Percutaneous Balloon Dilatation Research Articles

V02-04 ROBOT-ASSISTED MANAGEMENT OF URETERAL COMPLICATIONS IN KIDNEY TRANSPLANT PATIENTS: CASE SERIES AND DESCRIPTION OF SURGICAL TECHNIQUES

You have accessJournal of UrologyMisc. Benign Disease & Transplant & Renovascular (V02)1 Sep 2021V02-04 ROBOT-ASSISTED MANAGEMENT OF URETERAL COMPLICATIONS IN KIDNEY TRANSPLANT PATIENTS: CASE SERIES AND DESCRIPTION OF SURGICAL TECHNIQUES Joris Vangeneugden, Charles Van Praet, Liesbeth Desender, Caren Randon, Steven Van Laecke, Patrick Peeters, Evi Nagler, Jill Vanmassenhove, and Karel Decaestecker Joris VangeneugdenJoris Vangeneugden More articles by this author , Charles Van PraetCharles Van Praet More articles by this author , Liesbeth DesenderLiesbeth Desender More articles by this author , Caren RandonCaren Randon More articles by this author , Steven Van LaeckeSteven Van Laecke More articles by this author , Patrick PeetersPatrick Peeters More articles by this author , Evi NaglerEvi Nagler More articles by this author , Jill VanmassenhoveJill Vanmassenhove More articles by this author , and Karel DecaesteckerKarel Decaestecker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001979.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral complications following renal transplant procedures are common and mainly include urinary leaks, ureteral stenosis, vesicoureteral reflux (VUR) and acute graft pyelonephritis. First approaches for the management of stricture and VUR include, respectively, percutaneous balloon dilation with or without laser incision and endoscopic injection of dextranomer/hyaluronic acid copolymer. In case of recurrence after a primary endourological approach, a stricture >1cm or complex anatomy in transplant patients, ureteral reimplantation should be performed. A robotic approach may reduce morbidity in a fragile transplant population. We describe our case series and surgical video of robot-assisted ureteral reimplantation in kidney transplant patients. METHODS: We present 20 renal transplant patients who suffered from ureteral complications: 15 with VUR and 5 with ureteral stenosis. Given the complex anatomy and/or failed first endoscopic treatments, ureteral reimplantation was indicated in all cases. As each case had a unique indication and anatomy, five different surgical approaches were used, as displayed in the video: Lich-Gregoir non-dismembered and dismembered, uretero-ureterostomy, and ipsilateral and contralateral pyelo-ureterostomy. All surgeries were performed using the Da Vinci Xi® robot. RESULTS: All surgeries were completed successfully without intraoperative complications. Median pre- and postoperative (3 months) GFR values were 53 ml/min (IQR 30-70) and 55 ml/min (IQR 43-66) respectively in patients who suffered from VUR and 29 ml/min (IQR 22-36) and 35 ml/min (IQR 29-49) in patients who suffered from stenosis. Median hospital stay was 3 days (IQR 2-4). One patient had postoperative laryngeal edema requiring intensive care admission (Clavien-Dindo grade 4), one patient needed repositioning of a dislocated JJ stent (grade 3b), one patient had erysipelas of the left arm and one patient had febrile urinary tract infection within 90 days requiring antibiotics (both grade 2). No other complications occurred and all patients were free from nephrostomy tube or double J stent at a median follow-up of 12 months (IQR 7-19). CONCLUSIONS: We demonstrate the safety, feasibility and surgical technique of robot-assisted ureteral reimplantation options in kidney transplant patients. This approach allows for high-quality realignment of the urinary tract, a quick recovery with low complication rate and preserved renal function in a fragile renal transplant population. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e134-e134 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joris Vangeneugden More articles by this author Charles Van Praet More articles by this author Liesbeth Desender More articles by this author Caren Randon More articles by this author Steven Van Laecke More articles by this author Patrick Peeters More articles by this author Evi Nagler More articles by this author Jill Vanmassenhove More articles by this author Karel Decaestecker More articles by this author Expand All Advertisement Loading ...

Impact of Cholestasis on the Sensitivity of Percutaneous Transluminal Forceps Biopsy in 93 Patients with Suspected Malignant Biliary Stricture

The aim of this study was to determine the effect of hyperbilirubinemia in the sensitivity of percutaneous transluminal forceps biopsy (PTFB) in patients with suspected malignant biliary stricture. Ninety-three patients with suspicion of malignant biliary stricture underwent percutaneous transhepatic cholangiography followed by PTFB. Sensitivity, specificity and predictive values were analysed based on the presence or absence of hyperbilirubinemia, defined as total bilirubin equal to, or higher than 5mg/dL. Variables included demographic and clinical features, laboratory, tumour type and localization, stricture length, therapeutic approach and histopathology. Additionally, major morbidity and mortality were assessed. The overall sensitivity, specificity, positive predictive value and accuracy of PTFB were 61.1%, 100%, 100%, and 62.4%, respectively. Hyperbilirubinemia affected 57% of patients at the time of PTFB. There were 35 (37%) false negative results, none of them related to tumour type or localization, stricture length, or previous biliary intervention (i.e. PBBD (percutaneous biliary balloon dilatation), ERCP (endoscopic retrograde cholangiopancreatography)) (p > 0.05). However, when bilirubin was < 5mg/dL, false negative results decreased globally (p = 0.024) and sensitivity increased significantly for intrahepatic and hilar localization, as well as for colorectal metastasis, gallbladder carcinoma, and pancreatic carcinoma. No major morbidity occurred. The sensitivity of percutaneous transluminal biopsy for diagnosis of malignant stricture may significantly increase if samples are obtained in the absence of hyperbilirubinemia, without adding morbidity to the procedure. Level 3, Case- Control studies.

Neonates With Right Aortic Arch Requiring Arch Reconstruction: A Single-Institution Experience

BackgroundReconstruction of a right aortic arch is rarely required in the newborn period and has rarely been reported. MethodsAll patients who underwent a right aortic arch repair in the neonatal period from a single institution were retrospectively reviewed. The primary outcome measures included survival, complications, and reintervention. ResultsBetween 1984 and 2020, 15 patients were identified. Nine patients (60%) presented with an interrupted aortic arch, 5 with a hypoplastic arch (33%), and 1 with anomalous origin of the brachiocephalic vessels (7%). All patients had associated complex congenital heart disease. Median age at surgery was 6 days (range, 2-29 days); median weight was 3.11 kg (range, 2.5-4.18 kg). Genetic syndromes were prevalent and 77% of interrupted aortic arch patients had DiGeorge syndrome. Surgical techniques included end-to-side (27%), end-to-end (27%), or side-to-side anastomosis (13%) and placement of an interposition graft (7%); 65% required patch augmentation. Median intensive care unit and total hospital length of stay were 20 days (range, 7-92 days) and 28 days (range, 10-240 days), respectively. At a median follow-up of 3.97 years (range, 0.19-36 years), 13 of 15 patients were alive (87%). We found vocal cord paralysis in 27%, hemidiaphragm paralysis in 13%, and considerable airway compression in 27%. Overall, 27% patients required reintervention on the aortic arch: 2 surgical and 2 percutaneous balloon dilation. ConclusionsRight aortic arch reconstruction in the newborn period is rare and associated with complex lesions with an acceptable reintervention rate.

Early single-stage surgical revascularization of pulmonary artery in unilateral absence of a pulmonary artery

BackgroundThis research aims to summarize the findings of the early single-stage revascularization of remnant pulmonary artery in unilateral absent intrapericardial pulmonary artery.MethodsWe retrospectively analyzed the medical records of 10 patients with unilateral absent pulmonary artery, in which 7 were right and 3 were left, the median age and mean weight at surgery was 4 months and 5.6 kg, respectively. The patients received operation from January 2009 to June 2020.ResultsTen patients, 1 case associated with atrial septal defect, 2 cases with tetralogy of Fallot, and 1 case with aortopulmonary window. The mean diameter of the affected hilar pulmonary artery remnants was 3.14 ± 1.09 mm (1.6-5 mm), and the Z value was − 3.66 ± 1.86 (range, − 6.7 to − 1.75). All the patients received single-stage revascularization: tube graft interposition in 3 patients, autologous pericardial roll in 4, direct anastomosis in one, and main pulmonary artery flap angioplasty in the rest 3. No hospital deaths occurred. Mean follow-up in this cohort was 3.3 ± 1.9 years One case underwent percutaneous balloon dilatation due to new pulmonary artery stenosis. Nonetheless, the results were encouraging, symptoms have improved in all patients. The median Z value of the latest ipsilateral pulmonary artery diameter was − 1.88 (range, − 4.52 to − 1.35), a significantly improvement when compared to the preoperative value. The Z value of that in patients who using Gore-Tex tube increased relatively small.ConclusionsSingle-stage pulmonary artery revascularization is effective at restoring normal antegrade flow to the affected lung, resulting in improved diameter of the PA, regression of pulmonary hypertension, and patient’s symptoms. Revascularization by using the autologous tissue or autologous pericardium may obtain a preferred result. The new pulmonary artery stenosis certainly will need to be addressed in the long-term follow-up.

Ultrasonographically guided percutaneous transhepatic liver biopsy after pediatric liver transplantation.

Complications associated with ultrasonographically guided percutaneous transhepatic liver biopsy (PTLB) after liver transplantation (LT) have been rarely reported, and there is no consensus about its safety. We retrospectively reviewed the safety and outcomes of PTLB after pediatric LT. Between January 2008 and December 2019, 8/1122 (0.71%) pediatric patients who underwent ultrasonographically guided PTLB after LT developed complications. The median age at PTLB was 7.8years (range 0.1-17.9). Grafts included left lobe/left lateral segment in 1050 patients and others in 72. PTLB was performed using local anesthesia±sedation in 1028 patients and general anesthesia in 94. Complications after PTLB included acute cholangitis in 3 patients, sepsis in 2, respiratory failure due to over-sedation in 1, subcapsular hematoma in 1, and intrahepatic arterioportal fistula in 1. The incidence of complications of PTLB in patients with biopsy alone and those with simultaneous interventions was 0.49% and 3.19%, respectively (p=.023). Patients who developed acute cholangitis, respiratory failure, subcapsular hematoma, and arterioportal fistula improved with non-operative management. Of two patients with sepsis, one underwent PTLB and percutaneous transhepatic portal vein balloon dilatation and developed fever and seizures the following day. Sepsis was treated with antibiotic therapy. Another patient who underwent PTLB and exchange of percutaneous transhepatic biliary drainage catheter developed fever and impaired consciousness immediately. Sepsis was treated with antibiotic therapy, mechanical ventilation, and continuous hemofiltration. Percutaneous transhepatic liver biopsy after pediatric LT is safe. However, combining liver biopsy with simultaneous procedures for vascular and biliary complications is associated with an increased risk of complications.

Platelet-derived microvesicles induce calcium oscillations and promote VSMC migration via TRPV4.

Rationale: Abnormal migration of vascular smooth muscle cells (VSMCs) from the media to the interior is a critical process during the intimal restenosis caused by vascular injury. Here, we determined the role of platelet-derived microvesicles (PMVs) released by activated platelets in VSMC migration.Methods: A percutaneous transluminal angioplasty balloon dilatation catheter was used to establish vascular intimal injury. Collagen I was used to activate PMVs, mimicking collagen exposure during intimal injury. To determine the effects of PMVs on VSMC migration in vitro, scratch wound healing assays were performed. Fluorescence resonance energy transfer was used to detect variations of calcium dynamics in VSMCs.Results: Morphological results showed that neointimal hyperplasia was markedly increased after balloon injury of the carotid artery in rats, and the main component was VSMCs. PMVs significantly promoted single cell migration and wound closure in vitro. Fluorescence resonance energy transfer revealed that PMVs induced temporal and dynamic calcium oscillations in the cytoplasms of VSMCs. The influx of extracellular calcium, but not calcium from intracellular stores, was involved in the process described above. The channel antagonist GSK219 and specific siRNA revealed that a membrane calcium channel, transient receptor potential vanilloid 4 (TRPV4), participated in the calcium oscillations and VSMC migration induced by PMVs.Conclusions: TRPV4 participated in the calcium oscillations and VSMC migration induced by PMVs. PMVs and the related molecules might be novel therapeutic targets for vascular remodeling during vascular injury.

The immediate and late results for balloon angioplasty of native coarctation of aorta in pediatrics age group

Background: percutaneous balloon dilation of corotation of aorta is a less invasive and alternative to surgical repair for patients with discrete coaction of aorta and although the used of balloon angioplasty in patients with recurrent postoperative coarctation gained a wide consensus, the use this technique for native coarctation is still controversial in children less one years. &#x0D; Objective: to evaluate the immediate and late result of balloon dilation of native coarctation of aorta in infant and children.&#x0D; Type of the study: A prospective study. &#x0D; Subjects &amp; Methods: The study was done on forty-five patients who were referred for cardiac catheterization and balloon angioplasty of native coarctation of the aorta at Ibn-AL-Bitar center for cardiac surgery between January 2015 to May 2016.Left heart catheterization was performed with evaluation of the morphology and pressure gradient across the stenotic segment of aorta. Follow up evaluations were done between 1 week and 18 months after discharge (mean 6 months) with transthoracic echocardiography. &#x0D; Results: The age of patients range from 1month to 4 years (median age at time of procedure was12.3month). Associated lesions in 11 patients (24.4%). Immediate results were reduction in gradient from 42.5± 17.3 to 10.3± 8.2 mm Hg in forty-two patients (93.3%). Late result during follow up period, 29 patients (69%) had maintain gradient less than 20mmHg. Complications were reported in 6 patients (13.3%). there was one procedure related death (2.2%). &#x0D; Conclusions: Balloon angioplasty for treatment of native coarctation of the aorta is effective with sustained benefit on long-term follow-up in infants and children &gt;6 months. Transverse arch hypoplasia and children &lt;6 months old has major effect on late outcome of recurrent coarctation of aorta.

Abstract 12611: Preclinical in-vivo Testing and Early Clinical Experience With a Dilatable Expanded-polytetrafluoroethylene Cardiovascular Conduit

Background: exGraft is an FDA cleared synthetic vascular conduit. A unique property observed is controllable expansion. Preclinical studies with post-implantation balloon dilation and initial use in infants with congenital heart disease (CHD) are described. Methods: Eight piglets (1.5 months (mo)) and 8 lambs (2.5 mo) were implanted with exGraft using an aortic interposition model. Follow up for average 2.5 mo and 3.5 mo respectively allowed somatic growth. Balloon dilation was performed with fluoroscopy and inflation rate was varied to understand optimal expansion method. 3 CHD neonates were implanted with exGraft as a Right Ventricle (RV) to Pulmonary Artery (PA) conduit. Percutaneous balloon dilation of the RV-PA conduit was performed in the interstage period (Table 1). Results: Dilation was achieved to 150% of the original size in 6 piglets and 5 lambs when balloons were inflated gradually up to 6 ATM with a 5 second hold at each ATM. Rapid inflation resulted in anastomotic dehiscence in 2 piglets and 3 lambs. Gradual percutaneous exGraft dilation in 3 neonates was to 150-175% of original diameter to increase pulmonary blood flow and reduce cyanosis. There were no adverse events. Final diameter was confirmed upon explant of conduit (Table 1). Conclusion: In preliminary pre-clinical and clinical experience, safe serial and gradual exGraft expansion has been demonstrated. Expansion of vascular conduits via catheterization expands the options for CHD management. Figure 1: Dilation of 6mm exGraft RV-PA conduit in Patient 1. (A) Baseline angiogram with predominantly proximal stenosis. (B) Fluoroscopy of maximum dilation to 9mm. (C) Final angiogram with increased diameter.

Efficacy and safety of recanalization with transseptal needle for chronic total occlusion of the brachiocephalic vein in hemodialysis patients.

BackgroundWhilst there are effective techniques for the recanalization of central venous occlusions, recanalization of chronic total occlusions remains particularly challenging. This study aims to evaluate the safety and efficacy of recanalization using a transseptal needle in chronic total occlusions of the right brachiocephalic vein (RBV) in long-term hemodialysis patients.MethodsIn this single-center, retrospective study, maintenance hemodialysis patients with chronic total occlusion of the RBV were enrolled between February 2017 to March 2019 from West China Hospital of Sichuan University. Refractory lesions were defined as complete vascular occlusions with failed recanalization using conventional techniques. Occlusions were approached using a transseptal needle to penetrate which offers an alternative strategy with firm support force. Patient data, treatment outcomes and patency rates were collected and analyzed to assess the safety and efficacy of the technique.ResultsA total of 16 eligible patients were analyzed. The operation was successful in 13 of the 16 patients and the success rate was 81.25% (13/16). Twelve patients underwent percutaneous balloon dilatation and stent implantation after sharp recanalization, whilst one patient underwent balloon dilatation only. We achieved procedural success in 13 patients without surgical complications, and all of the patients were discharged in a stable condition. The primary patency rates at 3, 6 and 12 months after surgery were 100%, 84.6% and 69.2%, respectively. The primary assisted patency rates were 100%, 84.6% and 76.9%, respectively, and the secondary patency rates were 100%, 84.6% and 76.9%, respectively.ConclusionsThis study demonstrates that recanalization of chronic total occlusions to the RBV using a transseptal needle is a safe and effective method after traditional guide wire and catheter techniques fail. It was also found that additional techniques are needed for recanalization in patients with RBV occlusion combined with proximal stenosis or occlusion of the right subclavian vein.

Percutaneous transhepatic afferent loop balloon dilatation and indwelling catheter placement for benign afferent loop obstruction

Percutaneous transhepatic afferent loop balloon dilatation and indwelling catheter placement for benign afferent loop obstruction

Modified percutaneous transhepatic papillary balloon dilation for patients with refractory hepatolithiasis.

BACKGROUNDSome patients with hepatolithiasis cannot tolerate surgery due to severe cardiac or pulmonary comorbidities, or cannot be endoscopically treated because of altered gastrointestinal anatomies.AIMTo propose a modified percutaneous transhepatic papillary balloon dilation procedure, and evaluate the clinical efficacy and safety of this modality.METHODSData from 21 consecutive patients who underwent modified percutaneous transhepatic papillary balloon dilation with hepatolithiasis were retrospectively analyzed. Using auxiliary devices, intrahepatic bile duct stones were pushed into the common bile duct and expelled into the duodenum with an inflated balloon catheter. The outcomes recorded included success rate, procedure time, hospital stay, causes of failure, and procedure-related complications. Patients with possible long-term complications were followed up for 2 years.RESULTSIntrahepatic bile duct stones were successfully removed in 20 (95.23%) patients. Mean procedure time was 65.8 ± 5.3 min. Mean hospital stay was 10.7 ± 1.5 d. No pancreatitis, gastrointestinal, or biliary duct perforation was observed. All patients were followed up for 2 years, and there was no evidence of reflux cholangitis or calculi recurrence.CONCLUSIONModified percutaneous transhepatic papillary balloon dilation was feasible and safe with a small number of patients with hepatolithiasis, and may be a treatment option in patients with severe comorbidities or in patients in whom endoscopic procedure was not successful.

Comparative characteristics of reconstructive surgery and percutaneous balloon dilatation in the treatment of high benign strictures of the bile ducts

Aim: to compare the long-term results of various surgical treatment options for patients with high benign strictures of the bile ducts.Materials and methods. From 2012 to 2018, 87 patients with strictures of different levels according to the classification of E.I. Halperinwas observed. A stricture of type «0» was detected in 23 patients, type «−1» in 20, type «−2» in 31, type «−3» in 13 (E3 – 43, E4 – 31, E5 – 13 according to classification Bismuth-Strasberg). Open reconstructive interventions were performed in 63 patients, 24 percutaneous endobiliary ones.Results. Long-term results were traced in 77 (89%) patients, the follow-up period after reconstructive operations was 4.7 ± 1.6 years, after percutaneous – 2.0 ± 1.4 years. Excellent and good results according to the Terblanche classification were achieved in 31 (58%) patients after open reconstructive operations and in 18 (78%) after percutaneous transhepatic biliary drainage.Conclusion. Technically the most difficult for reconstructive and percutaneous interventions on the bile ducts with a high recurrence rate are strictures of types «−2» and «−3» (E4 and E5). A comparative analysis of the long-term results of percutaneous and open interventions showed a statistically significant advantage of percutaneous interventions compared with reconstructive (p = 0.05).

Percutaneous Management of Ureteral Obstructions and Leak After Renal Transplant.

The aim of our study was to evaluate the safety and efficacy of percutaneous treatment of ureteral obstructions and leak after renal transplant and to evaluate the long-term results and graft survival rates in a single center. This retrospective study included 27 transplant recipients who received percutaneous treatment between January 2000 and December 2010 and who had follow-up data until December 2018. During this period, 294 renal transplants were performed at our institution, with 17 (5.7%) having a ureteral complication. Ten patients included in the study had their transplants at another center. Percutaneous nephrostomy, balloon dilatation, and double J stent placement were used in the management of complications. Cutting balloon dilatation and tandem ureteral stent placement were done in cases of resistant stenosis. Technical success and ureter patency rates were calculated. Graft survival rates were compared between early and late obstruction groups and between successful and unsuccessful interventional treatment. Among included cases, 21 obstructions (7 early, 13 late) and 8 leaks were detected. The technical success rate of percutaneous nephrostomy was 100% in all groups. The technical success rates of balloon dilatation and double J stent were 100% and 88% in the early and late obstruction groups, respectively. Censored graft survival rates in all groups at 1, 5, and 10 years were 89%, 89%, and 73.9%, respectively. In long-term follow-up, ureter patency rates were 100%, 33%, and 50% for early obstruction, late obstruction, and urinary leak groups, respectively (P = .018). Graft survival rates between early and late obstruction groups were not significantly different. No major complication, allograft loss, or 30-day mortality was seen. Percutaneous management of ureteral complications is safe and effective and should be considered as first-line treatment because of its less invasive nature and lower complication and morbidity rates.

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 ...

Magnetic recanalization technique for the treatment of alimentray tract stricture: A clinical study

Magnetic compression anastomosis or magnetic recanalization technique is a revolutionary minimally invasive method to perform re-anastomosis in patients with alimentary strictures. We conduct magnetic recanalization for the treatment of severe alimentary strictures that cannot be treated by conventional methods. Data are analysed retrospectively in order to investigate the safety and efficiency of this method. From 2012 January to 2019 October, 17 patients with alimentary stricture after operation were enrolled in the first affiliated hospital of Xi’an Jiaotong University and the Chinese PLA General Hospital. The ages were 47±16.8 years, and 11 cases were men. 17 cases include 14 benign biliary strictures, two esophageal strictures and one colorectal anastomosis strictures. 14 cases are complete strictures, and the others are refractory one. Strictures are found 0–120 months after the last operation. All the patients have undergone 2–8 times unsuccessful standard treatments, including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangial drainage (PTCD) or endoscopic balloon dilation. Magnetic recanalization technique (MRT) is proposed. The MRT device consists of two identical, nickel-plated NdFeB magnets (rating, N45) termed the parent magnet and the daughter magnet. Each magnet shapes like a cylinder or annular. The daughter and parent magnet are delivered to the proximal and distal end of stricture respectively via different routes. The attraction force between the two magnets leads to necrosis of the fibrotic stricture tissue and the creation of a new transmural anastomosis. Thereafter, stent deployment or balloon dilation is performed to the new anastomosis. Data about stricture length, recanalization time, side effects in 30 days, time to remove the biliary stent and stricture recurrence are collected. All the patients are followed-up to 2019 December by telephone or outpatients service. After the MRT, 1 case fails. Magnets can couple stably in 16 patients (successful rate 94.1%), including 10 cases of choledocho-choledochostomy, 3 cases of bilio-enteric anastomosis, 1 case of esophago-esophagostomy, 1 case of esophago-gastrostomy and 1 case of colo-proctostomy. The delivery routes are per-PTCD/per-ERCP, per-PTCD or drainage tube sinus/per-gastroscope, per-gastroscope/per-gastroscope, per-gastroscope/per-operation and per-enterostomy/per-anus respectively. The daughter and parent magnets detach from each other in 3 patients after days post-MRT. The magnets couple automatically in 2 patients without any interventions. In the other patient, another daughter magnet is added through PTCD, and the magnets are again tightly approximated. Three adverse events are found (cholangitis, 1 patient; biliary bleeding, 1 patient; colon leakage, 1 patient), but are resolved with conservative treatment. The stricture length is 2–7.1 (4±1.9) mm in successful cases, and recanalization occurs after 7–50 (15.5±10.6) days. Biliary multiple plastic stents (4 patients), biliary fully covered self-expandable metallic stent (5 patients), percutaneous trans-hepatic cholangiodrainage catheter (4 patients), balloon dilation plus metallic stent (2 patients), or balloon dilation alone (1 patient) is used after recanalization. Stents are retrieved after 6.9±4.0 months in 14 patients, and 1 patient is still in stent period. During 3–70 months of stent-free follow-up, no stenosis is found in 13 biliary stricture patients, but 2 cases are found biliary stones and cured by endoscopic treatment. Two of three patients with esophageal or colorectal anastomosis stricture experience recurrence in follow up, and are still managed by endoscopic ways. In conclusion, magnetic recanalization technique is a minimally invasive, effective and safe method to complicated alimentary stricture, and can serve as a remedial method when conventional ways fail.

Endovascular treatment for non-thrombotic right iliac vein compression syndrome with intravascular ultrasound

Objective: To evaluate the clinical efficacy of endovascular treatment for non-thrombotic right iliac vein compression syndrome with intravascular ultrasound. Methods: The clinical data of 40 patients with non-thrombotic right iliac vein compression syndromereceiving intravascular ultrasound-assisted balloon dilatation combined with stent implantation from January 2012 to December 2018 were retrospectively analyzed. There were 32 males and 8 females, the average age of whom was 63 (46-81) years old. The patients were classified according to the CEAP (Clinical-Etiology- Anatomy-Pathophysiology) classification: 7 cases as C3, 18 as C4, 10 as C5 and 5 as C6. All patients underwent percutaneous right femoral vein puncture, intravascular ultrasound, and balloon dilatation combined with stentimplantation in the right iliac vein lesion location. Results: The success rate of clinical operations was 100%. There were no serious complications during the perioperative period. All patients were followed up for 4-58 months. During the follow-up period, the relief rate of limb edema was 88.6% (31/35), the pain relief rate was 86.7%(13/15), and the healing rate of ulcers was 100% (6/6). After the stent implantation, the endovascular area of the compression site was significantly enlarged (34.5mm(2)± 11.1mm(2)vs129.8 mm(2)±17.2 mm(2), P<0.001). The follow-up of color Doppler and/or anterograde angiography for deep veins of lower limb with digital subtraction angiography showed that the blood flow in the stentsweres mooth in all patients. Three cases were observed that the intimal hyperplasia led to mild in-stent restenosis, no obvious in stent restenosis (>50%). The abdominal X-ray plain film showed no obvious displacement and fracture of the stents. The venous clinical severity score (VCSS) was statistically significant (13.0±2.4 vs 6.2±2.0, P<0.001). The statistical results of short-form health surver SF-36 showed that the scores of life quality in all dimensions of the affected limb were significantly improved after operation (P=0.000). Conclusion: Intravascular ultrasound-assisted balloon dilatation combined with stent implantation is not only a safe and effective treatment for non-thrombotic right iliac vein compression syndrome, but also has a good mid-term patency rate.

Successful Percutaneous Balloon Dilatation of Membranous Sub-aortic Stenosis in a 22 Year Old Pregnant Patient

Congenital obstruction of the left ventricular outflow tract comprises a heterogeneous group of disorders, with obstruction potentially occurring below, above, or at the level of the aortic valve. Subvalvular stenosis is the second most common type of left ventricular outflow tract obstruction, of which discrete membranous type is the most common. Although surgical resection of the subaortic membrane is the treatment of choice in discrete membranous subaortic stenosis, in selected patients with isolated membranous subaortic stenosis, without significant aortic insufficiency, percutaneous balloon tearing of the membrane results in reduction in the degree of left ventricular outflow tract obstruction and symptomatic relief. We report a case of 22 year old pregnant patient admitted with NYHA class III breathlessness, found to have discrete membranous subaortic stenosis. Balloon aortic valvuloplasty was performed in the patient with good result. Patient underwent normal vaginal delivery at 38 weeks. Both mother and newborn were asymptomatic. Patient is asymptomatic on subsequent follow-ups.

A novel percutaneous transhepatic treatment of a benign bile duct stricture – a pilot study

AimTo assess the effectiveness and outcome of repeated percutaneous transhepatic balloon dilatation combined with targeted intramucosal corticosteroid injection in patients with benign biliary stricture.MethodsThis single-center pilot study, conducted between February 2014 and June 2016, involved five patients with benign biliary stricture (4 men and 1 woman, mean age 58.2 years). The study included only patients in whom previous surgical or/and non-surgical treatments failed or could not be performed due to patients’ medical history and local status.ResultsWe successfully developed an alternative treatment for patients with benign biliary stricture and performed it without side effects. There were no major complications, and the only one minor complication was cholangitis. In the median follow-up period of 30.24 months (range 14.5 to 44.6 months), no re-occlusion was detected. The disease-free survival, calculated after excluding the first patient (who died of heart attack), was 34.175 months.ConclusionPercutaneous transhepatic corticosteroid injection combined with balloon dilatation could provide an alternative method for the treatment of benign biliary strictures that is effective in the long term and results in positive outcomes.

Bile Duct Injury Repairs after Laparoscopic Cholecystectomy: A Five-Year Experience in a Highly Specialized Community Hospital

Bile duct injury represents a complication after laparoscopic cholecystectomy, impairing quality of life and resulting in subsequent litigations. A five-year experience of bile duct injury repairs in 52 patients at a community hospital was reviewed. Twenty-nine were female, and the median age was 51 years (range, 20-83 years). Strasberg classification identified injuries as Type A (23), B (1), C (1), D (5), E1 (5), E2 (6), E3 (4), E4 (6), and E5 (1). Resolution of the bile duct injury and clinical improvement represent main postoperative outcome measures in our study. The referral time for treatment was within 4 to 14 days of the injury. Type A injury was treated with endobiliary stent placement. The remaining patients required T-tube placement (5), hepaticojejunostomy (20), and primary anastomosis (4). Two patients experienced bile leak after hepaticojejunostomy and were treated and resolved with percutaneous transhepatic drainage. At a median follow-up of 36 months, two patients (Class E4) required percutaneous balloon dilation and endobiliary stent placement for anastomotic stricture. The success of biliary reconstruction after complicated laparoscopic cholecystectomy can be achieved by experienced biliary surgeons with a team approach in a community hospital setting.

Kissing stent management of stenosis of two branches of left renal artery bifurcation: a case report

BackgroundSecondary hypertension accounts for 5% of all cases of hypertension. Renal artery stenosis is one of the common causes of secondary hypertension. Atherosclerosis and fibromuscular dysplasia are the commonest types of stenosis associated with renal vascular hypertension, with the former accounting for 70–80% of all cases and the latter accounting for 10% of the incidence. The greatest incidence atherosclerosis is in men over the age of 40 years, mostly affecting the proximal part of the renal arteries, whereas fibromuscular dysplasia affects women ranging in age from 30 to 50 years. Currently, possible treatments are medical treatment using blood pressure-lowering drugs, balloon angioplasty with or without stent insertion, and surgery to reconstruct the artery.Case presentationWe report a case of a 46-year-old Asian woman with stenosis of two branches of renal artery bifurcation treated by percutaneous balloon dilatation and stenting of both branches after referral to our department for a renal angiogram following 8 months of uncontrolled hypertension despite receiving medications. Initially, the patient presented with severe headache and fatigue. She was a known nonsmoker, was not diabetic, and had no history of diabetes in her family. She had no history of atherosclerosis. Apart from high blood pressure, the result of her physical examination was unremarkable. Laboratory investigations revealed normal serum cholesterol, lipid profile, and serum creatinine. She had been attending a hypertension clinic and receiving antihypertensive drugs for the past 8 months on a regular basis under close observation. Despite this treatment and care, her blood pressure remained high at 175/110 mmHg, which the attending doctor concluded to be uncontrolled blood pressure. Initial imaging indicated left renal artery stenosis, and the patient was referred to our department.ConclusionsFor patients with uncontrolled hypertension despite receiving medications, renal Doppler ultrasound should be included in the diagnostic workup for secondary hypertension. Once renal artery stenosis is suspected, renal angiography is highly recommended because the technique is able to accurately diagnose stenosis in the branch arteries, unlike computed tomographic angiography and magnetic resonance angiography. Percutaneous transluminal renal angioplasty is the treatment of choice for renal artery stenosis in patients with renovascular hypertension or renal dysfunction.