Laparoscopic Ureteral Reconstruction Research Articles

Laparoscopic Ureteral Reconstruction in Children with Retrocaval Ureter: A Modern Single Center Retrospective Study.

Purpose: This study aims to report our experience in the treatment of children with retrocaval ureter (RCU) using laparoscopic ureteral reconstruction surgery. Patients and Methods: We retrospectively collected clinical data from 10 pediatric patients with RCU who underwent laparoscopic surgery at our hospital from April 2010 to April 2022. All patients underwent comprehensive preoperative radiological assessment and were diagnosed with RCU, subsequently undergoing laparoscopic ureteral reconstruction. Patient demographics, surgical data, and postoperative outcomes were recorded. Regular follow-ups were conducted postoperatively, evaluating clinical symptoms and radiological results. Results: The median age of the 10 patients was 8.8 years (range, 6-14 years). All surgeries were successfully performed laparoscopically without the need for open conversion, with an average surgical time of 153.3 minutes (range, 120-243 minutes). Intraoperative bleeding was minimal and no blood transfusions were required. No intraoperative complications were observed. The average hospital stay for the patients was 5.3 days (range, 4-7 days) and the Double-J (D-J) stent was removed 6 weeks postoperatively. Follow-up ultrasound results at 3 and 6 months postoperatively showed a reduction in renal pelvic dilatation, and all patients experienced significant relief of clinical symptoms related to flank and abdominal discomfort. Conclusion: Laparoscopic reconstruction for RCU demonstrates good feasibility and effectiveness in pediatric patients, offering a minimally invasive treatment option for the management of RCU in children.

A Course Book of Laparoscopic Ureteral Reconstruction for Gynecologists-from 100 Cases of Experience

A Course Book of Laparoscopic Ureteral Reconstruction for Gynecologists-from 100 Cases of Experience

Editorial Comment.

No AccessJournal of UrologyAdult Urology24 Feb 2023Editorial CommentThis article comments on the following:Final Results of a Phase I Trial of WST-11 (TOOKAD Soluble) Vascular-targeted Photodynamic Therapy for Upper Tract Urothelial Carcinoma Timothy D. Lyon, Ram A. Pathak, and Andrew J. Zganjar Timothy D. LyonTimothy D. Lyon Department of Urology, Mayo Clinic, Jacksonville, Florida More articles by this author , Ram A. PathakRam A. Pathak Department of Urology, Mayo Clinic, Jacksonville, Florida More articles by this author , and Andrew J. ZganjarAndrew J. Zganjar Department of Urology, Mayo Clinic, Jacksonville, Florida More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003202.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. . Management of low-grade upper tract urothelial carcinoma: an unmet need. Rev Urol. 2020; 22(1):1-8. Medline, Google Scholar 2. . Robot-assisted laparoscopic ureteral reconstruction for malignant pathology: Single-center experience with analysis of perioperative, functional, and oncologic outcomes. J Endourol. 2023; 37(1):42-49. Crossref, Medline, Google Scholar 3. Final results of a phase I trial of WST-11 (TOOKAD Soluble) vascular-targeted photodynamic therapy for upper tract urothelial carcinoma. J Urol. 2023; 209(5):000. Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology1 Feb 2023Final Results of a Phase I Trial of WST-11 (TOOKAD Soluble) Vascular-targeted Photodynamic Therapy for Upper Tract Urothelial Carcinoma Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy D. Lyon Department of Urology, Mayo Clinic, Jacksonville, Florida More articles by this author Ram A. Pathak Department of Urology, Mayo Clinic, Jacksonville, Florida More articles by this author Andrew J. Zganjar Department of Urology, Mayo Clinic, Jacksonville, Florida More articles by this author Expand All Advertisement PDF downloadLoading ...

Optimization of laparoscopic ureteral repair with a buccal graft in case of its extended strictures and obliterations

Purpose of the study. Currently, laparoscopic technique has become widely used in the treatment of extended strictures and obliterations of the ureter. The use of minimally invasive approaches will also be relevant for such a relatively new operation as buccal ureteroplasty. In the literature, there are isolated publications devoted to this technique. The aim of this study was to study the results of our own experience of laparoscopic ureteral reconstruction using a buccal graft.Patients and methods. We observed 5 patients – 2 men and 3 women, at the age of 30–62 years. All patients have already been operated on the urinary tract, of these, in four patients, the urinary tract was drained with a nephrostomy or internal ureteral stent. Two patients underwent replacement ureteroplasty with tubularized buccal graft, and three patients underwent augmentation ureteroplasty with buccal graft using the onlay method.Results. All operations in this group were carried out without conversions. The average length of the ureteral defect was 4.9 cm (4.0–6.0 cm). The patients did not have severe complications in the postoperative period according to the ClavienDindo classification. One patient underwent treatment for exacerbation of chronic pancreatitis; one man experienced ureteral stent migration, which required restentation. The follow-up period was 1–15 months; one woman developed unextended ureteral restenosis, which was eliminated by endoureterotomy and ureteral stenting. At the moment, all patients are spared from permanent urinary drains, they do not have upper urinary tract obstruction. Conclusion. All operations in this group were carried out without conversions. The average length of the ureteral defect was 4.9 cm (4.0–6.0 cm). The patients did not have severe complications in the postoperative period according to the Clavien-Dindo classification. One patient underwent treatment for exacerbation of chronic pancreatitis; one man experienced ureteral stent migration, which required restentation. The observation period for the patients was 1–15 months, one woman developed short ureteral restenosis, which was eliminated by endoureterotomy and ureteral stenting. At the moment, all patients do not have permanent urinary drains, violations of the urodynamics of the upper urinary tract were not revealed in them.

Laparoscopic ureteral reconstruction in a kidney transplant: successful clinical cases

Treatment of ureteral strictures in the long-term post-transplant period is a complex surgical procedure. We present successful clinical cases of developed laparoscopic ureteral stricture reconstruction methods at three levels (in the pelvis, along the ureter, in the anastomosis area). These methods have shown their clinical efficacy: they are less traumatic, there are no adverse events in the early and long-term postoperative periods, and there is accelerated rehabilitation of recipients after surgery.

V08-07 SINGLE-PORT ROBOTIC-ASSISTED LAPAROSCOPIC IPSILATERAL AND TRANSURETEROURETEROSTOMY

INTRODUCTION AND OBJECTIVE:Robotic-assisted laparoscopic ureteral reconstruction has shown excellent success and low complications rates. With the recent introduction of the single-port (SP) roboti...

Three different laparoscopic techniques for the management of iatrogenic ureteral injury: A multi-institutional study with medium-term outcomes

BackgroundExcellent success rates with short-term outcomes are noted for laparoscopic ureteral reconstruction (LUR) for iatrogenic ureteral injury. This multi-institutional study assessed the medium-term (>1 year) outcomes and compared three surgical techniques of LUR. MethodsPatients who underwent LUR at five tertiary hospitals between January 2007 and June 2016 were retrospectively analyzed. Patients with active abdominopelvic inflammatory disease, history of urothelial cancer, and tumor recurrence and those who received adjuvant chemotherapy or radiotherapy were excluded. ResultsThe success rates of LUR for 61 patients at 3 months postoperatively and at the last follow-up (at least 12 months postoperatively) were 100% and 95.1%, respectively. No significant difference was noted in the success rates of the three types of LUR. LUR was mainly performed in response to the demands of the primary surgeon responsible for the iatrogenic injury (33 of 45 cases, 73.3%). The vesicoureteral reflux (VUR) incidence was higher in the refluxing laparoscopic ureteroneocystostomy (LUN) group (40%) than in the anti-refluxing LUN group (15%, odds ratio: 1.5, p = 0.252). None of the patients in the LUN groups received treatment for VUR during the follow-up. The laparoscopic end-to-end ureteroureterostomy (LEEU) group had shorter operative time (p < 0.001) and lesser intraoperative blood loss (p < 0.001) than the LUN groups. ConclusionLUR is safe and feasible, with good medium-term outcomes. LEEU is a good surgical option in terms of the operative and subsequent outcomes. The anti-reflux technique in LUR reduces de-novo VUR development but is not necessary for preventing upper urinary tract infections in adults.

Laparoscopic ureteral reconstruction in infant with congenital mid ureteric valve

Congenital mid ureteric valve (MUV) stenosis is a very rare cause of ureteric obstruction and hydronephrosis (HN) in children. We describe how we manage laparoscopically one case of a patient with congenital MUV. We describe a 6-month-old boy born with antenatal left HN, with an anteroposterior diameter (APD) of 1,5cm. Follow-up renal ultrasound at 3 months of age showed an increase in left kidney HN, approximately 2.5cm below the PUJ associated with distal stenosis. Renal scintigraphy with DTPA showed an obstructive pattern. Urography scan showed an abrupt reduction in the caliber of the mid left ureter Based on a preoperative diagnosis of MUV stenosis, we performed a laparoscopic left ureteroplasty. Abrupt tapering of the left ureter at 3cm from the PUJ was identified. Proximal ureter repair was performed before the resection of the narrowing segment. The two edges of the ureter were spatulated and continuous anastomosis was performed without tension. An antegrade JJ stent was inserted after the posterior part of the anastomosis was done. Patient made an uneventful recovery and was discharged on the first postoperative day. Laparoscopic ureteroplasty is a complex but feasible option to treat patients with congenital MUV stenosis.

Laparoscopic Ureteral Reimplantation for the Management of Long-segment Ureteral Defect in Gynecologic Surgeries

To demonstrate techniques of laparoscopic ureteral reconstruction for long-segment ureteral defects in gynecologic surgeries. Step-by-step demonstration of a laparoscopic ureteral reimplantation using the Boari flap and ileal interposition. Gynecologic diseases often involve the ureter; hence, knowledge of ureteral reconstruction techniques is imperative in gynecologic surgeries. The important aspect of ureteral reconstruction is to ensure tension-free anastomosis; therefore, various methods are required depending on the length of the ureteral defect [1]. The Boari flap and ileal interposition are preferred for repairing 8-cm to 12-cm and >12-cm ureteral defects, respectively. These methods have traditionally required large incisions [2,3]. Laparoscopic ureteral reimplantation using the Boari flap and ileal interposition has been reported to be as safe as the open technique and superior in terms of postoperative recovery in urologic surgeries [3,4]; however, to the best of our knowledge, it has not been reported in the field of gynecology. To our knowledge, this is the first report to demonstrate the techniques of laparoscopic Boari flap and ileal ureter replacement in gynecologic surgeries. The technique was approved by our institutional review board. The first case involved an intra-abdominal desmoid tumor, whereas the second case involved recurrent endometrial cancer. In both cases, long-segment ureteral resection was required to achieve complete tumor clearance. Laparoscopic ureteral reimplantation was performed successfully, without any complications, using the Boari flap in the first case and ileal interposition in the second. Laparoscopic ureteral reimplantation is technically feasible for the management of long-segment ureteral defects.

V05-08 MANAGEMENT OF MULTIPLE URETERAL STRICTURES IN A PARTIALLY DUPLICATED COLLECTING SYSTEM

You have accessJournal of UrologyUpper-Tract Reconstruction (V05)1 Apr 2020V05-08 MANAGEMENT OF MULTIPLE URETERAL STRICTURES IN A PARTIALLY DUPLICATED COLLECTING SYSTEM Aeen Asghar*, Ziho Lee, Michael Metro, and Daniel Eun Aeen Asghar*Aeen Asghar* More articles by this author , Ziho LeeZiho Lee More articles by this author , Michael MetroMichael Metro More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000874.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Duplication of the collecting system can be found in nearly 1% of the general population. It can present as partial or complete duplication with or without obstruction and reflux. Herein, we present a patient with idiopathic high-grade ureteral strictures in both ureters of her partially duplicated system. METHODS: We present a 36-year-old female who was initially diagnosed with sepsis secondary to a distal left ureteral stone requiring percutaneous nephrostomy tube placement. After resolution of infection and spontaneous passage of stone, she was found to have a partially duplicated collecting system with dense strictures in both lower and upper proximal ureters on antegrade and retrograde pyelograms. A MAG-3 renal scan revealed functioning moieties with no drainage from the lower moiety and delayed drainage from the upper pole. Given her young age and desire for definitive surgery, we proceeded with Robot-Assisted Laparoscopic (RAL) ureteral reconstruction. Intraoperatively, we encountered severe peri-ureteral inflammation with an obliterated long segment lower pole proximal ureter and a dense 2.8 cm upper pole ureteral stricture, we decided to perform a ureteropyelostomy and an augmented anastomotic buccal mucosal graft ureteroplasty. This was done by creating an ureteropyelostomy anastomosis between the lower moiety pelvis to the upper moiety proximal ureter, followed by reconstruction of the 2.8 cm stricture in the upper ureter to create a new common ureteral drainage pathway. A ureteral stent was placed with the proximal curl in the lower moiety pelvis. We also placed a Foley catheter in the bladder and a Jackson-Pratt (JP) drain. RESULTS: Our console time was 303 minutes with 100 mL of blood loss. The foley catheter was removed on post-operative day (POD) 1, along with the JP drain, given its low output. Patient was discharged on POD 1 and had no 30-day post-operative complications. Her stent was removed 6 weeks post-operatively and her MAG-3 renal scan results are pending. CONCLUSIONS: Duplicated collecting systems are a rare congenital anomaly, often asymptomatic in those with bifid ureters. Patients in this population suffering from ureteral strictures may benefit from minimal invasive ureteral reconstruction. Complex ureteral reconstruction even in multi-level dense ureteral strictures in both limbs of a bifid ureter can be feasible by experienced teams if advanced surgical options such as RAL ureteropyelostomy and buccal mucosal graft ureteroplasty are utilized. 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 Aeen Asghar* More articles by this author Ziho Lee More articles by this author Michael Metro More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...

Robot-assisted laparoscopic ureteral reconstruction for ureter endometriosis: Case series and literature review.

The aim of this report was to review experience from a single hospital in treating ureteral obstruction related to endometriosis with robot-assisted laparoscopic ureteral reconstruction. This retrospective analysis study (Canadian Task Force classification II-3) was conducted at an academic tertiary hospital. Five female patients with hydronephrosis without significant elevation of serum creatinine levels were enrolled. Ureteral endometriosis with obstruction was suspected on radiological images. Previous treatment with double-J stenting with or without medical treatment had failed in all of the patients. We performed robot-assisted laparoscopic segmental resection for ureteral endometriosis and reconstructed the ureter through ureteroureterostomy (RUU) or ureteroneocystostomy (RUC). The involved ureters included left lower ureter in three patients and right lower ureter in two patients. RUU was performed in four patients and RUC in one patient. All of the operations were completed smoothly without complications. All ureteral endometrioses were successfully resected, and follow-up sonography or intravenous pyelography showed resolution of hydronephrosis in all of the patients. Our experience proves the feasibility and efficacy of a robot-assisted approach for this rare situation with good outcomes.

Laparoscopic ureteral reconstruction in gynaecological recurrent cancer surgeries: an initial case series study

Laparoscopic ureteral reconstruction in gynaecological recurrent cancer surgeries: an initial case series study

Laparoscopic Yang-Monti Ureteral Reconstruction in Children

To investigate the clinical outcome of surgical treatment for long ureteral defect in children, we evaluated our experience of managing 6 children with the long defect utilizing laparoscopic ureteral reconstruction technique using Yang-Monti technique. Six children with long ureteral defect who underwent laparoscopic Yang-Monti ureteral reconstruction between January 2013 and March 2016 were reviewed. The diagnosis and outcomes of long ureteral defects were reviewed based on clinical and imaging data. We assessed preoperative clinical data and outcomes, and analyzed the experience of laparoscopic Yang-Monti ureteral reconstruction. The mean age of the patients was 8.5 years. The etiology of the ureteral defect was failed pyeloplasty in 4 patients, failed pyeloplasty and ureteral reimplantation in 1, and trauma in 1. The mean defect length was 5.83 cm. All operations were performed successfully with no serious intraoperative complications and no conversion. The average operative time was 314 minutes, the average intraoperative blood loss was 25 mL, the average drain removal was 3.83 days, the average start of oral feeding was 5.17 days, and the average postoperative hospital stay was 7.17 days. Six patients suffered Clavien I and II complications postoperatively and were managed conservatively. Two patients suffered Clavien III complications postoperatively and were managed by replacing stent. A diuretic T1/2 showed the improvement of differential renal function without urinary obstruction in all patients. Laparoscopic Yang-Monti ureteral reconstruction is safe and feasible in children with an excellent outcome.

Robot-assisted laparoscopic ureteral reconstruction: а systematic review of literature.

IntroductionTo review the literature, as well as to analyze and compare available data on robot-assisted laparoscopic (RAL) surgery versus open surgery, carried out in ureteral reconstructions in terms of different surgical characteristics.Materials and methodsEligible studies, published between 1997 and July 2016, were retrieved through MEDLINE by applying predetermined inclusion and exclusion criteria with the English language restriction. Publications on RAL surgeries, carried out in different ureteral reconstructions and of any study design, including case series and comparative studies, were included. The study was performed in accordance with the PRISMA statement.ResultsA total of 12 retrospective studies (case series and comparative studies) met the systematic review selection criteria involving 245 RAL and 76 open ureteral surgery cases. Main indications for ureter reconstruction were strictures, tumors and injuries. The individual results of comparative studies revealed that the EBL was statistically significantly lower for RAL than for open surgery. As for operation time, length of hospital stay and follow-up time, the data was contradictory. The rate of recurrent stricture in RAL and open groups was similar: -9.0%. The meta-analysis of three comparative studies confirmed that patients lose statistically significantly less blood in RAL, compared to open surgery.ConclusionsThe analysis of limited data available shows that robot-assisted laparoscopic ureteral reconstruction is a safe and effective minimally invasive technique with high cure rates similar to those of the conventional open approach and, with favorable safety profile. Future well-designed randomized controlled trials are required to strengthen our findings.

Compared to Open Surgery, Laparoscopic Ureteral Reconstruction in Pediatric Patients Offers No Improvement in 30-Day Complications, Yet Requires Longer Operative Time: Data from the Pediatric National Surgical Quality Improvement Program

Compared to Open Surgery, Laparoscopic Ureteral Reconstruction in Pediatric Patients Offers No Improvement in 30-Day Complications, Yet Requires Longer Operative Time: Data from the Pediatric National Surgical Quality Improvement Program

V68 Simple technique to identify stricture site during laparoscopic ureteral reconstruction

V68 Simple technique to identify stricture site during laparoscopic ureteral reconstruction

Easily Reproducible Technique to Identify Stricture Site During Laparoscopic Ureteral Reconstruction for Iatrogenic Ureteral Stricture: Retrograde Ureteral Catheter Method

Abstract Introduction and Objectives: Iatrogenic ureteral strictures have been on a rise. In the management of upper urinary tract stricture, open ureteroureterostomy is the gold standard in treati...

Robotic Assisted Ureteral Reimplantation: Current Status

The da Vinci robot is being used for an increasing variety of reconstructive procedures. Robotic-assisted laparoscopic ureteral reconstruction is now performed routinely, and has been shown to have similar efficacy and safety profiles to open surgery in various studies. In this article, we focus on use of the robot to aid in distal ureteral reconstruction in the adult and pediatric population. Indications reviewed will include benign and malignant conditions. The appropriate pre-operative evaluation, the set-up of the operating room and patient positioning, the described techniques for ureteral reimplantation, and the appropriate post-operative care and follow-up will all be discussed. Literature for the past 10years has been reviewed, and emphasis given to most recent publications and those describing novel approaches to using the robot for distal ureteral reconstruction.

Laparoscopic reconstruction of iatrogenic-induced lower ureteric strictures: Does timing of repair influence the outcome?

Context:Influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric stricturesAims:To assess the influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures in our adult patient population.Settings and Design:Single surgeon operative experience in two institutes. Retrospective analysis.Materials and Methods:All patients were worked up in detail. All patients underwent cystoscopy and retrograde pyelography prior to laparoscopic approach. Patients were categorised into two groups: early repair (within seven days of inciting event) and delayed repair (after two weeks). Operative parameters and postoperative events were recorded. Postprocedure all patients were evaluated three monthly. Follow-up imaging was ordered at six months postoperatively. Improvement in renal function, resolution of hydronephrosis and unhindered drainage of contrast through the reconstructed unit on follow-up imaging was interpreted as a satisfactory outcome.Statistical Analysis Used:Mean, standard deviation, equal variance t test, Mann Whitney Z test, Aspin-Welch unequal variance t test.Results:Thirty-six patients (37 units, 36 unilateral and 1 simultaneous bilateral) underwent laparoscopic ureteral reconstruction of lower ureteric stricture following iatrogenic injury - 21 early repair (Group I) and 15 delayed repair (Group II). All patients were hemodynamically stable at presentation. Early repair was more technically demanding with increased operation duration. There was no difference in blood loss, operative complications, postoperative parameters, or longterm outcome.Conclusions:In hemodynamically stable patients, laparoscopic repair of iatrogenically induced lower ureteric strictures can be conveniently undertaken without undue delay from the inciting event. Compared to delayed repairs, the procedure is technically more demanding but morbidity incurred and outcome is at par.

New Porcine Model for Training for Laparoscopic Ureteral Reimplantation with Horn of Uterus to Mimic Enlarged Ureter

To develop a new porcine model with horn of the uterus to mimic an enlarged ureter for training for laparoscopic ureteral reimplantation (LUR) and to evaluate its feasibility. Ten female pigs were used in the training. The pig was placed to a dorsal position after an anesthetic was administered. The horn of the uterus near the bladder was dissected, then spatulated and trimmed to replace the enlarged ureter. LUR was performed according to standard operation steps. Four trainees completed the LUR procedure based on a mentor-trainee model to guarantee the success of the procedure and the quality of the anastomoses. The learning curve of operative time was analyzed. The anastomotic stoma was cut off postoperatively and checked extracorporeally. After the course, questionnaire surveys were sent to the trainees to investigate satisfaction of the training and assess the impact of the training on their learning of "real" LUR in future practice. This model reproduced the key technique steps of LUR. Four LUR procedures were performed on each pig. The operative time declined from 170.0 +/- 10.3 minutes to 90.3 +/- 3.7 minutes (P < 0.01) after the trainees had performed 10 LURs. There was proper stitching in each "ureterovesical" anastomosis. At the end of training, all trainees could accomplish a LUR procedure skillfully on the model; they were satisfied after the course and thought the training was helpful to future practice of LUR. The new model was feasible and cost-effective for training in the basic skills of laparoscopic ureteral reconstruction procedures.