Ureteral Catheter Research Articles

Navigating Cervical Fibroids during Laparoscopic Hysterectomy: Essential Tips and Tricks

<h3>Study Objective</h3> To review three key strategies to safely navigate cervical fibroids when performing a laparoscopic hysterectomy. <h3>Design</h3> Case series of two patients undergoing total laparoscopic hysterectomy (TLH) for abnormal uterine bleeding in the setting of large cervical fibroids. <h3>Setting</h3> Both patients underwent their planned surgeries at a large-volume county hospital. Video footage was obtained during these procedures. <h3>Patients or Participants</h3> Two women who had completed childbearing and desired definitive surgical management for abnormal uterine bleeding underwent TLH. The first patient's cervical fibroid was 6.5cm in size, and the second patient's cervical fibroid was 8cm in size, confirmed on both pelvic exam and pre-operative pelvic MRI imaging. Neither patient had a significant past medical or surgical history. <h3>Interventions</h3> Total laparoscopic hysterectomy for a patient with a large cervical fibroid can be completed safely using three key strategies: 1. Ureteral identification, including ureterolysis if necessary and consideration of prophylactic ureteral catheter placement 2. Ligation of the uterine artery at its origin to minimize risk of blood loss 3. Delineation of the cervicovaginal junction using a Breisky-Navratil retractor to safely perform the colpotomy <h3>Measurements and Main Results</h3> The two presented cases demonstrate successful incorporation of the above techniques and ultimately safe completion of the laparoscopic hysterectomy for both patients. <h3>Conclusion</h3> Cervical fibroids are rare, however when present, can pose unique challenges to the gynecologic surgeon when performing a laparoscopic hysterectomy. Here we demonstrate three reproducible techniques for minimizing injury to adjacent organs and minimizing intraoperative blood loss, allowing the surgeon to safely navigate the difficulties presented by the cervical fibroid and maintain a minimally invasive approach.

Ultrasound-guided percutaneous nephrolithotomy without indwelling ureteral catheter in older adults with upper urinary calculi: A retrospective study.

Retention of ureteral catheter to establish artificial hydronephrosis is a routine step of percutaneous nephrolithotomy procedure, which can improve the success rate of puncture, but it can prolong the procedure time and increase the risk of postoperative infection, especially for immunocompromised elderly patients. Therefore, this study aims to investigate the safety and effectiveness of ultrasound-guided percutaneous nephrolithotomy without indwelling ureteral catheter for older patients with upper urinary calculi. The clinical data of 119 older patients admitted to the Affiliated Hospital of Jining Medical University for percutaneous nephrolithotomy from January 2019 to December 2021 were retrospectively analyzed. The patients were divided into study and control groups according to whether the physician decided to use ureteral catheter during the procedure, and the differences in the success rate of one-time puncture, operative time, single-stage stone removal rate, postoperative hospital stay, and complication rate were compared between the 2 groups. There were no significant differences in the success rate of one-time puncture and single-stage stone removal rate between the 2 groups (P > .05). The operation time were significantly shorter in the study group [(30.0-61.0) minute vs (54.8-106.8) minute, P = .00], and the intraoperative bleeding was less in the study group [(5-20) mL vs (10-30) mL, P = .03]. The postoperative hospital stay was shorter in the study group [(2.5-4.0) days vs (3.0-5.0) days, P = .00], and the medical expenses were lower in the study group [(17,309.5-22,652.7) yuan vs (19,148.0-24,407.6) yuan, P = .02]. The incidence of systemic inflammatory response syndrome was lower in the study group (3.5% vs 19.4%, P = .007). There were no statistically significant differences in complications such as postoperative fever, renal artery embolism and blood transfusion between the two groups (P > .05). Ultrasound-guided percutaneous nephrolithotomy without indwelling ureteral catheter for elderly patients with upper urinary stones is safe and feasible.

Robot-assisted pyeloplasty and laparoscopic pyeloplasty in children: A comparison of single-port-plus-one and multiport surgery.

This study aimed to compare the effects of various trocar placements in robot-assisted and laparoscopic pyeloplasty involving children diagnosed with obstruction of the ureteropelvic junction (OUPJ). We retrospectively collected the data on 74 patients under 14 years of age who had been diagnosed with OUPJ; these patients underwent either robot-assisted or laparoscopic pyeloplasty in our hospital between January 2015 and November 2021. There were four groups, as follows: •Laparoscopic multiport pyeloplasty (LMPY),•Laparoscopic single-port pyeloplasty (LSPY),•Robotic-assisted multiport pyeloplasty (RMPY),•Robotic-assisted single-port-plus-one pyeloplasty (RSPY).Patients' characteristics as well as their perioperative and follow-up data were collected and evaluated. There was no significant difference in the data regarding patients' characteristics. These data included the grade of hydronephrosis according to the Society of Fetal Urology (SFU grade), anterior and posterior diameter of the renal pelvis and ureter (APDRPU), and the differential degree of renal function (DRF) at following time points: preoperative, postoperative, and comparison of preoperative and postoperative. There was no difference among these groups. During surgery, the time of trocar placement, urethroplasty time, and total operative time in the robotic groups (RMPY and RSPY) were longer than those in the laparoscopic groups (LMPY and LSPY). However, the ratio of the urethroplasty time and full operative time (UT/WT) in the robotic groups (RMPY and RSPY) was lower than that in the laparoscopic groups (LMPY and LSPY) (P = 0.0075). Also, the volume of blood loss was lower in the robotic groups (RMPY and RSPY) than that in the laparoscopic groups (LMPY and LSPY), although there was no statistical difference (P = 0.11). There were, however, significant differences in hospitalization days (P < 0.0001) and parents' cosmetic satisfaction scores (P < 0.001). There were no differences in fasting time, the length of time that a ureteral catheter remained in place, or the number of postoperative complications. Our study shows that both robotic multiple-port and single-port-plus-one approaches are comparable, with laparoscopic multiple-port and single-port approaches equally effective in resolving OUPJ in children. Robotic and single-port-plus-one approaches may be associated with some advantages in hospitalization time and cosmetic outcomes; therefore, these approaches may be useful in urologic surgery that requires precise suturing, especially in pediatric patients.

Ureteroscopy during pregnancy: Outcomes and lessons learned over 4 decades at a tertiary center in Norway.

The management of suspected kidney stone disease in pregnancy is challenging. In cases of persistent flank pain and where investigations may have rendered equivocal results, ureteroscopy (URS) is a recognized diagnostic and therapeutic intervention. This study aimed to investigate the safety and outcomes associated with performing URS during pregnancy, as the technique has evolved over the past 4 decades at our center. We performed a retrospective analysis of pregnant patients who underwent URS at our tertiary center between 1984 and 2022. Outcomes of interest included anesthetic approach, operative time, hospital stay, and complications. Eighty-seven pregnant patients underwent 96 URS procedures, and 60% (n = 57) of these procedures were performed during the third trimester. Overall, 58% (n = 56) of the procedures were achieved with local anesthesia and light sedation. During the most recent decade, the latter was successfully carried out in 97% of the procedures, with the remainder occurring under spinal anesthesia as per patient choice. Overall, 57% (n = 50) of the whole study group had ureteral calculi found at the time of surgery and in 88% (n = 44) of these cases, fragmentation/extraction was performed. The remainder had insertion of ureteral stent with definitive clearance deferred until postpartum. Mean operative time and postprocedure hospital stay was 33 minutes (range, 7-100 minutes) and 2.2 days (range, 0-16 days), respectively. The overall intraoperative and postoperative complication rates were 2% and 11%, respectively. During the final decade, the latter improved to 6% and all adverse events were minor (Clavien I/II), with the exception of a single case. Regarding exit strategy, ureteral stent was placed in 42% (n = 40) of the procedures, 23% (n = 22) had ureteral catheter inserted, and the remainder (35%, n = 34) had none. Ureteroscopy can be safely performed during pregnancy using anesthetic approach with local anesthesia and light sedation. Development of a local protocol and multidisciplinary management algorithm are instrumental in enabling the delivery of such a service.

A method for reducing thermal injury during the ureteroscopic holmium laser lithotripsy

ObjectiveMany studies have demonstrated the heat effect from the holmium laser lithotripsy can cause persistent thermal injury to the ureter. The purpose of this study was to elucidate the use of a modified ureteral catheter with appropriate firing and irrigation to reduce the thermal injury to the “ureter” during the ureteroscopic holmium laser lithotripsy in vitro. MethodsAn in vitro lithotripsy was performed using a modified catheter (5 Fr) as the entrance for the irrigation and the holmium laser fiber while using the remaining space in the ureteroscopic channel as an outlet. Different laser power settings (10 W, 20 W, and 30 W) with various firing times (3 s, 5 s, and 10 s) and rates of irrigation (15 mL/min, 20 mL/min, and 30 mL/min) were applied in the experiment. Temperature changes in the “ureter” were recorded with a thermometer during and after the lithotripsy. ResultsDuring the lithotripsy, the local highest mean temperature was 60.3 °C and the lowest mean temperature was 26.7 °C. When the power was set to 10 w, the temperature was maintained below 43 °C regardless of laser firing time or irrigation flow. Regardless of the power or firing time selected, the temperature was below 43 °C at the rate of 30 mL/min. There was a significant difference in temperature decrease when continuous 3 s drainage after continuous firing (3 s, 5 s, or 10 s) compared to with not drainage (p<0.05) except for two conditions of 0.5 J×20 Hz, 30 mL/min, firing 5 s, and 1.0 J×10 Hz, 30 mL/min, firing 5 s. ConclusionOur modified catheter with timely drainage reducing hot irrigation may significantly reduce the local thermal injury effect, especially along with the special interrupted-time firing setting during the simulated holmium laser procedure.

Clinical Value of Ureteral Catheterization before Trans-abdominal Radical Hysterectomy and Pelvic Lymphadenectomy

Introduction: Being in the close vicinity, chances of ureteral injury is high while doing radical operation for cervical cancer. Although the incidence is low, if it is not found during the operation, it can lead to serious complications such as urinary fistula. Timely detection and repair of ureteral injury can reduce the occurrence of serious complications.The placement of ureteral catheter before radical hysterectomy can be a good method to identify the ureter during operation to prevent injury.The objective of the study was to explore the advantages and disadvantages of the placement of ureteral catheter in radical operation of cervical cancer. Methods: 103 patients who were diagnosed as cervical cancer and underwent operation in the department of Obstetrics and Gynecology, Jinling Hospital from January 2019 to April 2020 were analyzed in this study. The clinical stage ranges from IA to IIA. Among them, 23 cases were placed with double J stent before operation (observation group), 80 cases were operated without stent (control group). The intra-operative condition, operation and postoperative complications were analyzed retrospectively. Results: There was a significant difference in the operation time and intra-operative blood loss between the two groups (P&lt; 0.05), and there was no significant difference in blood transfusion between the two groups (P&gt; 0.05). There was no significant difference in the incidence of urinary tract infection and urinary retention between the two groups (P&gt; 0.05). The incidence of postoperative hematuria (including microscopic hematuria) was significant in two groups（P&lt; 0.05). Ureteric injury occurred in the 9 patients in the control group (11.25%). Conclusion: Ureteral catheter inserted before radical operation of cervical cancer can help to identify the ureter easily, decrease urinary tract injury, shorten operation time and reduce intra-operative blood loss, and will not increase urinary retention and urinary tract infection. It is safe and effective method especially for young gynecologists.

PLANING RENAL PUNCTURE IN MINI-PERCUTANEOUS NEPHROLITHOTOMY:A RADIOLOGICAL ANATOMYBASED INTERVENTION

Objectives: To determine the outcome of mini-PCNL in terms of stone clearance considering renal puncture through diff erent calyces under fl uoroscopy.Materials and Methods: This study was conducted in the Department of Urology Institute of Kidney Diseases , Peshawar from 1st Jan 2022 to 31st May 2022. Patients fulfi lling the study criteria having renal stone≥2cm were recruited for the study. All the patients having abnormal blood caogulopathy and abnormal anatomy were excluded from the study. The cystoscopy was performed fi rst by keeping the patient in the lithotomy position and the ureteric catheter was passed. The anatomy of kidney is fully visualized targeting the calyx with gradual descent technique under fl uoroscopic guidance. Renal access to pelvicalyceal (PVC) system achieved percutaneously under fl uoroscopic guidance by renal puncture through diff erent calyces after which which guide wire was passed. The percutaneous tract was made and dilated up to 17Fr by using single-step metalic dilator and a 12-Fr-sized nephroscope was used. The stones were broken into pieces using pneumatic lithoclast.Results: Mean stone size was 15.35+3.073. Mean hospital stay was 2.62+0.487. Ninety six(60%) were male patients while 64 (40%) were female patients. 71.9%(115) patients achieved stone clearance by intervention through middle calyx while 21.85% (35) and 7%(10) patients achieved full stone clearance through upper and lower calyx approach respectively.Conclusion: The approach to the pelvicalyceal system through proper planning of renal puncture under fl uoroscopic guidance turns signifi cantly good in case of middle calyceal approach in terms of stone clearance.&#x0D; &#x0D;

Роль интраоперационного внутрилоханочного давления в течении послеоперационного периода перкутанной нефролитотрипсии у больных с мочекаменной болезнью.

Introduction. Percutaneous and endourological surgeries are the most common interventions for nephrolytiasis in urologists’ practice. During the operation, it is important to maintain the right balance between sufficient flow of irrigation fluid for adequate visualization and safe intrarenal pressure. Intraoperative increase in intrarenal pressure is associated with the development of purulent-inflammatory complications in the postoperative period. The aim of the study. To substantiate the expediency of intraoperative monitoring of intrarenal pressure, as well as to assess the risks of postoperative complications after percutaneous nephrolithotripsy. Materials and methods. The study included 250 patients with staghorn kidney stones. In the first group (n=120) percutaneous nephrolithotripsy (PCNL) was performed according to the standard procedure with a puncture canal diameter of 30-32 Сh. The second group included 130 patients who underwent percutaneous nephrolithotripsy using a mini nephroscope (mPCNL) with a working channel diameter of 16 Ch. To achieve the aim of our study, we have developed a method for determining intrapelvic pressure, implemented using a miniature pressure sensor, which is installed directly into the pelvis at the time of the calycopelvical system puncture. During the surgery, the intrapelvic pressure was constantly monitored according to the method we proposed. Results. The lowest values of intrapelvic pressure were recorded when performing PCNL with the installation of an Amplatz sheath exceeding the size of the nephroscope by 2 or more Ch. When performing mPNLT, the installation of a ureteral catheter allows minimizing the increase in intrapelvic pressure. Hyperthermia in the postoperative period significantly depends on an increased intrarenal pressure and the presence of an infectious agent in the renal system. Separately performed urine cultures from the pelvic and bladder with obstruction of even minimal severity may have significant differences. In patients of mini-PNLT group intraoperative intrapelvic pressure was significantly higher (p≤0.05). The frequency of fever and exacerbation of calculous pyelonephritis is significantly higher in group of standart PNLT (p &lt; 0.05), which is explained by greater traumatization of the renal parenchyma when creating a working fistula. Conclusion. The proposed method allows the most accurate intrasurgery monitoring of intrarenal pressure during minimally invasive surgical treatment of kidney stones in order to minimize the frequency of infectious and inflammatory complications.

The renal pelvis urobiome in the unilateral kidney stone patients revealed by 2bRAD-M

BackgroundThe pathogenesis of kidney stone disease (KSD) is not fully understood, and potential contributing factors remain to be explored. Several studies have revealed that the urinary microbiome (urobiome) of stone formers was distinct from that of healthy individuals using 16S rRNA gene sequencing, most of which only provided microbial identification at the genus level. 2bRAD sequencing for Microbiome (2bRAD-M) is a novel sequencing technique that enables accurate characterization of the low-biomass microbiome at the species resolution. We aimed to apply 2bRAD-M to profile the renal pelvis urobiome of unilateral kidney stone patients and compared the urobiome with and without stone(s).MethodA total of 30 patients with unilateral stones were recruited, and their renal pelvis urine from both sides was collected. A ureteroscope was inserted into the renal pelvis with stone(s) and a ureteral catheter was placed into the ureteroscope to collect renal pelvis urine. This procedure was repeated again with new devices to collect the urine of the other side. 2bRAD-M was performed to characterize the renal pelvis urobiome of unilateral stone formers to explore whether microbial differences existed between the stone side and the non-stone side.ResultsThe microbial community composition of the stone side was similar to that of the non-stone side. Paired comparison showed that Corynebacterium was increased and Prevotella and Lactobacillus were decreased in the stone side. Four species (Prevotella bivia, Lactobacillus iners, Corynebacterium aurimucosum, and Pseudomonas sp_286) were overrepresented in the non-stone side. 24 differential taxa were also identified between two groups by linear discriminant analysis effect size (LEfSe). Extensive and close connections among genera and species were observed in the correlation analysis. Moreover, a random forest classifier was constructed using specific enriched species, which can distinguish the stone side from the non-stone side with an accuracy of 71.2%.ConclusionThis first 2bRAD-M microbiome survey gave an important hint towards the potential role of urinary dysbiosis in KSD and provided a better understanding of mechanism of stone formation.

Preoperative flexible bronchoscopy-aided cannulation of a neonatal H-type tracheo-oesophageal fistula assists intraoperative identification of the fistulous tract

BackgroundThe surgical repair of H-type tracheo-oesophageal fistulas situated below the level of the second thoracic vertebra requires an open thoracotomy or a thoracoscopy. We describe a novel technique that allows for the use of a cervical incision to repair a fistula situated in the thorax, thus diminishing surgical risk.Case presentationIn this report, we describe a 3-day-old term baby with an H-type tracheo-oesophageal fistula where flexible bronchoscopy and gastroscopy were used to cannulate the fistula with a soft ureteric catheter. This allowed for it to be tractioned into the cervical region where it was surgically dissected and isolated. There was no need for re-intervention in the first 3 months after surgery.ConclusionFlexible bronchoscopy-aided cannulation of H-type fistulas can assist in intraoperative identification of the fistulous tract as well as help traction it into a surgically more accessible area like the cervical region.

The feasibility of reduced sutures in 3D laparoscopic tubal sterilization reversal

Study ObjectiveTo show the technique of reduced sutures in 3D laparoscopic tubal reanastomosis. DesignStep-by-step demonstration of the procedure using video. SettingLaparoscopic tubal sterilization reversal demands high precision and requires both skill and experience. Conventionally, 4 to 6 interrupted patterns using 6-0 to 8-0 absorbable sutures are used for laparoscopic tubal reanastomosis. We used fewer and larger sutures under a magnified 3D view to perform the procedure. InterventionsWe presented a case of a 42-year-old woman, gravida 3, para 3, who underwent tubal sterilization during Cesarean section 10 years ago. Preoperative hysterosalpingography (HSG) showed bilateral distal tubal occlusion. The procedure started with the subserosal injection of diluted vasopressin in both proximal and distal ends and in the mesosalpinx to facilitate dissection and hemostasis. After transection of tubal stump and removal of scar tissue, we used a 3 Fr ureteral catheter as the stent to facilitate suturing. Three interrupted 4-0 monocryl sutures were used for suturing both tubal mucosal and muscular layers at 6, 2, and 10 o'clock sites. We performed bilateral ampullo-ampullary reanastomosis. The tubes were successfully reanastomosed, and patency was confirmed by chromotubation performed at the end of the procedure (Figure 1). The operation lasted for 71 minutes. The operative blood loss was less than 50 ml. Patent right fallopian tube was confirmed on postoperative HSG 1 month later. The patient had a successful pregnancy 8 months after the operation. ConclusionOur experience shows the feasibility of 3D laparoscopy for tubal reanastomosis using reduced sutures. The technique alleviates the damage to the fallopian tube. The operative time, hospital stay, and postoperative adhesions were significantly lower than the conventional method with a comparable success rate.

Fluoroscopy-free RIRS on the second session after ureteral stent placement.

Fluoroscopy is used in some stages of the conventional Retrograde Intrarenal Surgery (RIRS) procedure and is beneficial. On the other hand, radiation exposure is its most obvious disadvantage. As a subgroup, we aimed to show that fluoroscopy-free technique is safe and effective in patients who underwent RIRS after passive dilatation. Between October 2018 and April 2020, 54 cases of second session RIRS of renal stones performed by a single surgeon were retrospectively evaluated. Patients' demographic characteristics (age, gender), stone features (laterality, size, number, volume, and location), mean operative time, and, perioperative and postoperative complications, as well as the stone-free rate (SFR), were all retrospectively evaluated. The results were classified as stone free, clinical insignificant residual fragments (CIRF), and presence of residual stones. Complications were graded using the Clavien-Dindo classification system. We used a modified surgical technique. All of complications were minor. There were no major complications (Clavien grade III-IV). The stone-free rate was 70.3% (38/54) on the first day after surgery and 83.3% (45/54) 1 month afterward, respectively. If we accept the absence of residual stone as success, we can say that it is about 91% successful in the first month. This technique has a high stone-free success rate and a low complication rate without the use of radiation. For surgeons experienced in endourology, we can say that the fluoroscopy-free technique is safe and effective in secondary-session RIRS cases which passive dilatation was performed by inserting a ureteral catheter before.

Novel ureteral navigation with a fluorescent catheter during hemi-hysterectomy in cloacal exstrophy

We used a near-infrared ray catheter (NIRC) in a child with cloacal exstrophy presenting with hematometra and assessed whether the NIRC could help with complicated adhesiolysis during hemi-hysterectomy in children. A 6-French pig tail-type NIRC was inserted into the left ureter with guidance from a cystoscope. Laparoscopic hemi-hysterectomy with fluorescence observation was performed using the VISERA ELITE 2 system. NIRC insertion into the left ureter was not as difficult as expected despite the eccentric position of the left ureter orifice. When we found an enlarged left uterus and fallopian tube, adhesion was extremely severe around them due to chronic inflammation caused by hematometra. When near-infrared rays were applied, a fluorescent ureteral catheter that emitted bright green excitation light was observed on the dorsal side of the enlarged left uterus and fallopian tube. Under ureteral navigation with an NIRC, dissection of the adhesions was performed safely and smoothly. Hemi-hysterectomy and adnexectomy were performed successfully. The patient was doing well 2 years postoperatively without any complications. An NIRC can provide useful real-time visualization of the ureter course and reduce the risk of ureteral damage in children with advanced adhesions.

Primary versus delayed ureteroscopy for ureteric stones: A systematic review and meta-analysis

Background: Ureteric colic is a major clinical and economic burden on the National Health Service. There has been a recent paradigm shift to consider definitive surgery as the primary intervention at the time of initial presentation. Objective: To systematically evaluate the outcomes of primary/emergency ureteroscopy versus delayed/elective ureteroscopy. Methods: We performed a critical review of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials–CENTRAL, CINAHL, Clinicaltrials.gov, Google Scholar and individual urological journals in April 2020. A robust database search was performed using a combination of the terms ‘primary ureteroscopy’, ‘immediate ureteroscopy’, ‘delayed ureteroscopy’ and ‘emergency ureteroscopy’. Adult patients (&gt; 16 years) with ureteric stones presenting as an emergency were included. Results: Twelve studies met the inclusion criteria, with 4 studies directly comparing primary/emergency to delayed/elective ureteroscopy for an acute presentation of ureteric colic. Across the studies, 1708 patients underwent primary/emergency ureteroscopy for ureteric calculi and 990 underwent delayed ureteroscopy. No significant differences in stone-free rates were found between both groups with primary/emergency achieving 85% and delayed/elective 91% ( p = 0.68). The majority of stones treated were located in the distal ureter in both groups. Overall, there were no differences in complications between the groups ( p = 0.42) or major complications (0.17). However, there were fewer minor complications in the primary URS group ( p = 0.02). Ureteral catheter or double-J stent insertion was used in 71% of delayed/elective ureteroscopy cases, compared to 46.8% of primary/emergency cases (p = 0.001). For patients undergoing primary/emergency ureteroscopy, 6.4% patients required auxiliary procedures. In the delayed/elective group, 7.6% required further definitive treatment (NS). Conclusion: Primary ureteroscopy is a safe and feasible procedure, when performed in suitable patients in the acute setting. It is associated with significantly lower stent usage, equivalent stone clearance, no increase in overall or major complications including sepsis, and fewer minor complications when compared to delayed/elective ureteroscopy. Prospective studies will do well to explore this area further but on current evidence, primary ureteroscopy is the safe procedure. Level of evidence: Not applicable

Use of ureteral catheter in uterine-sparing surgery for placenta accreta

Objective: The study aimed to investigate the effect of ureteral catheter use during surgery on the outcomes of obstetric and urinary complications in patients with placenta accreta spectrum (PAS) and placenta previa. Methods: The patients who were followed up at Meram Medical Faculty Hospital of Necmettin Erbakan University between January 2016 and November 2021 and diagnosed with PAS and placenta previa were included. Patients who underwent emergency and planned surgery were grouped as those with or without an intraoperative ureteral catheter. The primary outcome was determined as the rate of urinary system damage among these groups. The number of blood transfusions, preoperative and postoperative hemoglobin values and hemoglobin changes, length of hospitalization, patients who underwent uterine-sparing surgery or hysterectomy, urinary tract injury, and wound infection were compared regarding the use of catheters. Results: A total of 122 patients were included in the study. While an intraoperative ureteral catheter was placed in 56 (45.01%) patients, it was not used in 66 (54.09%) patients. Bladder injuries were determined in 31 (55.4%) patients with a catheter and 13 (19.7%) patients without a catheter, and no other urinary system injuries were found. The incidence of bladder injury was statistically significantly higher in the group with a catheter (p=0.001). The number of transfused erythrocyte suspensions, the hemoglobin change according to the preoperative hemoglobin level, and the mean duration of hospitalization in patients with a catheter were statistically significantly greater than the group without a catheter (p=0.001). Conclusion: Ureteral catheterization did not reduce urinary damage in patients with PAS and placenta previa who underwent uterine-sparing surgery and hysterectomy. However, we believe that the insertion of a catheter increases the possibility of diagnosing intraoperative damage.

Comparison of vacuum suction ureteroscopic laser lithotripsy and traditional ureteroscopic laser lithotripsy for impacted upper ureteral stones.

To compare a novel vacuum suction ureteroscopic laser lithotripsy (VS-URS) with traditional ureteroscopic laser lithotripsy (T-URS) for impacted upper ureteral stones and to better define the potential benefits of VS-URS. Between May 2019 and March 2021, 158 patients with impacted upper ureteral stones underwent ureteroscopic holmium-YAG laser lithotripsy. Of these, 76 underwent VS-URS and 82 underwent T-URS. In VS-URS procedures, the vacuum suction device is composed of a 5F ureteral catheter and a tee joint. The ureteral catheter is linked to the vacuum aspirator by the sidearm of the tee joint, and a 200μm fiber is inserted through the tee joint and the ureteral catheter into the stone site for lithotripsy. When compared to the T-URS group, the VS-URS group had a shorter mean operation time (38.18 ± 6.37min vs. 46.65 ± 5.66min;P = 0.000), lower fever rate (3.9% vs. 14.6%; P < 0.022), less stone retropulsion (5.3% vs. 18.3%; P = 0.012), lower extra management rate (6.58% vs. 21.95%; P = 0.006), and a higher stone-free rate of the first postoperative day (88.2% vs. 72.0%;P = 0.011). There were no significant differences in stone-free rates 1month after surgery between groups (94.7% vs. 92.7%; P = 0.748). VS-URS is an effective modality for impacted upper ureteral stones, and has a shorter operating time, lower fever rate, less stone retropulsion, and a higher primary stone-free rate compared with T-URS.

Uretero-Iliac Artery Fistula

Uretero-Iliac Artery Fistula: a rare cause of haematuria A 90-year-old male presented to our hospital with a onemonth history of intermittent gross hematuria. He had stage II rectal cancer and received neo-adjuvant concurrent chemoradiotherapy and low anterior resection 5 years ago. Additionally, he was under regular bilateral ureteral catheter replacement due to radiation related ureteral stricture for two years.\r\nDuring examination, there was no abdominal tenderness or flank pain. Urine analysis showed pyuria and hematuria. Abdominal and pelvic computed tomography without contrast medium revealed only bilateralwithout contrast medium revealed only bilateral hydronephrosis. After admission, several hematuria episodes that required blood transfusions and bladder irrigation occurred at an interval of 3 days and resolved spontaneously. Cystoscopy was unmarkable except bleeding from right ureteral orifice during ureteral stent replacement. Concerns for a ureteral arterial fistula prompted an angiogram, which later on proved the existence of a fistula with pseudoaneurysm(Figure 1) between external iliac and distal right ureter(Figure 1). A stent graft was placed from the common iliac into the right external iliac artery. After stent-graft deployment, the aneurysm is no longer opacified. At the 2-month follow-up, no hematuria recurrence was detected.\r\n

Treatment Outcome of Ureteral Reconstruction Surgery

We retrospectively reviewed the surgical outcome of ureteral reconstruction that was performed in Asahikawa Medical University Hospital between 2005 and 2021. A total of 14 patients (3 males, 11 females; 15 ureters) were included in this analysis. The median age was 57 years old. The reason for ureteral reconstruction was ureteral injury or stenosis due to pelvic surgery in 9 patients, transurethral lithotripsy for ureteral stone in 3, ureteral invasion of sigmoid colon cancer in one and ovarian cancer in one. The site of ureteral reconstruction was proximal ureter in 2, middle in 3 and distal in 10. The surgical procedure was ureteroneocystostomy with Boari flap in 8 patients (57%), ureteroureterostomy in 4 (21%), transureteroureterostomy in one (7%), and transureteroureterostomy combined with Boari flap for bilateral ureteral stenosis in the remaining patient (7%). Postoperatively, vesicoureteral reflux, ileus and surgical site infection were observed in 3, 2 and 1 patient, respectively. No patient required nephrostomy or ureteral catheter, or any additional procedure after the surgery. There was no episode of febrile urinary tract infection after the surgery. The mean estimated glomerular filtration rate was, respectivery 75.8 and 78.5 ml/min/1.73 m2 before surgery and at 1-101 months (median of 18) after the surgery. In conclusion, satisfactory outcome was achieved after ureteral reconstruction surgery. We emphasize the importance of selecting the most appropriate procedure for ureteral reconstruction in each patient to prevent renal function deterioration and urinary tract infection.

Efficacy and safety of emergency ureteroscopy as first-line treatment for patients with renal obstruction due to ureteral stones in the COVID-19 pandemic

Introduction and objective: Acute renal colic due to ureteral calculi is a common urological emergency that can be managed conservatively, by providing renal drainage and medical management of the pain syndrome followed by planned treatment, or by emergency surgery. With the onset of the COVID-19 pandemic leading to the temporary suspension of elective surgical activity, emergency ureteroscopy has become a valuable modality for the treatment of acute renal obstruction. The objective of this study is to evaluate the efficacy and safety of emergency ureteroscopy as first-line treatment for patients with acute renal obstruction due to ureteral stones during the COVID-19 pandemic. Material and methods: A prospectively collected database of 120 patients with acute renal obstruction due to ureteral stone who underwent emergency ureteroscopy within 24 hours from hospitalization between March 2020 and December 2021, was reviewed. Data on patients’ preoperative characteristics, stone-free rates and complication rates was analyzed. Results: Patients’ mean age was 51.4±15.2 years. Male-to-female ratio was 73.3%/26.7%. Mean preoperative serum creatinine values were 120.1±64.1 umol/l. 33 patients (2.5%) had a solitary functioning kidney. Stone location was proximal ureter in 3 patients (27.5%), mid-ureter – in 12 (10%), distal ureter – in 73 (60.8%), distal and proximal ureter – in 2 cases (1.6%). Mean stone size was 8.1±3.3 mm. Stone-free rate after a single procedure was 95% and mean operative time – 25.1±11.5 min. Postoperative drainage was stent JJ in 34 (28.3%) and ureteral catheter for 12h – in 22 (18.3%) patients. 21 patients (17.5%) had a narrow ureter, necessitating the use of smaller caliber ureteroscope (6 Fr). In 2 patients (1.7%) the ureter could not be accessed and a stent JJ was inserted. Intraoperative complications were present in 5 cases – 1 ureteral perforation (0.8%) and 4 cases of upward stone migration (3.3%). Postoperative complications were fever in 2 patients (1.7%) and postoperative renal colic pain - in 7 (5.8%). Conclusions: The results of this prospective study suggest that emergency ureteroscopy is a safe and effective first-line treatment for acute renal obstruction due to ureteral stones. It offers a one-stage management, without the potential complications of obstruction and loss of renal function due to delayed treatment during the COVID-19 pandemic. Key words: Ureterorenoscopy, Ureteral obstruction, Ureteral stone, Covid-19

TOTAL VAGINECTOMY FOR RECURRENT GYNECOLOGICAL CANCER:&#x0D; A SERIES OF CLINICAL CASES

Relevance: Treating vaginal recurrence of gynecological cancer remains a complex clinical problem. Surgery is an effective and relatively&#x0D; safe strategy for these cases. Vaginectomy is a method of surgical treatment of gynecological cancer local recurrence. Although vaginectomy is&#x0D; considered an effective treatment for a vaginal recurrence of cervical, ovarian, or endometrial cancers, only a few published reports of vaginal&#x0D; resections have been found. In most cases, vaginal resections were performed by vaginal and/or/or open access. Several reports on laparoscopic&#x0D; vaginal resection for recurrence in gynecological cancer were found.&#x0D; The aim was to study the effectiveness of vaginectomy in recurrent gynecological cancer.&#x0D; Methods: Clinical cases of seven patients after vaginectomy were analyzed.&#x0D; Results: The patients age ranged from 42 to 62 years (median 53 years). The duration of the operation varied from 240 to 480 minutes (median&#x0D; 317 min), the volume of blood loss – from 90 to 220 ml (median 140 ml), and resection margins were negative in all cases. An ureteral catheter was&#x0D; installed in 2 cases. The Foley catheter was removed after 10 days on average (from 1 to 11 days). The patients stayed in the hospital for 7-14 days&#x0D; (median – 7 days). No intraoperative complications were registered. All patients after vaginectomy are alive.&#x0D; Conclusion: Vaginal recurrence is the most common local recurrence in gynecological cancer, and there is no consensus regarding its treatment tactics. Although this article is somewhat limited in the number of patients, our results show the efficacy of vaginectomy in recurrent vaginal&#x0D; gynecological cancer