Treatment Of Ureteral Strictures Research Articles

Clinical efficacy of ureteroscopy-assisted laparoscopic ureteroplasty in the treatment of ureteral stricture after pelvic surgery.

This study is to investigate the safety and efficacy of ureteroscope-assisted laparoscopic ureteroplasty in treating ureteral stricture after pelvic surgery. A retrospective analysis of the clinical data of 95 patients treated for ureteral stricture at Ganzhou People's Hospital from June 2017 to March 2023 after pelvic surgery. In this group, 49 patients underwent ureteroscope and laparoscopic ureteroplasty under lithotomy position. The control group consisted of 46 patients who underwent simple laparoscopic ureteroplasty in a supine position. Postoperative data from both groups were collected and compared, including operation time, amount of blood loss during surgery, postoperative hospital stay, incidence of complications, success rate of ureteroplasty, and effectiveness of the operation. The success rate of end-to-end ureteral anastomosis in the observation group was 93.88%, and the operation effectiveness rate was 100%. The success rate in the control group was 78.26% and the operation effectiveness rate was 89.1%.The average operation time and intraoperative blood loss in the observation group were (121.3 ± 44.6)min and (137.5 ± 34.2)ml, respectively, while in the control group they were (151.2 ± 52.3)min and (165.6 ± 45.8)ml, the difference were statistically significant (P < 0.05). The incidence of perioperative complications in the observation group was 2%, significantly lower than that in the control group (19.6%) (P < 0.05). Ureteroscope-assisted laparoscopic ureteroplasty for ureteral stricture after pelvic surgery has the advantages of shortened operation time, increased success rate, and reduced incidence of complications, making it an optional surgical scheme in clinical practice.

Ureterocalicostomy for complex upper ureteral stricture: a narrative review of the current literature.

Upper ureteral stricture is a relatively rare but increasingly encountered condition in clinical practice. While simple stricture can often be addressed through endoluminal treatment or surgical reconstruction, complex upper ureteral stricture poses challenges, particularly in patients with ureteropelvic junction obstruction (UPJO) or perirenal pelvic fibrosis and scarring resulting from previous surgeries. These cases present difficulties for traditional endoluminal and ureteral reconstruction treatments, posing a significant problem for many clinical surgeons. Our study involved a thorough search and comprehensive analysis of the existing literature on Ureterocalicostomy (UC). The literature indicates that UC is a safe and effective treatment for ureteral stenosis. By resecting the renal lower pole parenchyma, it is possible to achieve mucosal anastomosis between the calyceal and ureteral mucosa, leading to the restoration of normal urinary excretion. This technique has emerged as an alternative for treating complex upper ureteral strictures. However, there is a lack of direct comparative studies between open surgery and minimally invasive surgery. Our findings revealed a scarcity of relevant review documents, with most being case reports or retrospective studies conducted in single centers with small sample sizes. Therefore, it is crucial to conduct large-scale, multicenter prospective studies and long-term follow-up to validate the long-term efficacy of UC. This article reviews the development history of UC and focuses on a comprehensive discussion of its indications, surgical techniques, and complications.

Pyeloureteral Anastomosis as a Reconstructive Technique for Post-Renal Transplant Ureteral Stenosis.

Ureteral stenosis in renal transplant patients is a frequent urological complication that involves significant morbidity and may compromise graft function. Despite the common use of minimally invasive techniques, surgery continues to be the definitive treatment for ureteral stenosis, and pyeloureteral anastomosis is an infrequent but effective technique in the management of this pathology and has been described as a safe treatment with a low percentage of complications. This is a retrospective study of patients in whom surgical intervention via pyeloureteral anastomosis was carried out in our center in the last 12 years. A descriptive analysis of perioperative management, complications, and functional results is provided. A comparison of renal function at diagnosis and after surgery was made to evaluate the effectiveness of the procedure. Thirteen patients underwent surgery within the described time frame. Time to diagnosis of stenosis was 60 days [interquartile range (IQR) 31-368]. Creatinine at diagnosis was 2.2 mg/dL [IQR 1.9-3] with a glomerular filtration rate, estimated by the modification of diet in renal disease equation, of 29 mL/min/1.73 m2 [IQR 22.6-34.5]. Of these patients, 92.3% underwent percutaneous nephrostomy, and 38.5% also had a ureteral catheter. The mean duration of surgery was 265 minutes [IQR 240-300], and hospital stay was 9 days [IQR 7.5-16]. A double J was placed in all cases, which was maintained for 36 days [IQR 30-49]. Postoperative complications occurred in 15.4% of patients. Serum creatinine 1 year after surgery was 1.6 ± 0.4 mg/dL. Among the patients, 76.9% had no new pyelocalyceal dilatation on follow-up Doppler ultrasound scans at a mean follow-up time of 12 months. The restenosis rate was 23.1%, and all were successfully treated by endoscopic approach. There was an improvement in renal function figures at 1, 3, 6, and 12 months compared to renal function at diagnosis, both in terms of serum creatinine and glomerular filtration rate, with statistically significant results. Pyeloureteral anastomosis as a reconstructive technique of the urinary tract in renal transplant patients is an effective and reproducible technique with good long-term results.

Allium® ureteral stent, a new player in the treatment of ureteral stenosis: a prospective cohort study

Introduction and objectivesUreteral stricture is a chronic condition that can result in the obstruction of urinary drainage from the affected renal unit, leading to loss of renal function. Treatment methods can be categorized into two main headings: endourological and reconstructive procedures. We aimed to investigate the efficacy and safety of the self-expandable Allium® ureteral stent, which has been used in the minimally invasive treatment of ureteral stenosis in recent years. Materials and methodsTwenty patients who were applied Allium® ureteral stent between 2017 and 2021 included in the study. The demographic and clinical characteristics of the patients, the details of the treatments applied to the patients, the perioperative and postoperative complications, the treatments applied for the complications and the findings in the follow-up were recorded and evaluated prospectively. ResultsEtiology included urolithiasis in 16 patients (80%), malignancy in 3 patients (15%), and a previous gynecological operation in 1 patient (5%). Stent obstruction was found to be the most common complication in 3 patients (15%). Stent migration was the second most common complication in 2 patients (10%). Our follow-up continues with 15 patients without stent-related complications and stent obstruction. The mean follow-up period was 28 ± 15.7 months. ConclusionsAllium ureteral stent is an effective and reliable method in the minimally invasive treatment of ureteral stricture with complications seen at acceptable rates and ease of treatment in the management of complications.

Effect of ureteral stricture in transplant kidney and choice of treatment on long-term graft survival.

To explore the risk factors of ureteral stricture in transplant kidney and the clinical effects of different treatment methods. The 62 patients with transplant kidney ureteral stenosis as the experimental group, and another group of recipients from the same donor as the control group (n = 59 cases). The risk factors for ureteral stricture and the survival rate of transplant kidney were analyzed and compared. The 62 patients were divided into open operation, luminal operation, and magnetic compression anastomosis (MCA) operation group. The effect of the operation and the survival rate of transplant kidney among the three groups were compared. In our study, we found that the above differences were statistically significant in clinical data such as gender, multiple donor renal arteries, history of infection, and delayed graft function (DGF) between the two groups (P < 0.05). Urinary tract infection and DGF history were the independent risk factors for the development of ureteral stricture. The open operation had the best treatment effect and the survival rate of the transplant kidney, followed by the MCA, the stricture recurrence rate in the luminal operation was the highest. The ureteral stricture has a negative correlation with the long-term survival rate of the transplant kidney, the curative rate and long-term effect of open surgery are the best, stricture recurrence rate of luminal surgery is high, and it may require multiple operations in the future, the MCA is a new breakthrough and innovation in the treatment of ureteral stricture.

Stent ureteral Allium®: una nueva alternativa para el tratamiento de estenosis ureterales. Estudio prospectivo de cohortes

Introduction and objectivesUreteral stricture is a chronic condition that can result in the obstruction of urinary drainage from the affected renal unit, leading to loss of renal function. reatment methods can be categorized into 2main headings: endourological and reconstructive procedures. We aimed to investigate the efficacy and safety of the self-expandable Allium® ureteral stent, which has been used in the minimally invasive treatment of ureteral stenosis in recent years. Materials and methodsTwenty patients who were applied Allium® ureteral stent between 2017-2021 included in the study. The demographic and clinical characteristics of the patients, the details of the treatments applied to the patients, the perioperative and postoperative complications, the treatments applied for the complications and the findings in the follow-up were recorded and evaluated prospectively. ResultsEtiology included urolithiasis in 16 patients (80%), malignancy in 3 patients (15%), and a previous gynecological operation in one patient (5%). Stent obstruction was found to be the most common complication in 3 patients (15%). Stent migration was the second most common complication in 2 patients (10%). Our follow-up continues with 15 patients without stent-related complications and stent obstruction. The mean follow-up period was 28±15.7 months. ConclusionsAllium ureteral stent is an effective and reliable method in the minimally invasive treatment of ureteral stricture with complications seen at acceptable rates and ease of treatment in the management of complications.

Аутотрансплантация почки как метод лечения дефектов мочеточника

The treatment of ureteral strictures is one of the most difficult problems of current urology. In recent years, an increase in post-radiation patients who have an iatrogenic ureteral damage during surgical procedures on the pelvic and abdominal organs is seen. We describe two cases in which a long ureteral stricture was diagnosed. The etiology of the strictures was associated with urolithiasis. After the removal of ureteral stones, long ureteral stricture developed in both patients. A nephrostomy tube was initially put. Considering the prolonged length of the stricture with a formation of obliteration, several treatment options were discussed, including nephrectomy. Nevertheless, due to the young age and the good functional state of the renal parenchyma, the decision was made about renal autotransplant, which was associated with a lower surgical risk. However, this procedure requires a high degree of training of the surgical team with appropriate experience.

MP044 - First experience and outcome data of Allium™ coated metal ureteral stent in treatment of ureteral strictures - a retrospective study

MP044 - First experience and outcome data of Allium™ coated metal ureteral stent in treatment of ureteral strictures - a retrospective study

Analysis of long-term effect of ureteral balloon dilatation combined with internal and external drainage tube in the treatment of benign ureteral stricture

PurposeThere are few reports about balloon dilatation combined with internal and external drainage tube in the treatment of ureteral stricture under interventional therapy. The aim of the study is to explore the safety, effectiveness and long-term efficacy of this treatment strategy.Materials and methodsIt is a retrospective and observational study. From October 2013 to October 2016, 42 patients with benign lower ureteral stricture received interventional treatment. Balloon dilatation combined with internal and external drainage tube implantation were used. There were 25 male patients and 17 female patients. There were 7 cases (16.7%) with congenital ureteral stricture, 12 cases (28.6%) with inflammation, 15 cases (35.7%) with ureteral stricture after lithotomy or lithotripsy, and 8 cases (19.0%) with ureteral stricture after pelvic or abdominal surgery. After the drainage tube was removed, B ultrasound, enhanced CTU or IVP of urinary system were reexamined every six months. The follow-up time was 12–60 months.ResultsThe age was 52.9 ± 11.6 years. The length of ureteral stricture was 1.1 ± 0.5 cm. 42 patients completed interventional treatment, the technical success rate was 100%, no ureteral perforation, rupture or other complications were identified. Preoperative urea nitrogen 9.2 ± 2.3 mmol/L and creatinine 175.8 ± 82.8umol/L. Urea nitrogen and creatinine were 3.8–9.1 mmol/L and 45.2–189.6 umol/L when removing the drainage tube. There were significant differences in the levels of urea nitrogen and creatinine before and after tube removal (P < 0.05). The ureteral patency rate was 100% at 6 months, 93% at 12 months, 83% at 18 months, 79% at 24 months, 76% at 30 months and 73% at 36–60 months. The overall success rate was 73%. Multivariate Cox regression analysis showed that stenosis length was a risk factor for postoperative patency (P < 0.05).ConclusionBalloon dilatation combined with internal and external drainage tube implantation in the treatment of benign lower ureteral stricture is safe and effective.

Systematic review and meta-analysis of ureteral stent for risk factors of restenosis after laparoscopic pyeloplasty.

Laparoscopic pyeloplasty (LP) has been widely used to treat ureteropelvic junction obstruction (UPJO); however, no previous series of reports has focused on analyzing the factors that influence the complications and outcomes of LP. In this study, we analyzed the risk factors related to complications of LP, especially that of restenosis. The aim of this study is to perform meta-analysis of relevant comparative studies to analyze the risk factors of restenosis after LP treatment with ureteral stent as of 30 April 2021. A systematic search was conducted in April 2021. The evaluation results included operation time (OT), intraoperative blood loss (IBL), anastomotic tension (AT), postoperative drainage (PD), and ectopic blood vessels (EBV). Relative risk (RR) and standardized mean difference (SMD) were extrapolated with a 95% confidence interval (CI). Subgroup analysis was performed based on research design and technology. After screening, 7 studies were included, incorporating a total of 979 patients with PUJO treated by LP. Analysis revealed the likelihood of risk factors as follows: OT [mean difference (MD) -3.16, 95% CI: -7.18 to 0.85; P=0.12], IBL (MD -3.16, 95% CI: -7.18 to 0.85; P=0.12), AT (RR 3.86, 95% CI: 2.96 to 5.02; P<0.00001), PD (MD 303.97, 95% CI: 219.49 to 388.44; P<0.00001), and EBV (RR 1.15, 95% CI: 0.78 to 1.68; P=0.49). The results indicated that high AT and increased PD are risk factors for postoperative ureteral restenosis. The results of the meta-analysis showed that among the factors related to the efficacy of LP in the treatment of ureteral stenosis, OT, IBL, AT, and EBV were not significantly correlated with postoperative restenosis. However, AT and PD are independent risk factors for postoperative restenosis of the ureter. Therefore, during the operation, the AT should be reduced, and the local injury is reduced to reduce the PD, thereby reducing the risk of restenosis.

A nomogram to predict stricture-free survival in patients with ureteral stricture after balloon dilation

BackgroundBalloon dilation is a commonly used minimally invasive endourological treatment of ureteral stricture, but the postoperative recurrence rate is relatively high. And factors contributing to recurrence after treatment are poorly understood. Herein, we sought to develop a novel clinical nomogram to predict ureteral stricture-free survival in patients suffering from ureter stricture and performed balloon dilation.MethodsThe nomogram was established based on a retrospective analysis of 321 patients who received endoscopic balloon dilation alone for ureter strictures from January 2016 to January 2020 in Sun Yat-sen Memorial Hospital using the Cox regression model. Perioperative clinical data and disease outcomes were analyzed. The primary endpoint was the onset of ureteral re-stricture after ureter balloon dilation. Discrimination of the nomogram was assessed by the concordance index (C-index) and the calibration curve. The results were internally validated using bootstrap resampling.ResultsOverall, 321 patients with a median follow-up of 590 days were enrolled in the study, among which 97 patients (30.2%) developed recurrence of ureteral stricture during follow-up. Five variables remained significant predictors of ureteral re-stricture after multivariable analyses: stricture nature (P < 0.001), urinary nitrite (P = 0.041), CKD (P = 0.005), stent retention time (P < 0.001), and balloon size (P = 0.029). The calibration craves for the probability of 1-, 3-, and 5-years stricture-free survival (SFS) presented satisfied with the consistency of nomogram prediction and actual observation. The C-index of the model was 0.74 (95% CI 0.70–0.79).ConclusionsOur study developed the first nomogram to effectively predict stricture-free survival in patients suffering from ureter stricture after balloon dilation. It is helpful to identify the optimal patients with ureter stricture for balloon dilation and improve treatment outcomes. However, further external validation of the nomogram is warranted.

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.

PD35-10 ALLIUM URETERAL STENT FOR THE TREATMENT OF URETERAL STRICTURE AND FISTULA AFTER ABDOMINAL SURGERY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (PD35)1 Sep 2021PD35-10 ALLIUM URETERAL STENT FOR THE TREATMENT OF URETERAL STRICTURE AND FISTULA AFTER ABDOMINAL SURGERY Massimiliano Di Marco, Antonio Luigi Pastore, Yazan Al Salhi, Andrea Fuschi, Raniero Parascani, Matteo Sampalmieri, Alessia Fraioli, Cristina Avitabile, Saleh Abuorouq, Fabio Maria Valenzi, and Antonio Carbone Massimiliano Di MarcoMassimiliano Di Marco More articles by this author , Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Yazan Al SalhiYazan Al Salhi More articles by this author , Andrea FuschiAndrea Fuschi More articles by this author , Raniero ParascaniRaniero Parascani More articles by this author , Matteo SampalmieriMatteo Sampalmieri More articles by this author , Alessia FraioliAlessia Fraioli More articles by this author , Cristina AvitabileCristina Avitabile More articles by this author , Saleh AbuorouqSaleh Abuorouq More articles by this author , Fabio Maria ValenziFabio Maria Valenzi More articles by this author , and Antonio CarboneAntonio Carbone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002039.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral injuries are well-known complications of abdominal surgery. The aim of the study is to evaluate the safety and feasibility of Allium ureteral prosthesis in patients with distal and upper ureteral injuries after abdominal surgery. METHODS: The Allium URS is a new-developed ureteral stent made of nickel-titanium (Nitinol) meant to automatically expand when inserted in a stricture in order to restore and preserve a larger caliber. Furthermore, the stent is coated with a biochemical co-polymer which prevents tissue ingrowth and incrustations. For this study 71 consecutive patients were enrolled. All of them had iatrogenic ureteral injury in the upper, mid and distal ureter after undergoing abdominal surgery. From these 71 patients, 21 underwent gynecologic surgery. The other 50 patients underwent abdominal surgery due to: ureteral stenosis caused by retroperitoneal lymph node metastasis (3pts 4,22%), uretero-cysto-anastomosis (4pts 5,63%), pyeloureteral junction stenosis (5pts 7,04%), colectomy (6pts 8,45%), ureteral obstruction due to bladder cancer (6pts 8,45%), bladder cuff excision (8pts 11,27%), ureteral stones (18 pts 25,36%). All of them were selected for positioning the allium prosthesis between January 2017 and December 2020. Ureteral leakage and stricture were diagnosed using intravenous pyelography. During the procedure the stent was inserted anterogradely or retrogradely with intraoperative x-ray guidance after dilation of the stricture. RESULTS: No major complications occurred during the stenting procedure. During the follow up (mean 36 months) 6 obstructions (8,45%) have been reported after 8 months caused by ureteral stones all successfully treated endoscopically with holmium laser. In addition, stent migration occurred in 10 patients (14,08%) within 3 months after its insertion, of which 5 were easily replaced and the other 5 were removed with the subsequent need of a robotic re-anastomosis. Among the 5 patients affected by pyeloureteral junction stenosis, 4 needed laparoscopic pyeloplasty due to stent migration. In 20 patients the stents were removed as planned after one year of indwelling time and remained asymptomatic in a follow-up period of up to 24 months. The removal of the left 31 stents is planned during the next 12 months. CONCLUSIONS: Due to its unique structure, the Allium stent resulted superior to the standard pigtail stents in the treatment of ureteral strictures. Stent migration was seen in 19.7% (14pts) of the patients, and mainly reported in patients with stricture of the upper ureter. The results of our study show that the use of Allium URS for the treatment of ureteral strictures is feasible, safe and effective. The relative ease of its insertion could encourage its use in a wide range of other indications. However, evaluating the results we do not recommend the use of Allium stent to treat pyeloureteral junction strictures because of its high risk of migration. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e593-e593 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Massimiliano Di Marco More articles by this author Antonio Luigi Pastore More articles by this author Yazan Al Salhi More articles by this author Andrea Fuschi More articles by this author Raniero Parascani More articles by this author Matteo Sampalmieri More articles by this author Alessia Fraioli More articles by this author Cristina Avitabile More articles by this author Saleh Abuorouq More articles by this author Fabio Maria Valenzi More articles by this author Antonio Carbone More articles by this author Expand All Advertisement Loading ...

Effect of Nanobubble-Based Ultrasound Imaging Technology on the Treatment of Ureteral Stenosis.

In order to explore the effect of nanobubble-based ultrasound imaging technology on the treatment of ureteral stenosis, a total of 120 patients, who were confirmed as ureteral stenosis by surgery, pathology or multiple imaging examinations at a designated hospital of the study from December 2015 to December 2018, were selected as research objects and were divided into three groups of targeted nanobubble (TN) group, blank nanobubble (BN) group and control (CT) group with 40 cases in each group. The TN group utilized the nanobubbles with a particle size of (499.52±72.87) nm as carriers to compare and analyze patients' ultrasound images for the predisposition and etiology of ureteral stenosis and the sonogram variations of hydronephrosis, renal pelvis; the BN group utilized the blank nanobubble with a particle size of (446.71±45.36) nm as carriers to perform ultrasound imaging and diagnostic analysis of ureteral stenosis; the CT group directly conducted ureteral stenosis treatment with ultrasound imaging technology. The results showed that the total coincidence rates of the targeted diagnosis for ureteral stenosis of the TN, BN and CT group were 94.38%, 87.52%, and 67.94%, respectively; the coincidence rates of different examination methods for different diagnostic parts were different and the diagnostic coincidence rates of TN group for pelvic ureteral transition area, end of ureter, and the area between pelvic ureteral transition area and end of ureter were 82.91%, 79.66%, and 75.17%, respectively; the diagnostic coincidence rates of BN group for those were 80.32%, 94.77%, respectively and 92.18% and the CT group were 58.66%, 72.14%, and 66.48%, respectively; the diagnosis coincidence rates for ureteral stenosis etiology of the TN, BN and CT group were 93.81%, 82.66% and 64.57%, respectively. Therefore, it was believed that the nanobubble-based ultrasound examination can accurately diagnose the site of ureteral stenosis through the exploration of hydronephrosis and ureteral dilatation with the advantages of simplicity, no pain, repeatable examination, and no impact on renal function, and having high clinical value for diagnosing ureteral stenosis.

Modern surgical strategies in the management of complex ureteral strictures.

The purpose of this article is to outline the various therapeutic options of ureteral strictures. Ureteral strictures with consecutive hydronephrosis can be due to endourological and surgical procedures, inflammatory processes, radiation therapy as well as spontaneous passage of ureteral calculi. When planning surgical correction, stricture length, anatomical location as well as patients' characteristics like age, comorbidities and previous treatment in the peritoneal cavity, retroperitoneum or pelvis should be taken into consideration. Treatment options include not only surgical reconstruction techniques like simple stricture excision, end-to-end anastomosis, ureterolysis with omental wrapping, ureteroneoimplantation, renal autotransplantation and ureter-ileum replacement, but also minimally invasive procedures such as self-expandable thermostents and pyelovesical bypass prosthesis. Various therapeutic options can be offered in the treatment of ureteral strictures, potentially leading to long-term success rate of more than 90% and a rate of significant complications < 5%.

Endoscopic Internal Urethrotomy (EIU) for the Treatment of Ureteral Stenosis: A Review of 233 Cases

Background: Urethral stricture is a not uncommon pathology consisting of the narrowing of the urethra lumen with consequent reduction or cessation of urine flow. Objective: The objective is to retrospectively evaluate the results of treatment of urethral strictures by endoscopic internal urethrotomy in a series of 233 cases. Patients and Methods: It is Retrospective and descriptive study of 233 cases of urethral strictures treated by endoscopic internal urethrotomy under visual control in a private facility in Abidjan (Ivory Coast) over the period from 1 December 2007 to 31 December 2017. The study parameters were epidemiological, etiological, characteristics of the narrowing and the outcome of the treatment according to the predictive elements. Results: 233 patients were treated with endoscopic internal urethrotomy (EIU). All patients were male. The mean age of the patients was 49 years with extremes from 17 to 84 years. Dysuria (55.79%) was the most frequent reason for consultation: the etiologies were infectious (51.50%), traumatic (32.18%), and iatrogenic (13.73%) and not found (2.57%). Retrograde urethrocystography with fictional films performed in all patients showed the following characteristics: the stricture was bulbar (81.04%), unique (55.79%) and short in 68.6%. There was a 39.91% good outcome after the first EUS. The average follow-up was 3 years. Mortality was nil and morbidity was assessed at 4.72%. The result was better when the procedure concerned a short (≤3 cm), single stenosis on the posterior urethra. The average duration of the postoperative urinary catheter was 14 days on average. The poor results (60.08%) were observed in cases of long stenosis, located on the anterior urethra or concerning elderly patients. 69.28% were cured after a second urethrotomy; the remaining cases were managed by urethroplasty or urethral dilatation. Conclusion: IEU is a simple, reproducible and attractive procedure with an overall success rate of 81.54% in 3 years. Its indication must be made in the case of short stenosis, single posterior and in the young subject.

Progress in the treatment of ureteral stricture

Progress in the treatment of ureteral stricture

Comparison of Yang-Monti ileal ureter-bladder anastomosis versus Yang-Monti ileal ureter-ureteral anastomosis for the treatment of ureteral stenosis: a randomized controlled trial in a miniature pig model

BackgroundThe aim of the present study was to establish an animal model of Yang-Monti ileal ureter-bladder anastomosis and Yang-Monti ileal ureter-ureteral anastomosis and compare the advantages and disadvantages of the two surgical methods.MethodsFourteen 12-month-old male Chinese miniature pigs weighing 21 ± 1.38 kg were randomly divided into two groups. Group A (n = 7) underwent end-to-end anastomosis of the left Yang-Monti ileal ureter, left ileal ureter and left lower ureter; group B (n = 7) underwent anastomosis of the left Yang-Monti ileal ureter, left ileal ureter and bladder. In both groups, the contralateral kidney was removed at 1 week postoperatively. The incision length and operation time of the two groups were compared. Changes in serum creatinine and urea nitrogen were observed preoperatively, and at 2, 6 and 12 weeks postoperatively. Venous pyelography and cystography were performed at 12 weeks postoperatively to determine the ureteral patency and vesicoureteral reflux. At 12 months postoperatively, urinary culture was performed, and the diameter and histological changes of the intestinal ureter were assessed.ResultsSurgery was successfully completed in all 14 pigs. In group A, one pig died due to an anesthetic accident, and one pig died from a lung infection on postoperative day 4. In group B, one pig died from adhesive intestinal obstruction on postoperative day 7. The overall survival rate was 78.6%, and the 11 surviving pigs had no urinary or intestinal fistulae. Compared with group B, group A had a significantly longer surgical incision (30.86 ± 2.41 cm versus 26.71 ± 3.64 cm; p = 0.01) and shorter operation time (181.29 ± 15.10 min versus 157.71 ± 20.49 min; p = 0.02). The serum creatinine and urea nitrogen concentrations did not significantly differ between groups. All pigs had normal renal function pre- and postoperatively. There was no stenosis or obstruction on venous pyelography. The narrowest diameter of the ureter was significantly smaller in group B (5.90 ± 0.30 mm) than in group A (7.26 ± 1.06 mm; p = 0.01), but no contrast agent returned to the upper urinary tract in either group. Escherichia coli was detected on urine culture. In group A, one pig had obstruction of the ureteral ureter, while another had stenosis of the lower ureteral anastomosis. In group B, one pig had pelvic and intestinal ureteral dilatation; however, all anastomoses were patent. The ileal ureteral diameter was significantly larger in group A (9.40 ± 2.35 mm) than group B (6.62 ± 0.37 mm; p = 0.02). Two pigs in group A had separation of the transitional epithelium and columnar epithelial mucosa, with granulation tissue hyperplasia. The pigs with stenosis and obstruction had smooth fibrous tissue and smooth muscle of the anastomosis. In both groups, the two types of epithelial tissue were close together, and the intestinal villi were mildly atrophied and shortened.ConclusionsAn animal model of Yang-Monti ileal ureter-bladder anastomosis was successfully established. Compared with Yang-Monti ileal ureter-ureteral anastomosis, Yang-Monti ileal ureter-bladder anastomosis is simpler, more reliable, and results in fewer complications.

Initial experience of ileal ureter replacement combined with augmentation cystoplasty in the treatment of ureteral stenosis with contracted bladder

Objective To explore the availability and safety of ileal ureter replacement combined with ileal augmentation cystoplasty in treating ureteral stenosis with contracted bladder. Methods From August 2015 to November 2018, three patients who underwent ileal ureter replacement combined with augmentation cystoplasty were treated with ileal ureter replacement combined with augmentation cystoplasty. There were 1 male and 2 females with the age ranging from 34 to 55 years (mean 39 years). Two patients suffered from left ureter stenosis, and one patient had stenosis on the both sides. The length of the ureter stenosis ranged from 6 to 18 cm (mean 9.8 cm). The preoperative bladder capacity ranged from 60 to 150 ml (mean 103.3 ml). In the surgery, part of ileum was used to replace the ureter, and the distal intestine was made into U-shape to enlarge the bladder. Results All operation were completed successfully. The operation time ranged from 220 to 400 min (mean 303.0 min), and the blood loss ranged from 150 to 500 ml (mean 283.3 ml). Laparoscopic surgery was performed in 1 case and open surgery in 2 cases. Three weeks after the surgery, the bladder volume underwent cystography ranged from 300 to 400 ml (mean 360.0 ml). Three months after the surgery, the postvoid residual urine volume ranged from 20 to 50 ml (mean 33.3 ml). Postoperative frequency and urgency of urine were completely relieved in 1 case, alleviated in 2 cases. Flank pain was completely relieved in 1 case, and alleviated in 2 cases postoperatively. The serum creatinine of 2 patients mildly increased after the surgery, while 1 patient remained stable. For complications, 1 patient had urinary infection, and 1 patient suffered from metabolic acidosis. Conclusions Ileal ureteral replacement combined with augmentation cystoplasty can be the choice of treatment for long segment ureteral stenosis and enlarge the bladder simultaneously. The postoperative complications and the kidney functions should be regularly followed up. Key words: Augmentation cystoplasty; Ileal ureter replacement; Ureteral obstruction; Urinary tuberculosis

Clinical observation of flexible ureteroscope combined with ultramini nephrostomy tract antegrade balloon dilatation on ureteral stricture

Objective To observe the clinical effect of flexible ureteroscope combined with ultramini nephrostomy tract antegrade balloon dilatation in the treatment of ureteral stricture. Methods A total of 24 patients with ureteral stricture in our hospital underwent flexible ureteroscope combined with ultramini nephrostomy tract under general anesthesia, and the guidewire and balloon dilatation catheters were used to expand urethral stricture, and F7 catheter was placed. Results All patients were successfully implemented flexible ureteroscope under direct vision narrow segment balloon dilatation and stent implantation, after the operation regular replacement of the stent, the stent was pulled out after six months. All patients were followed up for 1 year, and no long-term complications and recurrence occured. Conclusions Flexible ureteroscope combined with ultramini nephrostomy tract antegrade balloon dilatation is safe and effective method, especially for the patients under retrograde balloon dilation unsuccessful is a better alternative select. Key words: Ureteral Obstruction; Ureteroscopes; Balloon Dilatation