Complete Ureteral Avulsion Research Articles

Ureteral Avulsion Associated with Transurethral Lithotripsy for Ureteral Stones: A High-Volume Case Series

Background: The present study was conducted to report the incidence rate of ureteral avulsion and its management in two referral medical centers.
 Methods: We retrospectively reviewed a total of 36683 transurethral lithotripsy procedures performed during 17 years. All ureteral avulsions were also included in the current study as an intraoperative complication of Transurethral Lithotripsy (TUL). Data including stone location, avulsion site and management details were recorded.
 Results: Fourteen cases of complete ureteral avulsion had occurred in the study period (0.038%), consisting of 8 healthy males and 6 healthy females aged 26 to 73 years (mean age: 50 yrs). Out of these 14 cases, 7 cases had distal ureteral avulsion and seven others had proximal ureteral avulsion. Six cases of distal ureteral avulsion had been promptly treated by the reimplant method whereas immediate nephrectomy had been performed in the remaining case due to a history of poor condition of the renal unit. Proximal ureteral avulsions had been treated by combined Boari flap-psoas hitch procedures with renal mobilization in 3 cases, the autotransplant method in another 3 and by ileal interposition in one case.
 Conclusion: Although the present study is a case series which is normally classified as low level of evidence, it seems that both autotransplant and combined Boari flap-psoas hitch procedures with renal mobilization are safe and feasible techniques for the management of full-length complete ureteral injury.

Adverse events related to accessory devices used during ureteroscopy: Findings from a 10-year analysis of the Manufacturer and User Facility Device Experience (MAUDE) database.

The objective of this study was to evaluate adverse events and device events related to accessories used during ureteroscopy (URS). Analysis was performed of the records available in the Manufacturer and User Facility Device Experience database in the United States. Information was collected on characteristics of problem, timing, manufacturer verdict, successful completion of planned surgery, prolonged anaesthesia and injury to patient or staff. Five-hundred seventy-one events related to URS accessories were recorded. These were associated with the following devices: baskets (n = 347), access sheath (n = 86), guidewires (n = 78), balloon dilators (n = 27), ARDs (n = 17) and ureteral catheters (n = 16). Of the events, 12.7% resulted in patient injuries. Forty-eight per cent of the events resulted in prolonged anaesthesia, but the planned surgery was successfully completed in 78.4% of all cases. Collectively, the manufacturers accepted responsibility due to actual device failure in only 0.5% of cases. Common problems for baskets were failure to deploy (39.5%) and complete detachment of basket head (34.6%) and partial breakage of the basket head (12.4%). Of the basket group, 4.3% required open or percutaneous surgery to remove stuck basket. Full break of the body of the access sheath occurred in 41.9% and complete ureteral avulsion in 3.5%. For balloon dilators, there was a burst in 37% of cases. Broken guidewires were associated with 11.5% requiring repeat intervention for retrieval and 6.4% required JJ stent due to perforation to the collecting system. No injuries to operating staff were recorded with accessory usage. Accessories used during URS are fragile. Potential for serious injury does exist as a direct result of their use. Surgeons should familiarise themselves with these events and how they can be prevented.

The Predictive Factors of Renal Loss After Iatrogenic Ureteral Avulsion in the Medicolegal Perspective.

As an effective and minimally invasive technique, ureteroscopy has some potential intraoperative complications. Ureteral avulsion is among these complications, although rare. This study aimed to determine factors predicting nephrectomy by considering ureteral avulsion from a medicolegal perspective for the 1st time in the literature. A total of 33 patients with ureteral avulsion during ureteroscopic surgery, who presented to various hospitals in Turkey between September 2004 and April 2019 and whose cases were being reviewed at the Institution of Forensic Medicine with regard to malpractice, were evaluated retrospectively. The patients who underwent nephrectomy after ureteral avulsion were evaluated as Group 1, and those who underwent reconstructive surgery as Group 2. The mean age of the patients was 39.5±12.1 years. Seventeen (51.5%) patients had partial and 16 (48.4%) had complete ureteral avulsion. Nephrectomy was performed in 14 (42.4%) patients, and ureteral reconstruction in 19 (57.5%) patients. It was determined that the patients in Group 1 had more proximal stones and a higher degree of hydronephrosis compared to Group 2. Complete avulsion developed in 71.4% of the patients in Group 1 and in 31.6% of those in Group 2. After avulsion, 78.6% of the patients in Group 1 were treated in a state hospital, and 63.2% of those in Group 2 were treated in a tertiary referral hospital. The increase in the degree of hydronephrosis, presence of complete avulsion, and intervention at a state hospital were determined as independent predictive factors for nephrectomy. This is the first study with the largest cohort in the literature to medicolegally evaluate ureteral avulsion and determine predictive factors for nephrectomy. Although each patient should be treated with different methods in the presence of ureteral avulsion, our study aimed to provide a common approach to this catastrophic complication.

Case report series: management of complete ureteral avulsion with review of the relevant literature

BackgroundEndoscopic operations and ureteroscopy have become the first choice for ureteral calculi and ureter-related operations. The ratios of the complications, which are mostly iatrogenic, range between 9 and 11%. Total ureteral avulsion during URS is quite rare with a prevalence of 0–0.3%. We present three total ureteral avulsions we experienced in our clinic during the last 2 years and their treatment.Case presentationDuring the last 2 years, we experienced three total ureteral avulsions: one of these occurred in our clinic and the other two occurred in an external center and were referred to us. In two cases, the omental flap was rotated after ureteral reimplantation and the ureter was completely wrapped inside the omental flap. In the third case, boari flap was formed from the bladder. Due to the presence of extrarenal wide renal pelvis, anastomosis was made with boari flap after a y–v flap was rotated on the renal pelvis. D-J stents of the patients were removed at the end of 3 months. Although there was mild hydronephrosis, parenchymal thinning and a significant decrease in functions were not observed. Ureteral avulsion of the patients was successfully managed without the need for nephrectomy.ConclusionUreteral avulsion management is an extremely difficult condition for both the surgeon and the patient. So, the most important thing is to prevent ureteral avulsion. Ureteroplasty and omental flap treatment are applicable methods with quite successful results for complete ureteral avulsions.

V065 - Robotic ileal neoureter and psoas hitch for iatrogenic complete ureteral avulsion: Our 2 cases experience

V065 - Robotic ileal neoureter and psoas hitch for iatrogenic complete ureteral avulsion: Our 2 cases experience

V05-09 ROBOTIC ILEAL NEOURETER AND PSOAS HITCH FOR IATROGENIC COMPLETE URETERAL AVULSION: OUR 2 CASES EXPERIENCE

You have accessJournal of UrologyUpper-Tract Reconstruction (V05)1 Apr 2020V05-09 ROBOTIC ILEAL NEOURETER AND PSOAS HITCH FOR IATROGENIC COMPLETE URETERAL AVULSION: OUR 2 CASES EXPERIENCE Federica Balzarini*, Andrea Pacchetti, Alberto Caviglia, Emanuele Barabino, Alberto Olivero, Federico Dotta, Matteo Valcalda, Giovanni Camerini, and Carlo Terrone Federica Balzarini*Federica Balzarini* More articles by this author , Andrea PacchettiAndrea Pacchetti More articles by this author , Alberto CavigliaAlberto Caviglia More articles by this author , Emanuele BarabinoEmanuele Barabino More articles by this author , Alberto OliveroAlberto Olivero More articles by this author , Federico DottaFederico Dotta More articles by this author , Matteo ValcaldaMatteo Valcalda More articles by this author , Giovanni CameriniGiovanni Camerini More articles by this author , and Carlo TerroneCarlo Terrone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000874.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Complete ureteral avulsion during ureteroscopy (URS) is a rare but catastrophic complication. The paucity of literature on this complication and its management may lead urologists to trouble when they plan a repair procedure. A possible therapeutic option can be represented by ileal interposition. Less than 20 cases of totally intracorporeal robotic ileal neoureter are reported in literature. The aim of the video is to show how two cases of complete ureteral avulsion were managed at our centre with an intracorporeal robotic approach. METHODS: Case A. 47 years old male patient underwent a right semirigid URS and laser treatment for a 8mm stone below ureteropelvic junction (UPJ). Complete right ureteral avulsion occurred during the attempt of retrieving a stone fragment with a basket. A nephrostomy tube was immediately placed to control the urinary leakage. After discussion with the patient about the possible solutions, a robot-assisted ileal ureter was chosen. Patient and trocar positioning: 60° modified flank position; four 8-mm robotic trocars on the pararectal line, periumbilical and two assistant robotic trocars (5 and 12mm), along the xiphopubic line. Da Vinci Xi robot docking. Case B. 68 years old male patient with 5mm stone at the level of the UPJ underwent flexible URS. Complete avulsion of the left ureter occurred during the procedure. A nephrostomy tube was immediately placed. After careful counseling, the indication of replacement of the ureter with the ileum was given. Patient and trocar positioning were the same as described above. RESULTS: Outcomes: nephrostomy removal after 7 days, catheter removal after 8 days, discharge after 10 days and stent removal after 30 days in both cases. One-month cystogram: reflux in the neoureter for case A (only at high bladder filling). Follow-up blood tests: normal renal function and pH. Urine colture: negative. 6-months CT scan: no hydronephrosis, minimal delayed right renal contrast media elimination for case A. Technical aspects: 3 robot dockings for case B compared to 1 docking for case A; mesenterial rotation for case A to achieve an isoperistaltic neoureter; presence of the sigmoid colon for case B. CONCLUSIONS: In our experience, complete intracorporeal robotic ileal interposition is a feasible option for bridging full length ureteral defects, with low complication rates. These cases are so rare that it is very difficult to standardize the procedure. Patient’s age, comorbidities, ipsilateral and contralateral kidney function, patient's expectations and surgeon experience can affect the treatment choice. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e472-e472 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Federica Balzarini* More articles by this author Andrea Pacchetti More articles by this author Alberto Caviglia More articles by this author Emanuele Barabino More articles by this author Alberto Olivero More articles by this author Federico Dotta More articles by this author Matteo Valcalda More articles by this author Giovanni Camerini More articles by this author Carlo Terrone More articles by this author Expand All Advertisement PDF downloadLoading ...

P027 - Complete ureteral avulsion in left solitary functioning kidney

P027 - Complete ureteral avulsion in left solitary functioning kidney

Осложнения контактной уретеролитотрипсии

Shows the current real time terminology and variants of systematization and grading of complications of contact ureteral lithotripsy (CULT). Research papers related to complications of CULT published over the last three decades were analyzed. Currently there is no clear terminology, classification, systematization and grading of CULT complications. The terms used are deficient because they do not adequately characterize specific complications of CULT. For example, some researchers define a complete ureteral avulsion as a defect at two levels, but others interpret it as a defect of the ureter at only one level. And the use of such terms as extravasation of the contrast media and/or migration of the stone outside of the ureter is groundless because these complications occur only after the perforation of the ureter wall. Therefore, these conditions are complications not of CULT but of the ureteral wall perforation. Presently, the classical classification of CULT cannot be adequately used, since it is low-structured. Universal instruments (PULS, Satava, Clavien-Dindo) have low specificity and sensitivity to CULT complications and limited possibilities of their application. Both developers of different scales of systematization of CULT complications (PULS; Satava; Clavien-Dindo) and EAU consider further international randomized studies warranted for their greater integration and adaptation.

Management of complete ureteral avulsion in ureteroscopy

Ureteral avulsion is an uncommon yet severe complication of ureteroscopy. Among 8336 patients who received ureteroscopic procedures in our hospital from December 2001 to December 2011, we encountered two cases of ureteral avulsion. The first of these experienced disruption at the ureteropelvic junction due to extraction of the tubular ureter from the urethra, which was corrected by immediate open surgery to reposition and anastomose the ureter. The second patient sustained a proximal ureteral disruption following retrieval of the ureteroscope, which was wedged in the narrow lumen of the proximal ureter, and led to simultaneous extraction of the distal ureter. Immediate surgical intervention was performed to maintain ureteral continuity. Mild hydronephrosis was observed in kidneys that were ipsilateral to the ureteral avulsion in both patients. However, no physical discomfort or loss of renal function was indicated after 12 months.

Endoscopic Management of Complete Ureteral Avulsion from Uretero-Vesical Junction: A Novel Endoscopic Technique (Azayem Technique)

Abstract Introduction: This video presents our novel endoscopic technique for management of complete ureteral avulsion from uretero-vesical junction (UVJ). Materials and Methods: A retrospective study of prospective data on 1934 ureteroscopic stone manipulation procedures performed at our Urology Department in Saudi German Hospital–Jeddah from January 2001 to January 2011 was conducted. The ureterorenoscope used was an 8F, Storz, semirigid ureterorenoscope. During this period, three cases of complete ureteral avulsion from UVJ were recorded. All these three cases were managed successfully by our novel endoscopic technique that we present in this video. Surgical Procedure: Postavulsion event, the ureteroscope is withdrawn outside the patient keeping the guidewire (GW) in place. A Double-J (DJ) stent is then applied along the GW up to the kidney. The ureteroscope is then reinserted into the bladder, and guided by the DJ through the avulsion site into the retro peritoneum up to the lower end of the avulsed u...

Management of Complete Ureteral Avulsion and Literature Review: A Report on Four Cases

The aim of this study was to investigate the treatment modality of complete ureteral avulsion. This study retrospectively analyzed the data of four patients with complete ureteral avulsion who were treated between November 2003 and March 2008 in our hospital. Of the four patients, one had ureteropelvic junction avulsion, one had proximal ureteral avulsion, and the other two had distal ureteral avulsion. One patient underwent autotransplantation of kidney for treatment of severe proximal ureteral avulsion. Pyeloureterostomy plus greater omentum investment outside the native distal ipsilateral ureter was performed in the patient with ureteropelvic junction avulsion. The other two patients underwent ureterovesical anastomosis. All four patients were followed up for an average time of 29 months (16-45 months). Renal function recovered well in the patient who underwent autotransplantation of kidney and ureterovesical anastomosis and the two patients who underwent ureterovesical anastomosis. The other patient who underwent pyeloureterostomy developed hydronephrosis and nonfunctioning kidney. The patient then underwent nephrectomy. Complete ureteral avulsion is a rare but severe complication. Autotransplantation of kidney and ureterovesical anastomosis may result in positive outcomes in patients with proximal ureteral avulsion.