Psoas Hitch Research Articles

219 - Laparoscopic Ureteroneocystostomy Following UV Fistula in Ectopic Kidney

Ureteroneocystostomy with contralateral psoas hitch was performed in an operated case of Total Laparoscopic Hysterectomy with Left Ectopic Pelvic Kidney in a patient presenting with Uretero-Vaginal Fistula.

Open and Robotic Techniques for Appendiceal Interposition in Ureteral Stricture Disease

Introduction: Robot-assisted techniques for large ureteral strictures usually involve reconstruction with ureteroneocystostomy, Boari flap, psoas hitch, or with intestinal interposition with an ileal segment. These measures are highly involved, add significant operating room time, and have well-known complications. We present a novel robotic technique for management of right-sided ureteral stricture using an appendiceal interposition. Methods: Using the DaVinci XI Robotic System, we utilized standard right-sided port placement similar to a nephrectomy setup. The appendix was identified, dissected free, and stapled off the cecum, making sure to preserve the mesoappendix. The appendix was then serially dilated using feeding tubes and S-dilators over a guidewire. The ureteral segment to be excised was identified using collecting system administration of indocyanine green (ICG) both in antegrade and retrograde manners. Intravenous ICG was also used to help delineate the strictured ureteral segment as well as the appendiceal segment perfusion. An end-to-end anastomosis between appendix and ureteral ends, in a spatulated manner, was then performed over a Double-J stent. This novel approach was compared with a conventional open laparotomy technique, in which an appendix and cecal flap were utilized for a right-sided ureteral interposition. This patient had a previous ileal interposition for stricture disease that required a long segment replacement. The appendix was mobilized, preserving the blood supply, with the cecum to provide additional length. Dilation of the lumen was not required, and an end-to-end anastomosis was performed over a Double-J stent to bridge the gap between renal pelvis and the bladder. Results: The patient tolerated the procedure well. Operative time was 4 hours, and estimated blood loss was found to be less than 50 mL. The patient developed a postoperative MRSA bacteremia that was treated to resolution with antibiotics. A right antegrade nephrostogram at 6 weeks showed opacification of the entire collecting system with free flow of contrast into the bladder over the stent without evidence of a leak. In the open appendiceal–cecal interposition case, there were no postoperative complications, and antegrade nephrostogram at 6 weeks after stent removal illustrated a patent anastomoses, with excellent passage of contrast as well. Conclusions: Robotic appendiceal interposition for right-sided ureteral stricture is a safe alternative approach to management of right-sided mid ureteral stricture disease. The use of intravenous and intracollecting system-administered ICG significantly aids in identification of the diseased segment as well as vascularity to improve surgeon confidence in the healing capability of the interposed appendix and ureteral ends. This approach is comparable with the more traditional open laparotomy technique of appendix substitution. No competing financial interests exist. Runtime of video: 8 mins 16 secs

Appendix graft as a ureter substitution in recurrent ureter stenosis in horse -shoe kidney; a case report

Background: A horseshoe kidney is the most common renal fusion anomaly and occurs in 0.2% to 0.3% of the population. Horseshoe kidneys are fused by the formation of an isthmus between the lower poles of the left and right kidneys during development. The insertion of the ureter in the renal pelvis is displaced super-laterally, probably as the result of incomplete renal rotation, and is associated with a significant rate of ureteropelvic junction (UPJ) obstruction. Case Presentation: We report a patient with single kidney at right side with obstruction in upper ureter. Before the surgery our plan was transureteroureterostomy according to failure of previous surgeries, dismembered pyeloplasty and ureterocalicostomy, but after mobilizing the proximal ureter we noticed that transureteroureterostomy was impossible because of short fibrotic ureter. Other choices such as Boari flap technique with psoas hitch is impossible because of small fibrotic bladder, so we decided to use appendix as ureter substitute. Conclusions: According to our experience and previous studies, we can use appendix as a ureter substitution in refractory proximal and middle ureter stenosis, but in our case we anatomized proximal ureter to appendix instead of anastomosis of pelvic to appendix.

Pelvic ureter resection followed by psoas hitch bladder re-implantation

Pelvic ureter resection followed by psoas hitch bladder re-implantation

Managing Mid and Lower Ureteral Benign Strictures: The Laparoscopic Way.

The aim of this study is to assess etiopathogenesis of ureteral mid/lower benign strictures and outcomes of various methods of laparoscopic reconstruction and repair. We retrospectively reviewed the data of patients who underwent laparoscopic repair for mid and lower ureteral benign strictures at our department from January 2013 to February 2016. The demographic, operative, complication, and outcome data were analyzed. Twenty-two patients were treated by various methods of laparoscopic reconstruction in the department of urology for benign ureteral strictures. Ureteroneocystostomy was done by psoas hitch in 15 and Boari flap in 2. Ureteral tapering, followed by ureteral reimplantation, was done in 2 and ureteroureterostomy in 3 cases. The most common predisposing factor that leads to ureteral stricture was prior pelvic gynecological surgery. Other causes included endometriosis, tuberculosis, impacted ureteral calculus, and ureteroscopic removal of calculus. Seventeen patients had lower, 3 had mid, and 2 had mid/lower ureteral strictures. Ureteral patency was successfully reestablished in all 22 patients without significant complications during a mean follow-up of 25 months (range 12-48 months). Laparoscopic treatment of benign ureteral strictures imparted excellent outcomes without major complications with the advantage of the minimally invasive technique.

Psoas hitch ureteral reimplantation after surgery for locally advanced and locally recurrent colorectal cancer: Complications and oncological outcome

IntroductionThe most important prognostic factor for oncological outcome of rectal cancer is radical surgical resection. In patients with locally advanced T4 rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) (partial) resection of the urinary tract is frequently required to achieve radical resection. The psoas bladder hitch (PBH) technique is the first choice for reconstruction of the ureter after partial resection and this bladder-preserving technique should not influence the oncological outcome. MethodsDemographic and clinical data were collected prospectively for all patients operated on for LARC or LRRC between 1996 and 2014 who also underwent a psoas hitch ureter reconstruction. Urological complications and oncological outcome were assessed. ResultsThe sample comprised 70 patients, 30 with LARC and 40 with LRRC. The mean age was 62 years (range: 39–86). Postoperative complications occurred in 38.6% of patients, the most frequent were urinary leakage (22.9%), ureteral stricture with hydronephrosis (8.6%) and urosepsis (4.3%).Surgical re-intervention was required in 4 cases (5.7%), resulting in permanent loss of bladder function and construction of a ureter-ileo-cutaneostomy in 3 cases (4.3%). Oncological outcome was not influenced by postoperative complications. ConclusionThe rate of complications associated with the PBH procedure was higher in our sample than in previous samples with benign conditions, but most complications were temporary and did not require surgical intervention. We conclude that the bladder-sparing PBH technique of ureter reconstruction is feasible in locally advanced and recurrent rectal cancer with invasion of the urinary tract after pelvic radiotherapy.

Distal conservative urinary tract resections and reconstructions for locally advanced gynecologic malignancies

Due to the anatomical proximity of the urinary and gynecological tract, malignant processes originating from the gynecological viscera might involve the distal segments of the urinary tract, imposing the performance of en bloc resections. However, the demanded procedure widely varies in regard to the location of the invaded area as well as the other anatomical particularity of the patient. This is a literature review of the most commonly performed urinary tract resections and reconstructions for locally advanced gynecologic malignancies including ureteral resection and reimplantation, partial cystectomies with cystoraphy or augmentation cystoplasties and anti-reflux procedures such as psoas hitch or Boari flaps.

Psoas hitch and ureteral re‐implantation in an augmented bladder with ketamine uropathy: A case report

Ketamine has become a popular recreational drug among Asians in recent years. Ketamine uropathy is well known to affect the lower urinary tract leading to urgency, frequency, incontinence and pelvic pain. Concomitant upper urinary tract involvement with ureteric stricture is less common. We hereby present a case of a patient with ketamine‐related bladder contracture initially treated with augmentation cystoplasty, who subsequently developed left lower ureteric stricture requiring psoas hitch and ureteral re‐implantation. We further discussed the fundamental principles in managing ketamine uropathy.

Laparoscopic Extravesical Submucosal Tunneling Ureteroneocystostomy Combined with Psoas Hitch for Medium-Length Distal Ureteral Defects in Adults

Objective: This study aims to describe the technique and feasibility of laparoscopic submucosal tunneling ureteroneocystostomy in combination with psoas hitch to restore urinary tract continuity in patients showing medium-length distal ureteral defects. Materials and Methods: From January 2012 to April 2016, a total of 13 patients (4 males and 9 females) with a mean age of 37 years were performed with the laparoscopic operation of ureteral submucosal tunneling reimplantation combined with psoas hitch. The mean defective length was 5.5 cm (range 4-8 cm). The etiologies included ureteral strictures secondary to endoscopic laser lithotripsy in 2 patients, previous gynecological surgeries in 4, infiltrative ureteral endometriosis in 3, as well as ureteral strictures without obvious causes in the remaining 4. Results: The operations were successfully performed in all patients. The mean operating time was 179 min (range 150-230 min). The mean estimated blood loss was 32 mL (range 15-80 mL). The mean drainage time was 5.8 days (range 4-8 days). No major complications occurred during the perioperative period. The mean follow-up time was 25 months. All patients experienced symptomatic relief and showed good urine drainage. Conclusion: Extravesical submucosal tunneling ureteroneocystostomy combined with psoas hitch under laparoscopy is a feasible and effective option for medium-length distal ureteral defects in selected patients.

Ureteral Endometriosis: Preoperative Risk Factors Predicting Extensive Urologic Surgical Intervention

To identify risk factors for urologic reconstruction during surgery for endometriosis. We retrospectively identified patients in a surgical pathology database undergoing surgery for endometriosis at our institution from 2010 to 2015 and subsequently identified those patients with ureteral involvement. Patients were categorized as requiring minimal urologic surgery (eg, ureterolysis only) or more extensive urologic surgery (eg, ureteral reimplant). All patients were undergoing surgery for endometriosis, and preoperative risk factors were then identified to predict the need for intraoperative extensive urologic surgery. Of 386 women undergoing surgery for endometriosis, 82 (21%) women required a surgical procedure on the ureter. Fifteen of these 82 patients (18.3%) with ureteral involvement required urologic surgical expertise in the form of either ureteral reimplantation with or without psoas hitch, or ureterolysis with ureteral stenting or omental wrap. The remaining 67 underwent ureterolysis alone or no intervention. The presence of flank pain, any urinary symptom, or hydronephrosis on preoperative imaging was a significant predictor of the need for major urologic intervention. In patients with endometriosis undergoing surgery who complain of flank pain, any urinary symptom, or have hydronephrosis on preoperative imaging, one should have a high suspicion for needing to perform urologic reconstruction during surgery. Planning for this additional operation can afford the opportunity for appropriate urologic consultation and patient counseling.

Robot-assisted ureteral reconstruction using a tubularized peritoneal flap: a novel technique in a chronic porcine model.

To evaluate the feasibility and functional outcomes in porcine models of a novel robotic surgical technique for the treatment of complex ureteral injuries and strictures. Six pigs underwent robotic ureteral reconstruction using a long tabularized peritoneal flap and followed for 6-9weeks after the surgery. Ureteral flap vascularity, intra-renal pressure, patency of the conduct, endoscopic aspect of the flap, renal function and histopathology were evaluated. All animals successfully underwent ureteral reconstruction using a tubularized peritoneal flap. Median operative time was 223min (162-360). Flap tubularization suture took 31min (19-47), and proximal anastomosis took 20min (15-38). Bladder mobilization with psoas hitch and distal anastomosis took 9min (7-12) and 23min (13-46), respectively. On follow-up, significant shrinkage of the ureteral flap in both length and width was observed. Antegrade pyelograms confirmed dilation and tortuosity of the proximal ureter, dilation of the renal pelvis, and major and minor calyxes without any definitive strictures. Microscopically, focal urothelial lining was seen in the neoureter. Creatinine level was significantly higher at the end of the follow-up period (p=0.003). Robot-assisted ureteral reconstruction using a tubularized peritoneum flap is technically feasible and reproducible. The flap sustained abundant vascular supply after different intervals of follow-up and the peritoneal mesenchymal cells differentiated into urothelium and myofibroblasts. Further studies are needed to address the issue of functional obstruction to improve long-term renal function outcomes.

V1-10 ROBOT ASSISTED TRANSPLANT URETERONEOCYSTOSTOMY

You have accessJournal of UrologyRobotics-Bladder/Reconstruction1 Apr 2016V1-10 ROBOT ASSISTED TRANSPLANT URETERONEOCYSTOSTOMY Haidar Abdul-Muhsin, Kelli Gross, Karen Stern, Nitin Katariya, and Erik Castle Haidar Abdul-MuhsinHaidar Abdul-Muhsin More articles by this author , Kelli GrossKelli Gross More articles by this author , Karen SternKaren Stern More articles by this author , Nitin KatariyaNitin Katariya More articles by this author , and Erik CastleErik Castle More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2124AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Anastomotic ureteral strictures are one of the most common complications after kidney transplantation. Early diagnosis and management is key in preserving graft function. Definite surgical intervention provides durable cure and has a high success rate. However, it is technically challenging and associated with more morbidity due the dense fibrotic tissue around the transplanted ureter. In this video we will describe our technique in performing robot assisted transplant ureteroneocystostomy with a brief description of outcomes in a case series METHODS These procedures were performed through the collaboration of our urology and transplantation surgical teams. The procedure was performed through a transperitoneal approach in lithotomy position. The ports were placed in a similar location to robot assisted radical prostatectomy. This video will highlight the technical aspects of this procedure. These are: (1) Identification of the transplanted ureter. (2) Proximal and distal dissection of the ureter. (3) Techniques of approximation of the distal end of the transplanted ureter to the bladder (4) Urethrovesical anastomosis RESULTS Location of the transplanted ureter is variable and can be identified after careful dissection of the paravesical space. This should not be confused with medial the umbilical ligament, vas difference and native ureter. Preoperative stenting and intermittent filling of the bladder during dissection can help identify the ureter. It is important to ensure complete excision of the stenotic ureter to prevent recurrence. Previous balder wall defect should be closed in a water tight fashion to prevent urine leak. A stented, spatulated, tension free, water tight anastomosis should be done with absorbable sutures. In order to bridge the gap between the distal end of the ureter and the bladder the same techniques that are used in non-transplant patients can still be utilized. This includes psoas hitch, release of the contralateral pedicle in addition to release of the transplanted kidney from the anterior abdominal wall. The plane between the transplanted kidney and the anterior abdominal wall is an avascular plane that can be relatively easily to develop. This technique was successfully implemented in three cases with complete resolution of obstruction, no anastomotic leakage and no complications. All patents were discharged on day 1 with a foley catheter for a week. A nephrostogram was performed at 7 days. The stent was removed in 4-6 weeks. CONCLUSIONS Robot assisted ureteroneocystostomy can be performed with acceptable initial results and the robotic platform provide benefits of early recovery © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e64 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Haidar Abdul-Muhsin More articles by this author Kelli Gross More articles by this author Karen Stern More articles by this author Nitin Katariya More articles by this author Erik Castle More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Is the robotic approach feasible for repair of iatrogenic injuries of the lower ureter?

To analyze the robotic approach as treatment of iatrogenic ureteral injuries. Medical records were reviewed for patients undergoing robotic-assisted laparoscopic ureteral reimplantation at the University of Missouri from 2009 to 2014. Patient charts were analyzed for demographics, prior abdominal surgeries, circumstances of injury, outcomes, and other relevant information. Nine patients met inclusion criteria. The average age was 44.6. Patients had an average of 4.3 abdominal surgeries. Injury occurred during hysterectomy (open, laparoscopic, or vaginal) in eight patients (88.9%), five cases were laparoscopic, two utilized robotic assistance, and one injury occurred during uterosacral vault suspension. All cases were related to gynecological procedures. On average, ureteral injury was detected 17.2days after the initial surgery and repaired 62.3days after initial operation. The average surgical repair time was 295.9min (range 168-498) with an average blood loss of 77.2mL (range 20-150). Four patients required a psoas hitch, with one receiving both a psoas hitch and a Boari flap. Postoperatively, patients had an average hospital stay of 2.7days. One patient had ileus for greater than 3days, and another was readmitted within 30days for pain control and antiemetics following stent removal. One patient underwent open reimplantation 3years after original surgery for development of ureteral stricture. At follow-up, all patients had returned to baseline renal function. Robotic approach is feasible and a safe option for distal iatrogenic ureteral injuries occurring during gynecological procedures. Prior abdominal surgery or delayed repair does not preclude a robotic approach.

Pattern of iatrogenic ureteral injuries in a tertiary health center in Nigeria

Objective: To assess etiology, nature of injuries, and reconstruction techniques employed in the management of iatrogenic ureteral injuries. Patients and Methods: A retrospective review of patients with iatrogenic ureteral injuries from January 2009 to December 2013 was done. Records of the patients were reviewed with respect to etiology, mode of presentation, nature of injury, and type of repair done. Results: Twenty patients with iatrogenic ureteral injuries underwent a total of 28 ureteral reconstruction procedures at our institution over the 5-year period. There were 19 female patients (95.5%) and only 1 male patient (4.5%). The mean age of the female patients was 34.5 ± 3.8 years. Of the iatrogenic injuries to the ureter, 50% occurred on the left side while 8 (28.6%) were bilateral. In majority of the cases, 26 (92.9%), these injuries were the result of inadvertent ligation of the ureter. The average time at presentation after the injuries was 29.1 weeks with a range of 2 days to 8 years. The most common gynecological operation implicated was total abdominal hysterectomy (TAH) (55%) followed by myomectomy (20%), ovariectomy (10%), cesarean section (10%), and excision of the right colonic tumor (5%). The commonest mode of presentation was leakage of urine from the vagina as seen in 10 (50.0%) patients while 25% had complete anuria. Ureteroneocystostomy (UNC) was performed in 19 (67.8%) ureters. Psoas hitch and Boari flap were done in four (14.3%) and three (10.7%) cases, respectively. One patient (3.6%) required a transureteroureterostomy (TUU) and another one (3.6%) required a right nephroureterectomy. Outcome of the treatment was judged as satisfactory in all the cases as defined by improvement or resolution of the symptoms and normalization of renal function. Conclusion: Abdominal hysterectomy still remains the dominant cause of iatrogenic injury to the ureter. UNC can often be used to establish ureteral continuity in most cases of iatrogenic injuries to the distal ureter. Injuries to the right ureter are more likely to involve the middle third of the ureter, requiring some form of bladder mobilization or bladder flap to establish ureteral continuity. Attention to preventive measures, especially during gynecological surgeries, will help to reduce the incidence of ureteric injuries.

Salvage repair of rare iatrogenic bilateral ureteral injury after hysterectomy

Ureteric injury is a well-documented complication of gynecological surgery, however, bilateral ureteric injuries are rarely encountered and there is no consensus on the management of such complex injuries. We present our successful management of iatrogenic bilateral ureteric injuries in a patient after failed primary endourological surgery and attempted open repair. Our patient is a thirty-five years-old woman who sustained bilateral ureteral injury after open radical hysterectomy to treat a squamous cell carcinoma of her uterus. She subsequently became reliant on bilateral ureteral stents following a failed open surgical repair of her left ureter. Upon evaluation, retrograde pyelogram showed bilateral ureteral strictures with hydronephrosis and ureteroscope could not be passed beyond the tight strictures in the ureters following removal of double-J stents. Open bilateral repair of ureters aims to achieve tension-free bilateral ureteroneocystostomies with a unilateral right psoas hitch. We discussed the adaptations of conventional technique involving tunneling of the left ureter underneath the sigmoid mesentery. She recovered well and was stable on discharge. Upon follow-up in clinic one year later, hydronephrosis resolved completely with conserved renal function. Therefore, we demonstrated and outlined the principles in our successful approach and showed that it is feasible to treat bilateral ureteral injuries following hysterectomy with open repair in spite of unsuccessful primary endourological surgery and attempted open repair.

Technique of Tubularized Bladder Mucosa Method for Treating Recurrent Vesicoureteral Reflux.

Technique of Tubularized Bladder Mucosa Method for Treating Recurrent Vesicoureteral Reflux.

Étiologies et résultats fonctionnels après réimplantation urétéro-vésicale chez l’adulte : revue de la littérature

Vesico-ureteral reimplantations (VUR) for adults are complex procedures, often practicing for distal ureteral lesions. Our goal was to synthesis the main indications for VUR, different techniques and their functional outcomes. A literature review in English by Medline, Embase and Google scholar was performed using the following keywords: ureter; laparoscopy; robotics, reimplantation; surgery; obstruction; morbidity; complications; psoas hitch; Boari flap; ureteroneocystostomy. In more than half of the cases, aetiology was a iatrogenic ureteral lesion. When the ureteral defect was less than 2 cm, direct or non-refluxing VUR was the technique of choice. If defect was superior than 2 cm the Boari flap or vesicopsoas hitch were preferred. Several surgical approaches were feasible: open, laparoscopic only, robot assisted laparoscopic. Estimated blood loss, pain and mean hospital stay seemed better with conventional or robotic coelioscopy. Nevertheless, complications, pre-/post-operative renal function and mean operative time seemed similar. The most frequent major complication was the anastomotic urine leakage. The VUR techniques are well codified now even if it's a rare procedure. Functional outcomes are satisfied according to literature and morbidity is more and more decreasing but the level of evidence of the studies is low.

Robotic-Assisted Ureteral Re-implantation: A Case Series.

Minimally invasive surgical techniques are currently used for numerous urologic disorders and generally offer decreased morbidity and equivalent outcomes compared with open surgery. There is a relative paucity of data on robot-assisted ureteral re-implantation (RAUR) in adult patients for benign stricture disease. We retrospectively reviewed our recent experience with mid-/distal ureteral reconstruction at a single tertiary-care center. From 2010 to 2012, 13 consecutive patients presenting with benign obstruction of mid-/distal ureters were managed with RAUR. In all cases the operative procedure was undertaken with six-port transperitoneal access, and all procedures were completed robotically. All ureters (left, n=5; right, n=7; bilateral, n=1) were re-implanted in a standard Bricker fashion into the dome of the bladder with (n=8) or without (n=6) a psoas hitch. Catheters were removed 4-11 days postoperatively, and all cystograms were negative for leak. Stents were removed 14-48 days after surgery. All were negative for hydronephrosis. Average follow-up was 10 (range, 2-20) months. There were two grade 1, two grade 2, two grade 3, and no grade 4 or 5 complications in 3 patients. RAUR is a safe and effective procedure. Extensive laparoscopic lysis of adhesions represents the primary challenge to an otherwise straightforward minimally invasive surgery. At our institution, RAUR has replaced open ureteral re-implantation as the preferred treatment for benign mid-/distal ureteral stricture disease.

Robot-Assisted Laparoscopic Ureteral Reimplantation: Our Technique and Outcomes

Introduction: Robotic assistance has facilitated the performance of many complex reconstructive procedures previously relegated to an open approach with numerous reported advantages. Distal ureteral reconstruction and reimplantation is one such procedure often performed laparoscopically with robotic assistance using the da Vinci robotic surgical system. We evaluated perioperative and long-term outcomes among patients who underwent treatment with robot-assisted laparoscopic ureteral reimplantation (RALUR) at a single center. Materials and Methods: Patients who underwent RALUR between July 2006 and October 2012 were identified. In all procedures, the distal ureter was spatulated for 1.5 cm. An ~1 cm cystotomy was created. The ureterovesical anastomosis was completed in a triangular manner, including two arms of 4-0 polydioxanone suture up the sides of the spatulation and a third arm anteriorly following stent placement to form a widely patent refluxing anastomosis. All procedures were performed at a single institution. A retrospective review of perioperative and clinical data was performed assessing the operative time, estimated blood loss, length of admission, and success of procedure as indicated by the absence of obstruction on follow-up imaging. Results: A total of 21 patients underwent RALUR in the study period. The mean age of patients was 43.2 years. Twenty of the 21 RALUR were completed robotically with conversion to open in one patient. Etiology of stricture included 11 due to gynecologic procedural injury and three secondary to iatrogenic ureteral injuries. The remainder comprised congenital, nongynecologic surgery, radiation, and idiopathic. Thirteen required the psoas hitch procedure as well. The mean operative time was 237 minutes. The mean estimated blood loss was 85 mL. The average length of hospital admission was 3.1 days. Currently, all patients remain nonobstructed by a Lasix renogram at mean follow-up of 12.4 months. Conclusions: RALUR with psoas hitch (when indicated) is a safe and effective option for distal ureteral reconstruction. Further investigation will help to more clearly refine patient selection and delineate patient benefits in comparison to an open procedure. No authors with conflicts of interest to disclose. Runtime of video: 5 mins 45 secs

MP18-09 IATROGENIC GENITOURINARY INJURIES DURING COLORECTAL SURGERY: CHARACTERIZATION AND LONG-TERM OUTCOMES

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma I1 Apr 2015MP18-09 IATROGENIC GENITOURINARY INJURIES DURING COLORECTAL SURGERY: CHARACTERIZATION AND LONG-TERM OUTCOMES Valary T. Raup, Jairam R. Eswara, and Steven B. Brandes Valary T. RaupValary T. Raup More articles by this author , Jairam R. EswaraJairam R. Eswara More articles by this author , and Steven B. BrandesSteven B. Brandes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1041AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little is known about the rates of iatrogenic genitourinary (GU) complications that occur during colorectal surgery, nor is there data regarding the long-term outcomes of these GU repairs. The purpose of this study is to quantify and categorize these injuries and analyze their long-term outcomes, with special attention to patients who have undergone pre-operative chemotherapy and or/pelvic radiation. METHODS We performed a retrospective analysis of patients who developed iatrogenic GU injuries requiring surgical repair during colorectal surgery between 2003 and 2013. Repair failures were defined as development of urine leak/urinary fistula requiring repeat GU intervention. Possible risk factors associated with repair failures were examined, such as age, ASA score, comorbidities, type of colorectal surgery, and prior radiation or chemotherapy. RESULTS There were 75 patients in this series, with a mean age of 57.5 years (22–91) at time of surgery and median follow up of 16.7 months (0–127). GU injuries occurred most frequently in lower abdominal resections (21), colectomies (16), colonic resections with concurrent total abdominal hysterectomies and bilateral salpingo-oophorectomies (13), and abdominoperineal resections (9). The most common initial GU repairs were cystorrhaphy (26), ureteroureterostomy (22), ureteroneocystotomy with psoas hitch (13), and ureteroneocystotomy without psoas hitch (11). Sixty-four patients had single GU repairs and 16 patients experienced failure of their initial repair with need for additional GU intervention. Of the patients who had undergone pre-operative pelvic radiation, 11/27 (41%) experienced failure of their GU repair, versus 5/48 (10%) that had not been previously irradiated (p=0.003). Pre-operative chemotherapy as also shown to be associated with GU repair failure (12/35 vs. 4/40, p=0.013). Fifty patients (67%) were alive at time of final follow-up, with a 30-day mortality rate of 4%. CONCLUSIONS Pre-operative radiation and chemotherapy are associated with worse outcomes of GU repairs following GU injury during colorectal surgery. Further studies are required to assess potential benefit in postponing more complex GU repairs with interval temporary urinary diversion until peri-operative inflammation has had a chance to subside. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e208-e209 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Valary T. Raup More articles by this author Jairam R. Eswara More articles by this author Steven B. Brandes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...