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Tonyali S, Pietropaolo A, Emiliani E, Ortac M, Von Bargen MF, Turan S, Glienke M, Hamid Z, Tailly T. Factors associated with ureteral strictures following ureteroscopy for impacted ureteral stones? A multicenter study by EAU-YAU endourology and urolithiasis working party. Actas Urol Esp 2023; 47:631-637. [PMID: 37086846 DOI: 10.1016/j.acuroe.2023.04.005] [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: 02/27/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVE To determine the relation between ureteral stone impaction and ureteral stricture formation and associated factors. MATERIAL AND METHODS We retrospectively analyzed the medical records of all patients who underwent endoscopic ureteral stone surgery for impacted ureteral stone at three academic institutions in Turkey, United Kingdom and Spain between June 2019 and January 2022. Examined parameters included patient demographics, stone side, size and localization, time between initiation of symptoms and surgery, type of ureteroscopy (rigid/flexible), presence of nephrostomy or double-J stent prior to URS, intraoperative complications (avulsion/perforation, stone-free status, number of procedures required for stone-free status, postoperative imaging results. RESULTS A total of 41 patients whom 25 were male and 16 were female, from 3 institutions were included the study. The mean age of the patients was 48.2 ± 13.5 years. The median largest diameter of the stones was 9 mm (IQR: 8 mm). Total 14 (34.1%) patients developed ureteral strictures following ureteroscopy. There was no difference between patients who developed ureteral strictures and patients who did not developed strictures in terms of stone laterality, stone location, hydronephrosis and multiplicity, p = 0.58, p = 0.14, p = 0.79 and p = 0.31. Patients who developed ureteral strictures had a higher rate of preoperative urinary diversion such as nephrostomy or DJS, p = 0.000. CONCLUSION Interruption of urine passage through ureter via urinary diversion such as nephrostomy or DJS stent prior to ureteral stone surgery might lead ureteral stricture formation in the postoperative period.
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Affiliation(s)
- S Tonyali
- Servicio de Urología, Facultad de Medicina de la Universidad de Estambul, Estambul, Turkey.
| | - A Pietropaolo
- Servicio de Urología, Hospital Universitario Southampton NHS Trust, Southampton, United Kingdom
| | - E Emiliani
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Spain
| | - M Ortac
- Servicio de Urología, Facultad de Medicina de la Universidad de Estambul, Estambul, Turkey
| | - M F Von Bargen
- Servicio de Urología, Centro Médico de la Universidad de Friburgo, Germany
| | - S Turan
- Servicio de Urología, Facultad de Medicina de la Universidad de Estambul, Estambul, Turkey
| | - M Glienke
- Servicio de Urología, Centro Médico de la Universidad de Friburgo, Germany
| | - Z Hamid
- Servicio de Urología, Escuela de Medicina Father Muller, Mangalore, India
| | - T Tailly
- Servicio de Urología, Hospital Universitario de Gante, Gante, Belgium
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Aksakalli T, Adanur S, Demirdogen SO, Polat O. Allium® ureteral stent, a new player in the treatment of ureteral stenosis: a prospective cohort study. Actas Urol Esp 2023; 47:598-604. [PMID: 37442223 DOI: 10.1016/j.acuroe.2023.07.003] [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: 04/19/2023] [Revised: 05/20/2023] [Accepted: 05/26/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Ureteral stricture is a chronic condition that can result in the obstruction of urinary drainage from the affected renal unit, leading to loss of renal function. Treatment methods can be categorized into two main headings: endourological and reconstructive procedures. We aimed to investigate the efficacy and safety of the self-expandable Allium® ureteral stent, which has been used in the minimally invasive treatment of ureteral stenosis in recent years. MATERIALS AND METHODS Twenty patients who were applied Allium® ureteral stent between 2017 and 2021 included in the study. The demographic and clinical characteristics of the patients, the details of the treatments applied to the patients, the perioperative and postoperative complications, the treatments applied for the complications and the findings in the follow-up were recorded and evaluated prospectively. RESULTS Etiology included urolithiasis in 16 patients (80%), malignancy in 3 patients (15%), and a previous gynecological operation in 1 patient (5%). Stent obstruction was found to be the most common complication in 3 patients (15%). Stent migration was the second most common complication in 2 patients (10%). Our follow-up continues with 15 patients without stent-related complications and stent obstruction. The mean follow-up period was 28 ± 15.7 months. CONCLUSIONS Allium ureteral stent is an effective and reliable method in the minimally invasive treatment of ureteral stricture with complications seen at acceptable rates and ease of treatment in the management of complications.
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Affiliation(s)
- T Aksakalli
- Servicio de Urología, Hospital de Formación e Investigación de Erzurum, Universidad de Ciencias de la Salud, Erzurum, Turkey.
| | - S Adanur
- Servicio de Urología, Facultad de Medicina, Universidad de Atatürk, Erzurum, Turkey
| | - S O Demirdogen
- Servicio de Urología, Facultad de Medicina, Universidad de Atatürk, Erzurum, Turkey
| | - O Polat
- Servicio de Urología, Facultad de Medicina, Universidad de Atatürk, Erzurum, Turkey
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Ballesteros Ruiz C, Álvarez-Maestro M, Alonso Dorrego JM, De Castro Guerín C, Cansino Alcaide R, Carrión DM, Gómez de Vicente JM, Aguilera Bazán A, Martínez Piñeiro L. [Kidney transplant urinary complications. Diagnosis and treatment.]. ARCH ESP UROL 2021; 74:1029-1039. [PMID: 34851317] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There are different surgical techniques for reconstruction of the urinary tract in kidney transplant. However, urinary complications are frequent in the postoperative period, being the ureter the frequent location of these complications. This results in high health care costs, increasing patient morbimortality and sometimes graft loss. For this reason, prevention, correct diagnosis and treatment are important. The aim of this review is to describe the surgical techniques most commonly used in kidney transplant for ureteroneocystostomy. To analyze the advantages and disadvantages of each of them and to compare their complications. On the other hand, we summarize the recent literature on the four most frequent urinary complications in the postoperative period after transplantation. The possible causes and treatment of urine leak, ureteri cobstruction, hematuria and vesicoureteral reflux are presented.
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Affiliation(s)
| | | | | | | | | | - Diego M Carrión
- Departamento de Urologia. Hospital Universitario La Paz. Madrid. España
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Alonso Mediavilla E, Campos-Juanatey F, Azcárraga Aranegui G, Varea Malo R, Ballestero Diego R, Domínguez Esteban M, Ramos Barseló E, Zubillaga Guerrero S, Calleja Hermosa P, Gutiérrez Baños JL. Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center. Actas Urol Esp 2021; 46:49-56. [PMID: 34838493 DOI: 10.1016/j.acuroe.2021.06.010] [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: 03/16/2021] [Accepted: 06/03/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. MATERIAL AND METHODS Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t-test for independent groups or Mann-Whitney test. Statistical significance if P < .05. RESULTS The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Uretericre implantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). CONCLUSION Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.
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Affiliation(s)
- E Alonso Mediavilla
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - F Campos-Juanatey
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain.
| | | | - R Varea Malo
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - R Ballestero Diego
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - M Domínguez Esteban
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - E Ramos Barseló
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - S Zubillaga Guerrero
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - P Calleja Hermosa
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - J L Gutiérrez Baños
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain; Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain
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5
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Alonso Mediavilla E, Campos-Juanatey F, Azcárraga Aranegui G, Varea Malo R, Ballestero Diego R, Domínguez Esteban M, Ramos Barseló E, Zubillaga Guerrero S, Calleja Hermosa P, Gutiérrez Baños JL. Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center. Actas Urol Esp 2021; 46:S0210-4806(21)00119-4. [PMID: 34332809 DOI: 10.1016/j.acuro.2021.06.001] [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: 03/16/2021] [Revised: 05/03/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. MATERIAL AND METHODS Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t test for independent groups or Mann-Whitney test. Statistical significance if P<.05. RESULTS The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Ureteric reimplantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). CONCLUSION Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.
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Affiliation(s)
- E Alonso Mediavilla
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - F Campos-Juanatey
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, España.
| | | | - R Varea Malo
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - R Ballestero Diego
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - M Domínguez Esteban
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - E Ramos Barseló
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - S Zubillaga Guerrero
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - P Calleja Hermosa
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - J L Gutiérrez Baños
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, España; Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, España
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Gimbernat H, Redondo C, García-Tello A, Mateo E, García-Mediero JM, Angulo JC. Transumbilical laparoendoscopic single-site ureteral reimplantation. Actas Urol Esp 2015; 39:195-200. [PMID: 25060355 DOI: 10.1016/j.acuro.2014.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/12/2014] [Accepted: 06/17/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To analyze the outcomes of umbilical laparoendoscopic single-site (LESS) ureteral reimplantation using a reusable single-port platform. MATERIAL AND METHOD The casuistic of LESS ureteral reimplantation in 5 patients is presented. The surgical technique using KeyPort system (reusable umbilical single-site platform) is described. Dissection, suctioning and suturing by minilaparoscopy through 3.5mm accessory port in the iliac fossa are performed. Operative and postoperative outcomes are presented. The median follow-up at time of analysis was 11 ± 14 months. RESULTS The median age of patients was a 49 ± 34 year; male-female ratio was 1:1.15. Left surgery was carried out in all cases. In 4 patients, the etiology was secondary to stenosis (3 iatrogenic and 1 pelvic endometriosis). In the remaining case, the procedure was performed after excision of a symptomatic adult ureterocele. In all cases, bladder catheter and double-J ureteral catheter were inserted for 7 ± 3 and 30 ± 15 days and then removed. No conversion to convectional laparoscopic or open surgery occurred. The surgery time was 145 ± 60 min, and intraoperative bleeding was 100 ± 75 cc. Neither transfusion nor high analgesia was necessary. No postoperative complications, minor or major, have been reported. Hospital stay was 2 ± 0.5 days. In any patient, restenosis or worsening of renal function occurred. CONCLUSIONS In experimented centers, transumbilical laparoendoscopic single-site ureteroneocystostomy is a safe alternative with comparable results to conventional laparoscopy and an excellent cosmetic result at low cost thanks to device reuse.
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Affiliation(s)
- H Gimbernat
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España
| | - C Redondo
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España
| | - A García-Tello
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España
| | - E Mateo
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España
| | - J M García-Mediero
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España
| | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España.
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