pediatric Urology; Meyer Hospital; University of Florence; Florence Italy
| | - Riccardo Campi
- 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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Gheza F, Crivellaro S, Baiocchi GL. Re: Lee C. Zhao, Aaron C. Weinberg, Ziho Lee, et al. Robotic Ureteral Reconstruction Using Buccal Mucosa Grafts: A Multi-institutional Experience. Eur Urol 2018;73:419-26: Robotic Ureteral Reconstruction with Buccal Mucosal Graft: A Call Not To Lose Momentum. Eur Urol 2018; 73:e127-e128. [PMID: 29454472 DOI: 10.1016/j.eururo.2018.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/27/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Federico Gheza
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
| | - Simone Crivellaro
- Division of Urology, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
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Gild P, Kluth LA, Vetterlein MW, Engel O, Chun FKH, Fisch M. Adult iatrogenic ureteral injury and stricture-incidence and treatment strategies. Asian J Urol 2018; 5:101-106. [PMID: 29736372 PMCID: PMC5934506 DOI: 10.1016/j.ajur.2018.02.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 05/22/2017] [Accepted: 06/23/2017] [Indexed: 11/03/2022] Open
Abstract
Iatrogenic ureteral injuries and strictures are relatively common complication of pelvic surgery and radiation treatment. Left untreated they are associated with severe short- and long-term complications such as urinoma, septic state, renal failure, and loss of a renal unit. Treatment depends on timing of diagnosis, as well as extent of injury, and ranges from simple endoscopic management to complex surgical reconstruction under usage of pedicled grafts. While recent advances in ureteral tissue engineering are promising the topic is still underreported. Historically a domain of open surgery, laparoscopic and robotic-assisted approaches have proven their feasibility in small case series, and are increasingly being utilized as means of reconstructive surgery. This review aims to give an outline of incidence and treatment of ureteral injuries and strictures in light of the latest advances.
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Affiliation(s)
- Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Luis A Kluth
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Engel
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K H Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lee Z, Waldorf BT, Cho EY, Liu JC, Metro MJ, Eun DD. Robotic Ureteroplasty with Buccal Mucosa Graft for the Management of Complex Ureteral Strictures. J Urol 2017; 198:1430-1435. [DOI: 10.1016/j.juro.2017.06.097] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Ziho Lee
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
- Department of Otolaryngology (JCL), Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Benjamin T. Waldorf
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
- Department of Otolaryngology (JCL), Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Eric Y. Cho
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
- Department of Otolaryngology (JCL), Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Jeffrey C. Liu
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
- Department of Otolaryngology (JCL), Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Michael J. Metro
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
- Department of Otolaryngology (JCL), Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Daniel D. Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
- Department of Otolaryngology (JCL), Temple University School of Medicine, Philadelphia, Pennsylvania
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Buffi NM, Lughezzani G, Hurle R, Lazzeri M, Taverna G, Bozzini G, Bertolo R, Checcucci E, Porpiglia F, Fossati N, Gandaglia G, Larcher A, Suardi N, Montorsi F, Lista G, Guazzoni G, Mottrie A. Reply to Marc A. Bjurlin, Lee C. Zhao, and Michael D. Stifelman's Letter to the Editor Re: Nicolò Maria Buffi, Giovanni Lughezzani, Rodolfo Hurle, et al. Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions. Eur Urol. In press. http://dx.doi.org/ 10.1016/j.eururo.2016.07.022. Eur Urol 2016; 71:e92-e93. [PMID: 27641789 DOI: 10.1016/j.eururo.2016.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Nicolò Maria Buffi
- Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy.
| | - Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Gianluigi Taverna
- Department of Urology, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Giorgio Bozzini
- Department of Urology, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Riccardo Bertolo
- San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Enrico Checcucci
- San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | | | - Nicola Fossati
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium
| | - Giorgio Gandaglia
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium
| | - Alessandro Larcher
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nazareno Suardi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuliana Lista
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Guazzoni
- Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium
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Bjurlin MA, Zhao LC, Stifelman MD. Re: Nicolò Maria Buffi, Giovanni Lughezzani, Rodolfo Hurle, et al. Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions. Eur Urol. In press. http://dx.doi.org/ 10.1016/j.eururo.2016.07.022. Eur Urol 2016; 71:e91. [PMID: 27639535 DOI: 10.1016/j.eururo.2016.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Marc A Bjurlin
- Department of Urology, New York University, New York, NY, USA
| | - Lee C Zhao
- Department of Urology, New York University, New York, NY, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA.
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