Distal Ureteral Stricture Research Articles

The process of terminal augmented ureteroplasty with the bladder onlay flap technique for recurrent distal ureteral stricture after ureteroneocystostomy.

The process of terminal augmented ureteroplasty with the bladder onlay flap technique for recurrent distal ureteral stricture after ureteroneocystostomy.

Robot-Assisted Ureteral Reimplantation: A Single-Center Comparative Study.

Background: Aim of this study was 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, pathologic, perioperative, and postoperative features. The RAUR outcomes were compared with those of OUR. Results: Overall, 21 (42.8%) patients underwent RAUR, and 28 (57.2%) underwent OUR. The two groups were similar in terms of baseline and pathologic characteristics. There was a statistically significant difference in favor of RAUR for median operative time (216 vs 317 minutes, p = 0.01) and median blood loss (35 vs 175 mL, 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 length of stay 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.

Outcomes of Early Simultaneous Removal of Ureteric Stent With Indwelling Urethral Catheter After Kidney Transplant in Pediatric Recipients: A 10-Year Review

A ureteric stent is routinely placed to minimize urological complications during kidney transplant. However, some complications may occur in association with the ureteric stent, such as urinary tract infections, and the optimal duration for stent placement is unclear. We reviewed the outcomes following early simultaneous removal of the ureteric stent with the urethral catheter in pediatric kidney transplant recipients. We reviewed all kidney transplants from January 2009 to January 2019. The data we collated included demographics, donor and recipient characteristics, and perioperative details, including urological complications, stent-related complications, and kidney graft function. The financial cost of late stent removal was calculated. The early stent removal group was defined as 5 days, and the late removal group was about 4 to 6 weeks. The median follow-up time was 60 months (interquartile range, 31.5-91 months). There were 32 transplants in 31 patients during the study period (early vs late group = 23:9). No urine leak occurred in either group. One patient in the early group developed distal ureteric stenosis, and this condition was managed with interventional balloon dilatation. The median time for stent removal was 6 days in the early group and 39 days in the late group. There were 5 episodes of symptomatic urinary tract infections in 3 patients in the early group and 10 episodes of symptomatic urinary tract infections in 3 patients in the late group. The mean estimated glomerular filtration rate at 12 months was comparable between the 2 groups (84 ± 54 vs 64 ± 21 L/min/1.73 m²; P = .3). The average cost for each early removal was A$772.65 compared with the late group. Early simultaneous removal of the ureteric stent with the urethral catheter in pediatric kidney transplant recipients is feasible, safe, and cost-effective.

Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures

BackgroundTo summarize our experience with the Boari flap-psoas hitch and compare the indications, perioperative data and outcomes between open and laparoscopic procedures.MethodsThis study retrospectively reviewed 35 patients with complex distal ureteral stricture between January 2015 and April 2019. All patients were treated with Boari flap-psoas hitch by either an open or a laparoscopic procedure. Selection criteria were based on the etiology, comorbidities, medical history, and patient preference.ResultsAll surgeries were performed successfully. The median operation time was 201 min (range, 120 to 300 min), and the median estimated blood loss was 50 mL (range, 20 to 400 mL). The median postoperative hospitalization was 9 days (range, 3 to 46 days). Nineteen patients were treated by the open procedure, and 16 were treated by the transperitoneal laparoscopic procedure. The surgical indication of open surgery was broader than that for laparoscopic surgery. For patients experiencing iatrogenic injury and ureterovesical reimplantation failure, no significant differences in sex, laterality, operative time, ASA score or postoperative hospitalization stay were observed between the two groups. The median estimated blood loss was lower in the laparoscopic group than in the open group (P=0.047). Patients in the open group had more surgical complications than patients in the laparoscopic group (P=0.049). The postoperative follow-up showed the radiological resolution of hydronephrosis in 33 patients.ConclusionsWith the appropriate surgical considerations, Boari flap-psoas hitch is a valid method to bridge distal ureteral defects. For select patients, laparoscopic surgery had advantages being a minimal invasive surgery with less estimated blood loss and fewer surgical complications.

Pseudodiverticulum: A rare late complication of the Boari flap procedure for lower ureteric repair

The Boari bladder flap is a vital tool in the armamentarium of the urologist. It is used to maintain continuity of the urinary system when dealing with diseased segments of the mid and lower ureter. It is, however, associated with long-term complications. We present the case of a 46-year-old woman who developed a rare pseudodiverticulum as a consequence of the procedure. This patient had undergone a right-sided laparoscopic Boari bladder flap for a right distal ureteric stricture secondary to pelvic endometriosis, and presented 10 years later at our urology department with long-standing irritative voiding symptoms and a feeling of incomplete voiding. Radiological and endoscopic investigation revealed the presence of a capacious pseudodiverticulum which was seen on ultrasound to retain a significant amount of urine post micturition and then to empty back into her bladder, strongly suggesting that this was the cause of her sensation of incomplete bladder emptying. She had minimal symptom bother and no recurrent urinary tract infections, calculi or tumour, and it was decided that no further operative management was necessary and that her condition could be managed her conservatively. To the best of our knowledge, this is only the second case describing this rare, long-term complication of a Boari flap. Level of evidence: Level 5.

Video 4 - Simultaneous Robot assisted pyeloplasty and distal ureteric reimplantation for ipsilateral UPJ Obstruction and distal ureteric stricture

Video 4 - Simultaneous Robot assisted pyeloplasty and distal ureteric reimplantation for ipsilateral UPJ Obstruction and distal ureteric stricture

Ureteral Reimplantation via Robotic Nontransecting Side-to-Side Anastomosis for Distal Ureteral Stricture.

Objective: To describe a novel technique of ureteral reimplantation through robotic nontransecting side-to-side anastomosis. Although the standard approach to ureteroneocystostomy has a high rate of success, it involves transection of the ureter that may impair vascularity and contribute to recurrent strictures. Our method seeks to maximally preserve distal ureteral blood flow that may reduce this risk. Materials and Methods: We retrospectively reviewed a multi-institutional ureteral reconstruction database to identify patients who underwent this operation between 2014 and 2018, analyzing perioperative and postoperative outcomes. Results: Our technique was utilized in 16 patients across three U.S. academic institutions. Median operative time and estimated blood loss were 178 minutes (interquartile range [IQR] 150-204) and 50 mL (IQR 38-100), respectively. The median length of stay was 1 day (IQR 1-2). No intraoperative complications or postoperative complications with Clavien score ≥3 were reported. Postoperatively, 15 of 16 (93.8%) patients reported clinical improvement in flank pain, and all patients who underwent follow-up imaging had radiographic improvement with decrease in hydronephrosis at a median follow-up of 12.5 months. Conclusions: Ureteral reimplantation through a robotic nontransecting side-to-side anastomosis is a feasible and effective operation for distal ureteral stricture that may have advantages over the standard of care transecting ureteroneocystostomy.

Ureteral Reimplantation, Psoas Hitch, and Boari Flap.

Introduction: Ureteral reimplantation is indicated for patients with congenital distal ureteral strictures, for iatrogenic intraoperative distal ureteral injuries, and for those who require distal ureterectomy for transitional cell carcinoma. Methods: Using the da Vinci system from Intuitive, we demonstrate distal ureterectomy with reimplantation. Both a refluxing extravesical reimplant and nonrefluxing extravesical reimplant are shown. We also demonstrate modifications, including psoas hitch and Boari flap. Results: Robotic ureteral reimplantation with psoas hitch and Boari flap are demonstrated in a reproducible manner. Additional topics covered include the delineation of diseased ureter vs healthy ureter, the applications of indocyanine green, and the use of interoperative ureteral stents. Conclusions: Robotic ureteral reimplantation is safe and feasible when performed with proper technique. Ureteroscopy and near-infrared fluorescence technology facilitate improved detection of diseased ureteral segments. Key points include the maintenance of principles of open surgery such as a tension-free, watertight, and stented anastomosis.

V11-07 ROBOTIC-ASSITED TRANSPLANTED URETERAL STRICTURE MANAGEMENT

You have accessJournal of UrologyTransplant, Misc GU Cancers & Bladder Reconstruction (non-cancer) (V11)1 Apr 2020V11-07 ROBOTIC-ASSITED TRANSPLANTED URETERAL STRICTURE MANAGEMENT Begoña Etcheverry Giadrosich*, Andreu Alabat Roca, Lluis Riera Canals, Maria Fiol Riera, Sergi Beato Garcia, and Francesc Vigués Julià Begoña Etcheverry Giadrosich*Begoña Etcheverry Giadrosich* More articles by this author , Andreu Alabat RocaAndreu Alabat Roca More articles by this author , Lluis Riera CanalsLluis Riera Canals More articles by this author , Maria Fiol RieraMaria Fiol Riera More articles by this author , Sergi Beato GarciaSergi Beato Garcia More articles by this author , and Francesc Vigués JuliàFrancesc Vigués Julià More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000945.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract complications are relevant source of morbidity and mortality after kidney transplantation (KT). Ureteral stricture (US) is the most common urinary complications (0,6%-10,5%). The aim of this video is to present a minimally invasive technique using Da Vinci Robot for the ureteral reimplantation. METHODS: We present three patients with distal US after KT managed by a robot-assisted ureter reimplantation. The first case was a 29 years old man, transplanted on 2018. A Lich-Gregoire extravesical anastomosis was performed, a ureteral stent was placed. At third month he presented renal failure. The second one, was a 59 years old man, he received KT on 1984. A Politano-Lead better intravesical anastomosis was performed, without ureteral stent. He presented worsening renal function after 35 years. The third one was a 67 years old man, transplanted on 2018. A Lich-Gregoire extravesical anastomosis was performed and ureteral stent was placed. He presented an obstructive pyelonephritis two months later. In the three cases an ultrasound demonstrated hydronephrosis, needing the placement of a nephrostomy. The anterograde pyelography showed a distal US. The third patient was treated unsuccessfully with percutaneous balloon dilation. We present three robotic ureterovesical reimplantation after kidney transplant. We present two different ways to visualization the ureter. In the first patient serum through nephrostomy tube was instilled. In the others 2 patients, indocyanine green through nephrostomy tube was instilled and visualized using Firefly system. The ureteral end is spatulated and the anastomosis to the bladder is done with monocryl 4/0 suture. In the first and second patient, an ureterovesical reimplantation according to the Lich-Gregoir technique was performed. We left a 4,8 Ch, 12cm in the first and third patient. RESULTS: Overall, the mean operative time was 149 minutes. Median estimated blood loss was about 70mL. Anterograde pyelography showed good pass of the contrast medium through the ureter until the bladder in the three patients. Serum creatinine value and ultrasound remained stable, with a median follow-up of 7 months.The nephrostomy tube was removed within 2 months.The patients were discharged within 5 days. There were no recurrences neither urological complications. CONCLUSIONS: Minimal invasive Robotic approach for the management of ureteral stricture after kidney transplantation is safe and helpful. The instillation of saline solution and/or indocyanine green may assist with identification of the ureter and the stricture. Source of Funding:. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1016-e1016 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Begoña Etcheverry Giadrosich* More articles by this author Andreu Alabat Roca More articles by this author Lluis Riera Canals More articles by this author Maria Fiol Riera More articles by this author Sergi Beato Garcia More articles by this author Francesc Vigués Julià More articles by this author Expand All Advertisement PDF downloadLoading ...

Laparoscopic Ureteric Reimplantation in Distal Ureteric Injury Post-total Laparoscopic Hysterectomy: A Case Series

ABSTRACT Introduction Ureteral injuries have been recognized as a potential complication of gynecological surgical procedures since the inception of our discipline; incidence ranging from 0.5 to 1.5% and morbidity associated with it may be serious. Traditionally, most ureterovaginal fistulas have been repaired by ureteroneocystostomy. Open ureteral reimplantation is a potentially morbid surgical procedure. Endourological techniques are highly successful in treating posthysterectomy ureteral injuries. The objective of this presentation is to relate our experience and result with laparoscopic ureteral reimplantation. Materials and methods Five patients with complaints of leakage of urine per vaginum postoperatively on day 12–24 (post-TLH) presented for treatment. After diagnosis, treatment of ureterovaginal fistula was performed completely laparoscopically. Laparoscopic ureteral reimplantation was done. Results No major intraoperative or postoperative complications were encountered. The operating room time was 120 minutes (range 120–240 minutes). The average hospital stay was 4 days. Patients had a successful outcome defined as no evidence of radiographic obstruction and no clinical complaints of persistent renal colic or any other urinary symptoms. Conclusion Our experience demonstrates that laparoscopic ureteral reimplantation is an effective minimally invasive treatment option for distal ureteral strictures. How to cite this article Dadhich CP, Mehta N, Dadhich T, et al. Laparoscopic Ureteric Reimplantation in Distal Ureteric Injury Post-total Laparoscopic Hysterectomy: A Case Series. J South Asian Feder Obst Gynae 2020;12(5):291–294.

Efficacy of laparoscopic urinary tract reconstruction with intraoperative retrograde ureteroscopy-assisted technique for treatment of complex ureteral stricture

To investigate the feasibility and clinical effects of the laparoscopic urinary tract reconstruction with intraoperative retrograde ureteroscopy-assisted technique for the treatment of complex ureteral stricture. Methods: The clinical data of 16 patients with complicated ureteral stricture treated by the laparoscopic urinary tract reconstruction with intraoperative retrograde ureteroscopy-assisted technique from February 2016 to June 2018 were retrospectively analyzed. All 16 patients were iatrogenic stenosis. There were 4 cases of severe hydronephrosis in the affected side, 7 cases of moderate hydronephrosis, and 5 cases of mild hydronephrosis. According to the specific location and length of the ureteral stricture, the corresponding surgical method was selected. Results: All patients successfully completed the operation without conversion to open surgery and organ injury. After the operation, the patients were followed up for 8-18 months. The hydronephrosis of all patients was relieved to varying degrees, and no ureteral restenosis occurred. Conclusion: The laparoscopic urinary tract reconstruction with intraoperative retrograde ureteroscopy-assisted technique can accurately locate the stenosis segment, test the anastomosis effect, expand the inflammatory stenosis, and improve the end-to-end anastomosis of the distal ureteral stricture, which is a new and effective technique for the treatment of complex ureteral strictures.

V03-06 TRANSECTION-FREE SIDE-TO-SIDE DISTAL URETERAL REIMPLANTATION

INTRODUCTION AND OBJECTIVES:Distal ureteral strictures pose a potential risk for renal impairment. The surgical gold standard involves ureteroneocystotomy with transection of the ureter. We present the technique of side-to-side anastomosis as a useful treatment option that avoids aggressive distal ureteral dissection and further compromise of blood supply. Additionally, the presence of the native ureteral orifice allows for ureteroscopic access if required.METHODS:In this video, we show our robotic surgical technique for side-to-side anastomosis for distal ureteral stricture performed by three genitourinary reconstructive surgeons from three different institutions. Our technique involves the performance of adequate ureterolysis of the healthy, proximal and non-strictured segment. Extensive dissection of the posterior ureter towards the ureterovesical junction is avoided, preventing vascular compromise. Indocyanine dye can be used to demonstrate vascularity prior to anastomosis. A psoas hitch or bladder mo...

Robot-assisted surgery for benign distal ureteral strictures: step-by-step technique using the SP® surgical system.

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. 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. 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. Robot-assisted reconstructive surgery for benign distal ureteric strictures is feasible and safe using the da Vinci SP surgical system.

Ureteral Obstruction in Endometriosis

Aim: Endometriosis is defined as functional endometrial glands and stroma that occur outside the uterine cavity. It is an estrogen dependent, benign, inflammatory disease that affects women during premenarcheal, reproductive and postmenopausal hormonal stages.
 Methods: This is a retrospective review of six cases with diagnosis of ureteral endometriosis. All the patients were referred to Department of Surgery, Kathmandu Model Hospital and the study period was from September 2015 to August 2018.
 Results: In our study all the patients had involvement of the ureter. All the patients who had undergone open surgery had extrinsic involvement of the ureter. Two patients who had mild distal ureteric stenosis only were managed by diagnostic URS and retrograde DJ stenting. Another two patients with right distal ureteric stenosis were managed initially with retrograde DJ stenting but after removal of ureteric stent and in subsequent follow up the degree of hydroureteronephrosis increased in both the cases. These two patients were finally undergone right Lich Gregoir ureteroneocystostomy. In the remaining two patients, ureterorenoscopy (URS) guided double J stenting were attempted but failed to insert the stent due to stenosed ureter so they underwent open abdominal hysterectomy with excision endometriotic cyst with ureterolysis and double J stenting.
 Conclusions: Ureteral endometriosis is a rare disease presenting most commonly with nonspecific symptoms and signs and thus making preoperative diagnosis often difficult for the clinicians. Treatment of ureteral endometriosis is primarily surgical. The surgical procedures which are usually performed are excision of all endometriosis lesion, ureterolysis, ureterectomy with ureteroureteral anastomosis and ureteroneocystomy.

Treatment of congenital distal ureteral orifice stenosis by endoscopic laser ablation in dogs: 16 cases (2010-2014).

OBJECTIVE To determine characteristics of and outcomes for dogs with congenital distal ureteral orifice stenosis (CDUOS) treated by cystoscopic-guided laser ablation (CLA). DESIGN Retrospective case series. ANIMALS 16 client-owned dogs with CDUOS treated by CLA at 2 veterinary hospitals between 2010 and 2014. PROCEDURES Medical records were reviewed and data collected regarding clinical findings, imaging results, surgery characteristics, treatment, and outcome. Follow-up information was collected from dog owners and referring veterinarians via standardized interview. RESULTS Dogs included 10 males and 6 females; median age was 11.5 months (range, 4 to 112 months). Labrador Retriever (n = 6; 3 males) was the most common breed. Intramural ectopic ureteral openings were identified at the site of stenosis in 15 dogs (18/20 stenotic ureteral openings). Treatment with CLA to enlarge and relocate the stenotic opening was successful in all dogs. Median duration of anesthesia and hospitalization was 105 minutes and 24 hours, respectively. No complications were noted. Fourteen dogs remained alive (2 lost to follow-up) during a median follow-up period of 14.5 months. Owners of 11 of 13 dogs reported improvement in their dog's quality of life after CLA. The treated ureteral orifice remained patent in the 2 dogs that were reimaged. CONCLUSIONS AND CLINICAL RELEVANCE CDUOS should be considered as a differential diagnosis for dogs with idiopathic distal ureteral obstruction, particularly young male Labrador Retrievers, and was most often associated with an intramural ectopic ureter in this study. Treatment with CLA was safe and effective for opening the ureteral orifice.

V02-09 LAPAROSCOPIC PYELO-URETEROSTOMY OF GRAFT KIDNEY TO NATIVE URETER FOR A POST TRANPLANT RECURRENT URETERAL STRICTURE

You have accessJournal of UrologyBPH, Male Voiding Dysfunction, and Transplantation1 Apr 2018V02-09 LAPAROSCOPIC PYELO-URETEROSTOMY OF GRAFT KIDNEY TO NATIVE URETER FOR A POST TRANPLANT RECURRENT URETERAL STRICTURE Jitendra Jagtap, Lokesh Sinha, Vinayak Kore, Vikash Kumar, Sachin Veer, and Pradeep Rao Jitendra JagtapJitendra Jagtap More articles by this author , Lokesh SinhaLokesh Sinha More articles by this author , Vinayak KoreVinayak Kore More articles by this author , Vikash KumarVikash Kumar More articles by this author , Sachin VeerSachin Veer More articles by this author , and Pradeep RaoPradeep Rao More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.468AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Complicated recurrent ureteral strictures post renal transplantation have traditionally been managed by standard open surgical technique. We describe a successfully performed laparoscopic pyelo-ureterostomy between the graft kidney and native ureter for a long segment recurrent distal ureteral stricture in a 40 year old female. METHODS The patient had undergone a living related renal transplantation 3.5 years ago. She developed a distal ureteral stricture 3 years later and underwent an antegrade placement of a nephroureteral stent after balloon dilatation of the stricture. A month later she required an exploration, excision of distal ureteral strictured segment and ureteroneocystostomy for obstructive uropathy. Four months later she again presented with oliguria, rising creatinine and moderate hydroureteronephrosis. This time a laparoscopic pyelo-ureterostomy was performed using conventional three ports (two 10mm and one 5mm) triangulated towards the graft kidney. Intraoperative use of a 12MHz drop-in ultrasound probe aided in identification of the dilated graft pelvis and preoperative ureteral catheterisation helped in identification of right native ureter. Spatulated tension free anastomosis was performed with Polyglactin 4-0 sutures. RESULTS Operative time was 112 min with no intra operative complication. Postoperative course was uneventful. Hemoglobin drop was 0.2 gm/dL. Drain and catheter were removed on third postoperative day. Postoperative hospital stay was four days. Ultrasound on discharge showed resolution of the hydroureteronephrosis. DJ stent was removed after 15 days of surgery. CONCLUSIONS Laparoscopic pyelo-ureterostomy is a safe and efficacious technique for management of complicated recurrent ureteral strictures post renal transplantation. It additionally offers better comesis and shorter convalescence. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e169 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jitendra Jagtap More articles by this author Lokesh Sinha More articles by this author Vinayak Kore More articles by this author Vikash Kumar More articles by this author Sachin Veer More articles by this author Pradeep Rao More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V03-10 COMPLICATED REMOVAL OF AN ENCRUSTED ALLIUM™ URETERAL STENT

You have accessJournal of UrologyUrolithiasis & Endourology1 Apr 2018V03-10 COMPLICATED REMOVAL OF AN ENCRUSTED ALLIUM™ URETERAL STENT Etienne Xavier Keller, Vincent De Coninck, Maria Rodriguez-Monsalve, Steeve Doizi, and Olivier Traxer Etienne Xavier KellerEtienne Xavier Keller More articles by this author , Vincent De ConinckVincent De Coninck More articles by this author , Maria Rodriguez-MonsalveMaria Rodriguez-Monsalve More articles by this author , Steeve DoiziSteeve Doizi More articles by this author , and Olivier TraxerOlivier Traxer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.835AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Allium stents are indicated for long-term stenting of lower ureteral stenoses and are fully covered by a polymeric coating designed to prevent tissue in-growth into the lumen as well as reduce encrustation, stone formation and calcification. According to the manufacturer's instructions for use, Allium stents are easy to remove.We report about a complicated removal of an encrusted Allium ureteral stent. METHODS A 66 years old male had an Allium stenting of his right distal ureter 9 months ago at our institution. He suffered from a distal ureteral stenosis causing a urine outflow obstruction and was known for recurring stone disease. We agreed for a diagnostic ureteroscopy (Flex Xc, Karl Storz, Germany) and stent removal trial with the patient. RESULTS A retrograde ureteropyelography revealed full patency of the Allium stent. Diagnostic ureteroscopy revealed calcifications along the entire inner lumen of the stent. Identification of the distal nitinol loop of the Allium stent allowed us to perform the first extraction trial. We chose a 3.0 Fr Boston scientific Tricep to securely anchor the distal nitinol loop. Despite several trials, we were not able to extract the Allium stent hereby. We then inserted a 3.0 Fr Boston scientific Piranha forceps over a semi-rigid ureteroscope. The extraction of the stent was not possible by these means either. Finally, a foreign-body grasper inserted over the semi-rigid ureteroscope made the extraction of the Allium stent possible. High force levels were necessary to extract the stent. The coating of the Allium stent got ripped off the nitinol wires and a spontaneous rupture of the stent occurred during stent extraction. Unraveling of the stent did not occur. A control ureteropyelography did not reveal any contrast media extravasation. A control ureteroscopy showed extended mucosa oedema with several mucosal lesions Grad I according to the Traxer classification. Noteworthy, a few additional calcifications were found between the former external surface of the Allium stent and the ureteral mucosa. In light of the complicated stent removal, we decided to replace the Allium stent by two double J Tumorstents (7F / 30 mm, Bard). The insertion was performed in a parallel manner. CONCLUSIONS This video teaches us that Allium ureteral stent removal is not always as easy as stated by the manufacturer. In this particular case, the unraveling of the stent did not occur and may have been responsible for the high resistance to extraction.Potential complications such as stent calcification and ureteral mucosa damage have to be considered whenever an Allium stent has been inserted. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e324-e325 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Etienne Xavier Keller More articles by this author Vincent De Coninck More articles by this author Maria Rodriguez-Monsalve More articles by this author Steeve Doizi More articles by this author Olivier Traxer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

An Atypical Coincidence of Colon Ischemia and Bilateral Distal Ureteral Strictures

An Atypical Coincidence of Colon Ischemia and Bilateral Distal Ureteral Strictures

Ureterocystoneostomy in complex oncological cases with an "Uebelhoer" modified Boari bladder flap.

The study aims to describe the technique and analyze the outcome of an arcuated bladder incision with building of a triangular flap, first described by Uebelhoer (UBBF), as a modification of the classical rectangular Boari bladder flap (BBF), that is often viable, but can present difficulties, such as reduced flap vascularization and mobility in pretreated patients. Twelve consecutive patients with distal or mid ureteral leakage or stenosis, that underwent UBBF, were retrospectively analyzed. We assessed postoperative morbidity using Clavien-Dindo classification. Short- and long-term functional outcomes were assessed using glomerular filtration rate (GFR), ultrasound, and renal scintigraphy. Patients underwent UBBF during initial oncological surgery in five cases and due to ureteral defects following oncological surgery or radiotherapy in seven cases. Median patient age was 57 (interquartile range (IQR) 46-72), defect length was 7.5cm (IQR 5-8cm), and median follow-up period was 41 (IQR 36-48) months. In short-term follow-up, 11/13 postoperative morbidities were Clavien-Dindo level I-II complications, mostly infections. Two level IIIa complications occurred. One anastomotic leakage was treated sufficiently with temporarily ureteral stenting and one voiding disorder needed intervention. In the long-term follow-up, 84% of patients had improved or constant GFR. In the one-year renal scintigraphy, no urodynamically relevant voiding disorder occurred. The UBBF is a reliable procedure to reconstruct ureteral trauma even in complex oncological, pretreated patients suffering from distal or mid ureteral defects. It can be performed easily by a modified arcuate incision and provides good long-term functional outcomes.

V8-10 AN EFFICIENT TECHNIQUE TO ENGAGE AND CATHETERIZE A URETERAL ORIFICE IN DIFFICULT SITUATIONS

You have accessJournal of UrologyBladder Oncology/Testis/Transplantation/Trauma1 Apr 2016V8-10 AN EFFICIENT TECHNIQUE TO ENGAGE AND CATHETERIZE A URETERAL ORIFICE IN DIFFICULT SITUATIONS Cu Phan, Stephanie Y. Johng, Stephanie G. Wong, Alan Hung, and Dominic D. Tran-Nguyen Cu PhanCu Phan More articles by this author , Stephanie Y. JohngStephanie Y. Johng More articles by this author , Stephanie G. WongStephanie G. Wong More articles by this author , Alan HungAlan Hung More articles by this author , and Dominic D. Tran-NguyenDominic D. Tran-Nguyen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.753AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Catheterization of the ureteral orifice can be very challenging. These situations include patients with a very large median lobe of the prostate, a transplanted kidney, a cross-trigonal ureteral reimplantation, tumors/ stones obstructing the lumen of the ureteral orifice, and a distal ureteral stricture. We will present a technique that makes ureteral catheterization efficient and easier to perform. METHODS Use a 5 Fr. Open-ended ureteral catheter and an angled tip glidewire (hydrophilic guidewire with an angled tip). Insert the open-ended catheter into the scope and insert the glidewire sticking out of the inserted end. We can adjust the length, and thus curvature, of the glidewire sticking out of the inserted end. Use the Kelly clamp or mosquito clamp at the distal end of the catheter to fix the catheter to the glidewire inside. In order to steer the angled tip inside the bladder, we just need to gently rotate the clamp from the outside. The angled tip glidewire inside the bladder is soft and flexible. It can get into a challenging ureteral orifice easier than a regular open-ended catheter. We then advance both the catheter and the glidewire up the ureter. The catheter is fixed to the glidewire by the clamp. RESULTS We have used this technique to catheterize multiple patients with a transplanted kidney, cross-trigonal ureteral implantation, and with very large prostates. Once the catheter gets inside the ureteral orifice and into the ureter, we can easily release the clamp to advance the glidewire® quickly. CONCLUSIONS This technique is simple and more effective than traditional techniques – for example, using an Alberran deflecting bridge or an angled tip angiographic catheter. The Alberran deflecting bridge may also catch organs such as the prostate and cause bleeding. On the other hand, the angled tip angiographic catheter, although also curved, is static – meaning the surgeon has no flexibility in adjusting the curvature of the catheter. The advantage of using a glidewire® as opposed to simply using an open-ended catheter is that the curvature can easily be manipulated and that the wire is flexible enough to fit into tortuous paths such as a J-hook ureter. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e774 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Cu Phan More articles by this author Stephanie Y. Johng More articles by this author Stephanie G. Wong More articles by this author Alan Hung More articles by this author Dominic D. Tran-Nguyen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...