Flap Ureteroplasty Research Articles

Robotic-assisted appendiceal onlay flap ureteroplasty combined with ureteral reimplantation for multifocal ureteral strictures: Case report and technical description.

To describe the surgical technique of robotic-assisted appendiceal onlay flap ureteroplasty combined with ureteral reimplantation to repair unilateral multifocal ureteral strictures in one stage and report 9-month follow-up outcomes. A longitudinal ventral incision of proximal ureter strictures No. 1 and 2 was performed, and the appendix was detubularised along its antimesenteric border. Then, the appendiceal onlay flap was anastomosed with the spatulated ureter in an onlay fashion. To manage the distal ureteral stricture No. 3, ureteral reimplantation was performed in a tension-free manner. Voiding cystourethrography and antegrade urography showed urine regurgitation into the ureter without dilation and no obstruction of the reconstructed ureteral segment 7weeks after surgery. No postoperative complications occurred during the 9-month follow-up. Robotic-assisted appendiceal onlay flap ureteroplasty combined with ureteral reimplantation appears to be a safe and effective surgical method for repairing the unilateral multifocal ureteral strictures.

Retracted: The Clinical Study of Bladder Flap Ureteroplasty (Psoas Hitch) in the Treatment of Lower Ureteral Injuries and Strictures (19 Cases).

[This retracts the article DOI: 10.1155/2022/4607735.].

The Clinical Study of Bladder Flap Ureteroplasty (Psoas Hitch) in the Treatment of Lower Ureteral Injuries and Strictures (19 Cases).

Objective The aim of this study was to investigate the efficacy and safety of bladder flap ureteroplasty (psoas hitch) in the treatment of lower ureteral injuries and strictures. Methods 19 patients with lower ureteral injuries and strictures scheduled for a bladder flap ureteroplasty (psoas hitch) in our hospital from January 2020 to January 2021 were recruited. The outcome measures included treatment efficacy and safety. Results The operative time, intraoperative bleeding, catheter extubation time, hospital stay, extubation time of ureteral stent, and follow-up time were (125.36 ± 15.38) min, (75.37 ± 11.09) ml, (7.25 ± 1.04) d, (8.76 ± 1.11) d, (46.34 ± 7.66) d, and(19.27 ± 1.27) months, respectively. No serious perioperative adverse reactions were observed, and all the symptoms of patients were relieved. Conclusion Bladder flap ureteroplasty (psoas hitch) is safe and effective for the treatment of lower ureteral injuries, with advantages such as less intraoperative bleeding and trauma and rapid recovery, so it is worthy of promotion. This was a retrospective study supervised by the Ethics Committee of Hebei Yanda Hospital.This trial is registered with no. hebYD076.

Robotic ureteroplasty with appendiceal onlay flap: an update on the outcomes of 18-month follow-up.

BackgroundTo describe our technical experience of robotic appendiceal onlay flap ureteroplasty (RAUP) for complex ureteral stricture disease and report the updated analysis of 18-month follow-up outcomes.MethodsSince May 2019, nine patients with right ureteral strictures have undergone RAUP in our medical centre. Patients’ perioperative data and follow-up information were collected prospectively. Patients were excluded in present study if the postoperative follow-up time was less than 6 months.ResultsEight patients were recruited. Proximal ureteric strictures were present in 5 patients, and 3 patients had middle ureteric strictures. The mean stricture length was 4.3 cm (range, 3.0–6.0 cm). Nephrostomy was performed in 4 patients, and 4 patients had indwelling double-J ureteral stents before they were admitted to our hospital. All operations were implemented successfully without intraoperative complications. The mean operation time was 162 minutes (range, 135–211 minutes), and the mean estimated blood loss was 78 mL (range, 30–200 mL). The mean postoperative hospital stay was 8 days (range, 4–12 days). No patients had high-grade postoperative complications (Clavien-Dindo III and IV) 30 days after surgery. At a mean follow-up of 18 months (range, 6–28 months), all patients were not needed further surgical intervention and could be considered successful. But 2 cases still have stable mild hydronephrosis without symptoms such as flank pain or fever.ConclusionsRAUP is a workable option for managing long-segment (3–6 cm) proximal and middle ureteral strictures of the right side. The outcomes of 18-month follow-up are satisfactory.

Onlay Repair Technique for the Management of Ureteral Strictures: A Comprehensive Review

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.

A Multi-Institutional Experience With Robotic Appendiceal Ureteroplasty

To report a multi-institutional experience with robotic appendiceal ureteroplasty. This is a retrospective review of 13 patients undergoing right appendiceal flap ureteroplasty at 2 institutions between April 2016 and October 2019. The primary endpoint was surgical success defined by the absence of flank pain and radiographic evidence of ureteral patency. Eight of 13 (62%) underwent appendiceal onlay while 5/13 (38%) underwent appendiceal interposition. Mean length of stricture was 6.5 cm (range 1.5-15 cm) affecting anywhere along the right ureter. Mean operative time was 337 minutes (range 206-583), mean estimated blood loss was 116 mL (range 50-600), and median length of stay was 2.5 days (range 1-9). Balloon dilation was required in 1/12 (8%). One patient died on postoperative day 0 due to a sudden cardiovascular event. Otherwise, there were no complications (Clavien-Dindo > 2) within 30 days from surgery. At a mean follow up of 14.6 months, 11/12 (92%) were successful. Robotic appendiceal ureteroplasty for right ureteral strictures is a versatile technique with high success rates across institutions.

Appendiceal Onlay Flap Ureteroplasty for the Treatment of Complex Ureteral Strictures: Initial Experience of Nine Patients.

Purpose: To evaluate the onlay technique using the appendix for ureteral reconstruction and describe the initial experience of nine operations performed by one surgeon. Methods: Nine patients with complex ureteral strictures who underwent appendiceal onlay flap ureteroplasty since May 2019 were recruited from our RECUTTER database. There were seven men and two women, with a mean age of 38.9 years; four patients underwent robot-assisted laparoscopic surgery, and five patients underwent traditional laparoscopic surgery. All patients had iatrogenic injuries of the ureter after treatment of stone disease. Seven patients had proximal ureteral strictures, and two had midureteral strictures. The mean stricture length of the nine patients was 3.9 (range 3-4.5) cm. Nephrostomy was performed in seven patients before they presented to our center, and the other two patients had indwelling Double-J ureteral stents. Results: All nine operations were effectively completed without open conversion. The mean operation time was 182 (range 135-220) minutes, the mean estimated blood loss was 71 (range 20-100) mL, and the mean length of postoperative hospital stay was 9 (range 6-12) days. No postoperative complications of high grade (Clavien-Dindo III and IV) occurred within 30 days of surgery. All the patients had their Double-J ureteral stents and nephrostomy tubes removed after complete ureteroscopy and upper urinary tract urodynamic examination or CTU, which showed that the anastomosis healed well and that the urinary tract was unobstructed, respectively. The objective success rate was 100% (all the patients had endoscopic and radiographic resolution of their ureteral strictures). The subjective success rate was 88.9% (one patient developed recurrent back discomfort and a 0.5 cm calculus was found in her renal pelvis). Conclusions: Appendiceal onlay flap ureteroplasty is a viable and effective technique for treating complex proximal and middle ureteral strictures at the right side.

Reverse Tubularized Pelvis Flap Method for the Treatment of Long Segment Ureteropelvic Junction Obstruction

Objective: The most common cause of urinary obstruction is ureteropelvic junction (UPJ) obstruction. In short stenosis, a dismembered pyeloplasty is performed, but for long segment stenosis, the procedure is not well defined. We present the reverse flap ureteroplasty method, which we prepared from the pelvis for use in long segment UPJ obstruction. Methods: Between 2007 and 2016, we operated on 6 cases (4 males, 2 females) with an age range of 2–6 months. After reaching the UPJ region, depending on the length of the long segment obstruction, a flap measuring 25–35 mm in length was prepared from the pelvis so that its width would be 10–12 mm on the pelvis side and 10 mm in the distal portion. It was then reversed and tubularized with an absorbable suture over a 10-French nelaton catheter. The end of this ureter and the end of the distal ureter were spatulated and anastomosed. A double J and minivac drain were used in each case. Results: There were no complications in the postoperative period of all our patients. They were all discharged with good health. Follow-up with renal ultrasonography showed that the anteroposterior diameters were decreased and that parenchymal thicknesses had returned to normal. Secondary stenosis, flap necrosis, and retraction did not develop. Conclusion: Because the blood supply of the pelvis is increased in patients with UPJ obstruction, a reverse flap of adequate length with preserved blood supply can be achieved and tubularized. We suggest that this method will be appropriate for the treatment of long segment UPJ obstruction.

Robotic-assisted laparoscopic Boari flap ureteroplasty for ureteral strictures after kidney transplantation

Objective To evaluate the clinical efficacy and safety of robotic-assisted laparoscopic Boari flap ureteroplasty for ureteral strictures after kidney transplantation. Methods The clinical data of 2 patients with ureteral stricture after kidney transplantation in our department from May 2017 to September 2017 were retrospectively analyzed. All 2 cases were male. Case 1 was 73 years old and the transplanted kidney was located in the left iliac fossa. The patient was hospitalized due to still recurrent fever with long-term retention of nephrostomy tube because of hydronephrosis with repeated urinary tract infection after calculi surgery. Case 2 was 62 years old and the transplanted kidney was located in the right iliac fossa. The patient was hospitalized due to hydronephrosis and ureteral calculi after calculi surgery. All 2 cases were treated by robotic-assisted laparoscopic Boari flap ureteroplasty. The operative and postoperative complications were recorded and the postoperative examination data were collected. Results The operation time of the 2 cases were 165min and 189min, and the bleeding amount were 50ml and 100ml respectively. No urinary leakage, renal colic, high fever and other complications occurred. In case 1, nephrostomy tube was removed 8d after operation. The urinary catheters were removed 14d after operation in the 2 cases. The postoperative hospital day was 9d and 6d respectively. CT examination was performed 3 months after surgery. Compared with preoperative, case 1 had no significant change in hydronephrosis and the hydronephrosis of case 2 obviously relieved. In case 1, double J tube was removed in 3 months after operation. In case 2, double J tube was replaced in 3 months after operation and was removed after 3 months. 2 patients were followed up to 18 months and 14 months after operation, respectively. No hydronephrosis aggravated. Conclusions Robotic-assisted laparoscopic Boari flap ureteroplasty is a safe and effective treatment for ureteral strictures after kidney transplantation. It has the advantages of small trauma, quick recovery, exact effect and few complications. Key words: Kidney transplantation; Ureteral stricture; Robot; Laparoscopy; Boari flap plasty

Review of appendiceal onlay flap in the management of complex ureteric strictures in six patients

To evaluate appendiceal onlay flap ureteroplasty for repairing complex right proximal and mid-ureteric strictures. Between August 2006 and August 2012 four women and two men (mean age 34.2 years) underwent right laparoscopic appendiceal onlay flap ureteroplasty. The mean stricture length was 2.5 cm. Stricture formation was secondary to impacted ureteric stones in three patients and failed pyeloplasty for congenital pelvi-ureteric junction obstruction in the remaining three. Each patient had ipsilateral flank pain before surgery. The mean operating time, estimated blood loss and hospital stay were 244 min, 175 mL and 3.2 days, respectively. No intra- or peri-operative complications were noted. The objective success rate was 100% (all patients had radiographic and/or endoscopic resolution of their ureteric strictures). The subjective success rate was 66%, (two patients developed recurrent discomfort, which upon exploration was found to be attributable to fibrosis away from the appendiceal onlay graft, where the gonadal vessels crossed the ureter). Both patients with recurrent pain underwent laparoscopic ureterolysis and bladder advancement flap proximal to the appendiceal onlay, which markedly improved one patient's pain but the other patient continued to have discomfort, ultimately resulting in a laparoscopic nephroureterectomy. Appendiceal onlay ureteroplasty is a viable treatment option for patients with complex right proximal and mid-ureteric strictures, while minimising the potential morbidity of appendiceal and ileal interposition.

Curative effect of using spiral pedunculated bladder muscle flap in long ureteral segment defect repairing

Objective To investigate the effects of using spiral pedunculated bladder muscle flap ureteroplasty in the treatment of long ureteral segment defects ( ＞ 20 cm). Methods A retrospective analysis was conducted on the clinical effects of five patients who encountered long ureteral segment defects caused during ureteroscopic lithotripsy.The five patients included three males and two females with an age range from 37 to 59 yrs ( average age 48 ).Four of the cases had defects on the left and one case on the right.Two cases had whole ureteral mucosal avulsion and three cases had whole ureteral ruptur from the pelvis to the bladder junction.Defect lengths measured from 21 to 25 cm( mean length 22.5 cm).All five patients underwent emergency surgery using spiral pedunculated bladder muscle flap ureteroplasty and 7 F double J stent placement in the repaired ureters which was fixed on psoas muscles.The average length of the new ureters using spiral pedunculated bladder muscle flap was 22.5 cm. Results All the operations were successful and the operation time was 1 -2 hrs (average 1.5 hrs).Drainage tubes for four patients were removed three days after operation.IN the remaining case the drainage tube was removed 10 days after surgery due to urine leakage.All wounds healed uneventfully.Serum creatinine and blood urea nitrogen were normal two weeks after surgery.Double-J tubes were removed safely under cystoscope eight weeks after surgery.In following-up,one case was found to have mild hydronephrosis and ipsilateral ureter slight expansion six months after surgery,but renal function was normal.There was no abnomality found in the remaining four patients after 2 -4 years of follow-up.The IVU showed normal morphology and good developments in the ipsilateral ureter. Conclusions Spiral pedunculated bladder muscle flap ureteroplasty is an ideal treatment method in repairing long ureteral segment defects. Key words: Ureteroscopy; Complication; Bladder muscle flap; Ureteroplasty

Flap ureteroplasty for segmental stricture of middle third of ureter

A technique is described for repair of segmental stricture of the middle third of the ureter utilizing spiral or vertical flap from the proximal dilated ureter. In all cases a 10 F polyethylene ureteric stent with a ureterotomy exit 5 cm. distal to the repair site was used. Twenty-eight ureters in 27 patients were repaired by this technique, with good results in all except 3 cases which showed postoperative residual dilatation three months after surgery.

SUCCESSFUL RECONSTRUCTION OF THE UPPER URINARY TRACT BY A COMBINED BOARI FLAP URETEROPLASTY AND TRANSURETEROURETEROSTOMY

Acute obstructive uropathy, following an abdominal hysterectomy in a 45-year-old woman, had been temporarily circumvented by bilateral nephrostomy. Reconstruction of the upper urinary tracts, in the face of a small, defunctionalized bladder, was successfully accomplished by a Boari flap ureteroplasty and transureteroureterostomy.

Management of Ureteral Obstruction After an Antireflux Operation: Triangular Flap Ureteroplasty

Pronounced ureteral obstruction following an antireflux operation is an uncommon but often difficult problem to manage. Based on a limited experience we have found that triangular flap ureteroplasty is a worthwhile means of repeat reimplantation of the obstructed ureter and perhaps provides a better alternative than transureteroureterostomy.

Flap Ureteroplasty in Ureteral Defects: An Experimental Study in Dogs

Flap Ureteroplasty in Ureteral Defects: An Experimental Study in Dogs

Use of Teflon Grafts for Replacement of Ureters

No AccessJournal of Urology1 Mar 1961Use of Teflon Grafts for Replacement of Ureters John W. Warren, Walter P. Bandura, Frank A. Beltran, and Alejandro Horochowski John W. WarrenJohn W. Warren More articles by this author , Walter P. BanduraWalter P. Bandura More articles by this author , Frank A. BeltranFrank A. Beltran More articles by this author , and Alejandro HorochowskiAlejandro Horochowski More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)65319-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1961 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byStrauch A, Olesen S and Madsen P (2018) Flap Ureteroplasty in Ureteral Defects: An Experimental Study in DogsJournal of Urology, VOL. 98, NO. 2, (177-183), Online publication date: 1-Aug-1967.Thompson I, Kovacsi L and Porterfield J (2018) Reconstruction of the Ureteropelyic Junction with Pedicle Grafts of Renal CapsuleJournal of Urology, VOL. 89, NO. 4, (573-577), Online publication date: 1-Apr-1963.Deniz E, Calams J and McDonald J (2018) Repair of Total Defect of Ureter with a Single Pedicle Ureteral FlapJournal of Urology, VOL. 88, NO. 2, (191-196), Online publication date: 1-Aug-1962. Volume 85Issue 3March 1961Page: 265-267 Advertisement Copyright & Permissions© 1961 by The American Urological Association Education and Research, Inc.MetricsAuthor Information John W. Warren More articles by this author Walter P. Bandura More articles by this author Frank A. Beltran More articles by this author Alejandro Horochowski More articles by this author Expand All Advertisement PDF downloadLoading ...

Replacement of the Ureter by Small Intestine: Clinical Application and Results of the “ileal Ureter”

Replacement of the Ureter by Small Intestine: Clinical Application and Results of the “ileal Ureter”

Bladder flap ureteroplasty.

Bladder flap ureteroplasty.

Intubated Ureterotomy: Experimental Work and Clinical Results

Intubated Ureterotomy: Experimental Work and Clinical Results

Reconstruction of Lower Segment of Ureter with Tube Made from Bladder Flap: Preliminary Report

No AccessJournal of Urology1 Mar 1948Reconstruction of Lower Segment of Ureter with Tube Made from Bladder Flap: Preliminary Report1 Roger W. Barnes and Stanley Farley Roger W. BarnesRoger W. Barnes More articles by this author and Stanley FarleyStanley Farley More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)69399-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1948 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGross M, Peng B and Waterhouse K (2018) Use of the Mobilized Bladder to Replace The Pelvic UreterJournal of Urology, VOL. 101, NO. 1, (40-44), Online publication date: 1-Jan-1969.Habib H, Charuworn T, Primeau J, Mark D and Thompson I (2018) Repair of Ureteral Defects Using Uninterrupted Non-penetrated Bowel WallJournal of Urology, VOL. 100, NO. 3, (270-279), Online publication date: 1-Sep-1968.Harada N, Tanimura M, Fukuyama K, Asakura T, Morimoto Y and Hattori H (2018) Surgical Management of a Long Ureteral Defect: Advancement of the Ureter by Descent of the KidneyJournal of Urology, VOL. 92, NO. 3, (192-197), Online publication date: 1-Sep-1964.Scott F (2018) Submucosal Bladder Flap Ureteroplasty: Experimental StudyJournal of Urology, VOL. 88, NO. 1, (42-50), Online publication date: 1-Jul-1962.Kočvara S and Žák F (2018) Ureteral Substitution with Dacron and Teflon ProsthesesJournal of Urology, VOL. 88, NO. 3, (365-376), Online publication date: 1-Sep-1962.Uson A (2018) Cystoureteroplasty in Dogs: An Evaluation of the Full Thickness Bladder Flap TechniqueJournal of Urology, VOL. 85, NO. 5, (759-766), Online publication date: 1-May-1961.Hardy Ulm A and Krauss L (2018) Total Unilateral Teflon Ureteral Substitutes in the DogJournal of Urology, VOL. 83, NO. 5, (575-582), Online publication date: 1-May-1960.Dillon J (2018) Use of Bladder Pedicles as Substitutes for the Lower UreterJournal of Urology, VOL. 83, NO. 5, (583-592), Online publication date: 1-May-1960.Burns R (2018) Reconstruction of the Lower Ureters by a Tube Made from Bladder Flaps: a Case ReportJournal of Urology, VOL. 74, NO. 3, (348-353), Online publication date: 1-Sep-1955.Higgins R (2018) A New Ureteroplasty: Advancement of the Ureter by a Vesico-Ureteral Pedicle GraftJournal of Urology, VOL. 70, NO. 3, (376-385), Online publication date: 1-Sep-1953.Rosenberg M and Dahlen G (2018) Autogenous Vein Grafts and Venous Valves in Ureteral Surgery: An Experimental StudyJournal of Urology, VOL. 70, NO. 3, (434-446), Online publication date: 1-Sep-1953.Barnes R, Wilson W, Bergman R, Farley S and Hadley H (2018) Plastic Surgery on the Urinary BladderJournal of Urology, VOL. 69, NO. 5, (641-651), Online publication date: 1-May-1953.Aschner P (2018) Accidental Injury to Ureters and Bladder in Pelvic SurgeryJournal of Urology, VOL. 69, NO. 6, (774-786), Online publication date: 1-Jun-1953. Volume 59Issue 3March 1948Page: 466-470 Advertisement Copyright & Permissions© 1948 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Roger W. Barnes More articles by this author Stanley Farley More articles by this author Expand All Advertisement PDF downloadLoading ...