Ureteral Reanastomosis Research Articles

Cost Effective Simulation Model for Laparoscopic Uretero-Ureterostomy

<h3>Study Objective</h3> The objectives of this video are to review the techniques of uretero-ureterostomy, to develop a low-cost simulation model, and to provide instruction to gynecologists on how to perform this procedure in the absence of a urologist. <h3>Design</h3> A simulation model for ureteral re-anastomosis was created using rubber tubing and a pipe cleaner. The model was placed in a laparoscopic simulation box trainer, and the steps of the procedure are reviewed in sequence. <h3>Setting</h3> Simulation center at an academic tertiary care center. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> The simulation model was developed and explained during the course of the video. <h3>Measurements and Main Results</h3> A piece of rubber tubing is placed in a laparoscopic box simulator, and both ends are secured. A cut is made in the mid-portion of the tube to mimic a ureteral injury. Spatulation is performed to both the proximal and distant parts of the ureter. A pipe cleaner is introduced into both ends of the tube in order to simulate a ureteral stent. Once the stent is secure, we check if the spatulated ends are in position. Interrupted sutures are placed to secure the ureteral ends in the correct anatomical position. Intra-corporeal knot tying is performed to secure the sutures. <h3>Conclusion</h3> Our simulated uretero-ureterostomy model can easily be reproduced to teach residents, fellows, and early career physicians how to repair a ureter laparoscopically. We feel that simulation is essential to teach surgical skills, and ureteral re-anastomosis is a highly technical skill that is very useful for gynecologists who may not always have access to Urology consultation. Using a low-cost model like ours is helpful to practice the steps of the procedure and build confidence for surgeons who may find themselves in an emergent situation where ureteral repair is required.

Upside-down kidney placement: An alternative in pediatric renal transplantation

Purpose“Upside-down” kidney placement has been reported as an acceptable alternative in cases of technical difficulty in kidney transplantation but there are few reports in the pediatric population.The aim of our study is to analyze whether the placement of the upside-down kidney could affect graft outcome or produce more complications. Materials and methodsA retrospective study was conducted of pediatric kidney transplants performed in our center between 2005 and 2017 with at least 6 months' follow-up.Epidemiological and anthropometric data, type of donor (deceased/living), graft position (normal/upside-down), reason for the upside-down placement, early, medium and long-term complications and renal function were analyzed and compared with patients transplanted in the same period with a normal graft placement. ResultsFrom 181 transplants, 167 grafts were placed in a normal position (mean age: 10 y and mean weight: 30 kg) and 14 were placed upside-down (10 y, 37 kg) mainly because of vessel shortness after laparoscopic nephrectomy. Male predominance was observed in both groups.57% of grafts from the control group and 64% of those from study group came from a living donor.Four vascular and two ureteral re-anastomoses were recorded in the control group and two vascular and one ureteral re-anastomosis in the study group (p > 0.05). In the latter group, no grafts have been lost due to vascular or urological causes and no patients have required dialysis. ConclusionsWhen necessary, an upside-down placement for the renal graft is a safe alternative in the pediatric population. Level of evidenceLevel III.

How to manage total avulsion of the ureter from both ends: our experience and literature review

To evaluate the treatment alternatives of total avulsion of the ureter from both ends including ureteropelvic junction (UPJ) and ureterovesical junction (UVJ). Total ureteral avulsion on both ends of the ureter was examined in 4 cases performing ureteroscopy. In two male patients of the four cases, avulsion was noticed intraoperatively and ureteral re-anastomosis at UPJ and re-implantation at UVJ were performed immediately. Boari flap was performed for one female patient immediately and for the other female patient who was referred from another hospital after the ureteroscopy, 4 days later. One patient who had ureteral re-implantation was followed with 3-month intervals by ultrasonography and abdominal X-ray. At the end of 1 year, it was determined that kidney parenchyma was normal and the patient had kidney and upper ureteral stones. Percutaneous nephrolithotomy was performed, and the patient was stone-free at the end of the operation. Two years after the surgery, both kidneys were normal. This is the only case who had a successful ureteral re-implantation in literature. The other patient turned up a year later for routine checks after the ureteral stent was removed. Then, hydronephrosis and renal atrophy were detected. The patient did not accept nephrectomy or any other intervention and he was lost to follow-up. Boari flap procedure was performed after UPJ repair for the other two female patients. Their kidneys were both normal 3 months after the operation. In case of ureteral avulsion from both ends of the ureter in the male patients, as bladder capacity is not enough for a Boari flap, proximal anastomosis and distal re-implantation could be a good choice for the management of this untoward event. This new approach also saves time for reconstructive treatments if necessary. If bladder capacity is enough to reach UPJ, Boari flap could be a good choice in female patients.

Laparoscopic ureteral repair in gynaecological surgery

To review laparoscopic surgery in the treatment options for ureteral lesions in gynaecological surgery. Laparoscopic treatment of ureteral injuries has been increasingly reported over the past years. Treatment has progressively shifted from ureteroneocystostomy performed by laparotomy to less invasive treatment options such as ureteral stenting or dilatation in case of stricture, stenting under laparoscopic guidance and laparoscopic stitching of lacerations, laparoscopic ureteral reanastomosis or laparoscopic ureteroneocystostomy for transections. Deep endometriosis surgery of an associated hydronephrosis is associated with a high incidence of ureteral lesions making preoperative stenting desirable in order to facilitate the eventual repair, while avoiding the more problematic insertion of a stent after a lesion is made.The available data confirm the excellent outcome of stenting obstructive lesions. When stenting proves difficult or in case of a ureteral leakage, laparoscopic aided stenting is strongly suggested, in order to avoid further damage while permitting simultaneous repair if necessary. Laparoscopic suturing of a laceration over a stent is clearly superior to stenting only. Results of ureteral reanastomosis of a transected ureter vary from 88 to 100%; an occasional subsequent stenosis can be treated with dilatation. Bladder reimplantation has become feasible by laparoscopy and results seem promising. Laparoscopic bladder reimplantation is suggested as the method of choice in case of failure of a previous laparoscopic treatment. Data strongly support laparoscopy as the method of choice for the management of ureteral lesions.

Percutaneous antegrade ureteral stenting as an adjunct for treatment of complicated ureteral injuries.

We report our use of percutaneous antegrade ureteral stenting (PAUS) as an adjunct for the management of dehisced ureteral repairs and delayed-presentation ureteral injuries secondary to penetrating trauma. This procedure was performed in treating six patients with ureteral injuries. Four patients had dehiscence of a lacerated ureter that had been primarily repaired. Two other patients had ureteral contusions that subsequently became full-thickness disruptions postoperatively. One of these patients developed a pancreaticoureteral fistula. The sepsis resolved in all six patients and in five of the six patients the ureteral disruption healed within 2 months after PAUS without operative intervention. In one patient the ureter healed with stricture, necessitating ureteral reanastomosis. All urinomas resolved with percutaneous drainage. The PAUS technique was used to successfully treat four dehisced ureteral repairs and was the primary method used to successfully treat two disrupted ureteral contusions that were associated with multiple collections and fistulas. These techniques can be utilized for complex ureteral injuries associated with pancreatic leaks, colon or duodenal injuries, and multiple abscesses.

Bilateral fibroepithelial polyps of ureter in a child

Presented here is the first case of bilateral ureteral polyps in a patient under eighteen years of age, with vivid colored intraoperative photographs. The importance of careful identification of the base of the polyp to reduce operative morbidity and the necessity of ureteral reanastomosis rather than simple excision of the polyp in children is emphasized.

Effect of Ureteral Reanastomosis by Stapling on Ureteral and Renal Function

Effect of Ureteral Reanastomosis by Stapling on Ureteral and Renal Function

Intubated Ureterotomy: Experimental Work and Clinical Results

Intubated Ureterotomy: Experimental Work and Clinical Results