Ureteral Resection Research Articles

Evaluation of Two Ureter Sealing Methods During Radical Nephroureterectomy.

To investigate the safety of electrocoagulation and thulium laser (Tm-laser) sealing methods of distal ureter resection during radical nephroureterectomy (NFU) in a porcine model. 9 pigs were used in the study: 6 were used to measure the bursting pressure (BP) and 3 were used to measure the highest pressure during NFU. Twelve ureters were to measure BP after being sealed by electrocoagulation or Tm-laser (n = 6, each). Six experimental NFUs were performed in 3 pigs to measure the intraluminal pressure of all procedures. The mean BP in the electrocoagulation group (104.3 ± 25.0 cmH2O) was similar to that of the Tm-laser group (74.8 ± 23.3 cmH2O, P > .05). The peak intraluminal pressure (35.9 ± 7.6 cmH2O) during NFU was significantly lower than the BP (P < .05). The effectiveness of the sealing was confirmed using both electrocoagulation and Tm-laser during NFU.

Robot-assisted laparoscopic ureteroneocystostomy combined to hysterectomy for intrinsic ureteral and deep pelvic endometriosis: Video presentation

Introduction: We present a case of posterior deep infiltrating endometriosis with intrinsic ureteral involvement in a 43-year-old patient treated by robot-assisted laparoscopic technique. To our knowledge, this is the second case of robot-assisted ureteroneocystostomy with concomitant hysterectomy reported in the literature1–5, yet the first one to be described with a video presentation. Case description: A 43-year-old woman with a past history of endometriosis treated laparoscopically was referred to our clinic for grade II–III left hydronephrosis. Pelvic ultrasound and magnetic resonance imaging demonstrated a 3-cm paracervical endometriotic nodule causing ureteral compression, another 1.6-cm endometriotic nodule at the rectosigmoid junction, an adenomyotic nodule in the anterior uterine wall, and an endometrioma on the right ovary. Given that the patient had an absolute contraindication to hormonal therapy, we opted for robot-assisted laparoscopic complete eradication of endometriosis. The procedure consisted in total hysterectomy with concomitant removal of the rectovaginal nodule, right adnexectomy, left salpingectomy, and left ureteral resection with ureteroneocystostomy. After 8 days, a cystography was accomplished to confirm anastomosis integrity, and the bladder catheter was removed. The patient was discharged on day 8 after a regular postoperative period. One year after the surgery, the patient refers wellbeing. Conclusion: The robotic approach in such a complex procedure as surgical treatment of ureteral and deep infiltrating endometriosis is feasible and safe with acceptable postoperative outcome. Further investigations with larger comparative cohorts that include cost analysis are needed to fully assess the benefits achieved by robotic assistance in patients with ureteral and deep infiltrating endometriosis.

Learning curve for detection of pelvic parts of ureters by transvaginal sonography: feasibility study.

To investigate how many examinations it takes to be able to identify the pelvic parts of the ureters on transvaginal sonography (TVS). This was a prospective study including consecutive women attending a gynecological outpatient clinic in a tertiary referral setting. Prior to commencement of the study, three trainees, with a focus on gynecological surgery and TVS but with no experience in identifying ureters, each observed an expert examiner performing 10 routine TVS examinations, including identification of both ureters. All were standardized gynecological TVS examinations, with visualization of the pelvic part of both ureters. Consecutive women were then examined, first by the expert, unobserved by the trainees, and then by one of the three trainees, in the presence of the expert. To ensure that identification of the pelvic parts of the ureters could be incorporated feasibly into routine gynecological TVS in a tertiary referral setting, a time limit of 150 s was set for successful identification of each ureter. A successful examination was defined by identifying both ureters within the time limit. The number of women examined by each trainee was determined by how quickly they achieved proficiency, which was evaluated using the learning curve cumulative summation (LC-CUSUM) score. Between January 2017 and June 2017, a total of 140 women were recruited for the study, with 135 patients being included in the final analysis. The three trainees were able to identify the right ureter after a maximum of 48 (range, 34-48) TVS examinations, and the left ureter after a maximum of 47 (range, 27-47) TVS examinations. Sonographers and/or gynecologists who are familiar with gynecological TVS should be able to become proficient in identifying both ureters after 40-50 TVS examinations. Detection of the ureters is a feasible part of the TVS workup of patients attending a clinic in a tertiary referral center. © 2019 the Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Clinical features and surgical outcomes of major urological interventions during cytoreductive surgery and hyperthermic intraperitoneal chemotheraphy.

Background:Urinary system resections and reconstructions are needed in peritoneal carcinomatosis due to abdominal malignancies. The effect of hyperthermic intraperitoneal chemotherapy on these urological procedures after reconstruction remains uncertain. The aim of the study is to evaluate major urological interventions during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in complex abdominal malignancies with peritoneal carcinomatosis.Methods:Forty-four cases underwent surgical intervention related to the urinary system among 208 cases who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy because of peritoneal carcinomatosis. Urinary system procedures performed in these patients (radical-partial cystectomy, partial ureter resection ureteroneocystostomy, ureteroureterostomy, nephrectomy) were evaluated in terms of postoperative morbidity–mortality and survival.Results:Urinary system resections were performed during cytoreductive surgery in a total of 44 cases. The mean age was 54 years (20–73). Patients were diagnosed with peritoneal carcinomatosis due to colorectal cancer in 21 (47.8%), ovarian cancer in nine (20.4%), sarcomatosis in five (11.4%), cervical cancer in four (9%) and other cancers (mesothelioma, uterus, breast, gastric) in five (11.4%) cases. Total nephrectomy was performed in three cases and partial nephrectomy in one case. Cystectomy was performed in 21 cases; 16 of these were partial and five were total cystectomies. Ureteroureterocystostomy with double J was performed in four cases and ureteroneocystostomy in 12 cases. While Clavian–Dindo grade 3–4 complications were seen in nine cases (20.4%), three cases (6.8%) became exitus during the first 30-day follow-up.Conclusions:Although urinary system involvements have been regarded as inoperable in the past, we think that with adequate experience radical urinary interventions performed in suitable patients can be carried out with acceptable morbidity and mortality as seen in our series.

Extended Pelvic Resections as Part of Secondary Cytoreduction for Relapsed Ovarian Adenocarcinoma.

Ovarian cancer presents an aggressive tumor biology, a significant number of patients experiencing recurrent disease. The aim of this study was to examine the feasibility and effectiveness of secondary debulking surgery for relapsed ovarian cancer. Between 2014 and 2018, debulking surgery for relapsed ovarian cancer was performed in 40 cases. Debulking surgery to no residual disease was achieved in 31 cases; among the remaining cases, an R1 resection was feasible in six cases, while in the remaining three cases an R2 resection was performed. The most commonly performed visceral resections were represented by rectosigmoidian resection, right colon resection, total or partial cystectomy and unilateral or bilateral ureteral resection. The early postoperative morbidity rate was 32.5% while the postoperative mortality rate was 2.5%. Extended pelvic resections are feasible in patients with relapsed ovarian cancer and might be performed with acceptable rates of postoperative complications.

The outcomes of isolated ureteral resection and reconstruction in non-urologic cancer patients who underwent cytoreductive surgery (CRC) and hyperthermic intraperitoneal chemotherapy (HIPEC)

BackgroundUrinary system resections are performed during the cytoreductive surgery with hypertermic intraperitoneal chemotherapy (CRS-HIPEC). However, isolated ureter resection and reconstruction results are uncertain. The aim of this study was to evaluate the postoperative outcomes of isolated ureteral resection and reconstructions in patients who underwent CRC and HIPEC procedure.MethodsA total of 257 patients that underwent CRC and HIPEC between 2015 and 2017 in the Department of Surgical Oncology, Faculty of Medicine, Ankara University, were retrospectively analyzed. Twenty patients that had undergone isolated ureteral resection and reconstruction were included in the study. Predisposing factors were investigated in patients who developed postoperative complications.ResultsThe mean age of the patients was 55.1 years. The mean follow-up time of all the patients was 11.6 months. Postoperative mortality occurred in two patients. The mean PCI score was 13.9. Postoperative urologic complications were observed in eight patients after ureter reconstruction. There was no statistically significant difference between the groups in terms of reconstruction techniques and postoperative complications (P = 302). There was no correlation between age (P = 0.571) and gender (P = 0.161) with complications. CRS-HIPEC was performed mostly due to gynecologic malignancy. However, there was no correlation between the primary cancer diagnosis and the development of complications (P = 0.514). The hospital stay duration was higher in the group with complications (16.3 vs 8.8 days, P = 0.208).ConclusionsUreteral resections and reconstructions can be performed for R0/1 resections in CRS-HIPEC operations. It leads to an increase in hospital stay. But there is no significant difference in the development of complications. In the management of complications, conservative approach was sufficient.

Bladder and Urinary Deep Pelvic Endometriosis: A Step-by-Step Standard Approach

To demonstrate how to treat bladder and ureteral deep pelvic endometriosis using a laparoscopic approach with partial cystectomy and resection and end-to-end anastomosis of the ureter. Step-by-step explanation of the surgery using a video approved by the local institutional review board. University Hospital of Strasbourg, France. A 27-year-old nulliparous woman with severe endometriosis stage IV (revised American Fertility Society classification score >40) of the bladder and left ureter. On pelvic magnetic resonance imaging, we found dilatation of the left ureter and left hydronephrosis induced by a 17-mm endometriosis nodule. A JJ probe was placed on the left ureter before the surgery because of dilatation of the ureter and decreased renal function. During the exploration, we found an abdominal cavity free of adhesion. There was an endometriosis implant in the bladder in front of the uterus and a large nodule of the left uterosacral ligament that was compressing the ureter. In the first step, we made a section of the round ligament to perform anterior ureterolysis and progressive dissection of the nodule surrounding the ureter. Once the nodule was resected, tight stenosis was observed approximately 1 cm from the bladder. The vesicouterine and vesicovaginal spaces were then dissected to pass under the nodule to the vagina. We opened the dome of the bladder using the thunderbeat (Olympus) and dissected the bladder to remove the transfixing nodule while staying away from the ureters. The closure of the bladder was performed by 2 lateral sutures and a running suture using a braided suture (V-Loc) 2-0, with good tightness as checked by a blue test. Ureteral resection was performed around the JJ probe in place to remove the stenotic zone; thereafter, we performed an end-to-end anastomosis of the ureter using 4 sutures of monofilament (Monocryl) 4-0 with a good anatomic result. Finally, an omentoplasty was fixed around the ureter using a 2-0 monofilament suture (Monocryl). The postoperative course was uneventful. A Foley catheter was left in place for 10 days, and the JJ probe was removed 6 weeks later. The operative time was 140 minutes. The step-by-step explanation technique was simple with minimal operative difficulty and a low rate of morbidity. This video shows how deep urinary endometriosis can be treated laparoscopically. Mastering suturing is essential to avoid complications.

A Case of Recurrent Uterine Leiomyosarcoma Treated with Complete Laparoscopic Resection

Video Objective Uterine leiomyosarcoma (uLMS) is aggressive mesenchymal neoplasm and is associated with a high risk of recurrence and poor prognosis. The 5year overall survival rate is about 60% even in FIGO stage I disease. There is no firm evidence of chemotherapy, so surgical resection should be considered to control the disease in case of localized recurrence. We will report a case underwent total laparoscopic complete resection for recurrent mass involved sigmoid colon and right ureter. Setting Gynecology and Obstetrics department of a general hospital. Interventions The patient was a 56-year-old woman underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy for enlarged 9cm cervical leiomyoma. The pathological examination of the uterus resected showed cytologic atypia,nuclear mitoses and coagulative necrosis, she was diagnosed as primary uLMS, stageⅠB. She rejected to receive adjuvant chemotherapy. After 7months, the isolated metastasis in pelvic and lung was suspected. Magnetic resonance imaging revealed that the 4cm tumor possibly be involved sigmoid colon and right lower ureter. Resection of the recurrent mass with segmental bowel resection and partial resection of ureter with ureteroneocystotomy was performed laparoscopically without any complications. Complete tumor resection with histologic negative margins was achieved. She had postoperative adjuvant chemotherapy with doxorubicinfor 6 cycles and additional surgery for lung meta is scheduled. Also, we experienced another three salvage cases with successful resection in combination with laparoscope and thoracoscope. Conclusion The surgical indications for recurrent uLMS should be selected, but the complete resection of localized recurrence may lead to control the disease. Minimally invasive approach may be one of the feasibleoption.

Gemcitabine/Cisplatin therapy for an urothelial carcinoma patient undergoing hemodialysis: a case report

Abstract Background Gemcitabine/Cisplatin (GC) therapy is first-line chemotherapy for advanced urothelial carcinoma (UC). The Renal Impairment Clinical Practice Guidelines 2016 suggest that, Cisplatin (CDDP) may be administered by up to 50% of standard dose for patients with hemodialysis (HD) because of the renal toxicity. The evidence is, however, scanty to evaluate safety. We report a case of GC therapy for a UC patient undergoing HD. Patient A 80-years old male with bilateral papillary UC had a total renal ureteral resection and underwent HD. Two courses of adjuvant GC therapy were to be performed. The standard dose of Gemcitabine (GEM) and 50% of standard dose of CDDP were administered on the same day based on CDDP and GEM interview form and literature for HD patients. HD started 6 hours after GEM administration and 1 hour after CDDP administration. The volume of infusion was 600 mL; diuretics were not used. Side effects were evaluated according to Common Terminology Criteria for Adverse Events v4.0. Results In first course, Grade 4 side effects were observed: leukopenia, neutropenia and thrombocytopenia. They were treated by granulocyte-colony stimulating factor (G-CSF) administration and platelet transfusion. No febrile neutropenia was observed. Because the second course was administered without reducing the doses, G-CSF was prophylactically administered, and the Grade 4 side effects were reduced to Grade 3. No relapse was observed by now. Conclusion We could performed GC therapy safety for a patient with advanced UC undergoing HD by managing adverse event adequately.

Evaluation of curative effect of kidney-sparing surgery in elderly patients with upper urinary tract urothelial tumors

Objective To evaluate the value of kidney-sparing surgery in the treatment of upper urinary tract urothelial tumors by retrospectively analyzing and comparing the clinical data of elderly patients with upper urinary tract urothelial tumors between patients undergoing kidney-sparing surgery and nephroureterectomy in our hospital during the same period. Methods Thirty elderly patients with upper urinary tract urothelial tumors were treated with kidney-sparing surgery(ureteroscopy, segmental ureteral resection)and followed up from April 2004 to July 2017.One hundred and forty-nine patients who underwent nephroureterectomy during the same period were selected as the control group.The survival rate and local recurrence rate were compared between the two groups. Results In the kidney-sparing group, 23 cases were pathologically diagnosed as tumors, 3 cases as inflammatory polyps and 4 cases without pathological findings.There were no statistically significant differences between kidney-sparing surgery and nephroureterectomy in bladder recurrence[4 cases(13.3%)vs.24 cases(16.1%), χ2= 0.011, P=0.915], pelvic orthotopic recurrence[3 cases(10.0%)vs.6 cases(4.0%), χ2=0.825, P=0.364], cancer-specific death rate[2 cases(6.7%)vs.16 cases(10.7%), χ2=0.118, P=0.731]and overall survival rate[4 cases(13.3%)vs.22 cases(14.8%), χ2=0.410, P=0.550]. There were no significant differences between kidney-sparing surgery versus nephroureterectomy among postoperative 1-year, 5-year and 10-year in the overall survival rates(100.0%vs.95.1%、85.9%vs.84.1%、80.5%vs.60.8%, P=0.156), tumor-specific survival rates(100.0%vs.95.1%, 85.7%vs.87.6%, 85.7%vs.76.8%, P=0.380)and progression-free survival rates(100.0%vs.100.0%, 90.9%vs.96.0%, 90.9%vs.79.7%, P=0.680). Conclusions Elderly patients have poor physical conditions and poor tolerance to radical surgery with a significant damage on postoperative renal function.Kidney-sparing surgery(ureteroscopy, segmental ureteral resection)as the treatment of upper urinary tract tumors can minimize the risk of surgery and optimize the quality of life.The individual assessment based on individual conditions, postoperative complications, and the recovery of renal function should be conducted and the operation with the greatest benefit should be adopted. Key words: Ureteral neoplasms; Kidney-preserving therapy

Robotic radical nephroureterectomy and segmental ureterectomy for upper tract urothelial carcinoma: a multi-institutional experience.

To report a multi-institutional experience on robotic radical nephroureterectomy (RNU) and segmental ureterectomy (SU) for upper tract urothelial carcinoma (UTUC). Data were prospectively collected from patients with non-metastatic UTUC undergoing robotic SU or RNU at three referral centers between 2015 and 2018. Transperitoneal, single-docking robotic RNU followed established principles. Bladder cuff excision (BCE) was performed with robotic or open approach. Techniques for SU included: ureteral resection and primary uretero-ureterostomy; partial pyelectomy and modified pyeloplasty; ureteral resection with BCE and direct- or psoas hitch-ureteroneocystostomy. We retrospectively evaluated the technical feasibility, and peri-operative and oncologic outcomes after robotic RNU/SU. 81 patients were included. No case required conversion to open surgery. Early major (Clavien-Dindo grade > 2) complications were reported in six (7.4%) patients (two after SU, four after RNU). Three patients experienced late major complications (one after SU, two after RNU). Median ΔeGFR at 3months was - 1ml/min/1.73m2 after SU and - 15ml/min/1.73m2 after RNU. Positive surgical margins were recorded in five patients (one after SU, four after RNU). Median follow-up was 21months and 22months in the SU and RNU groups, respectively. Three (20%) patients had ipsilateral upper tract recurrence after SU, while five (7.5%) developed metastases after RNU. No case of port-site metastases or peritoneal carcinomatosis was reported. At last follow-up, 67 (82.7%) patients were alive without evidence of disease. Robotic SU and RNU are technically feasible and achieved promising peri-operative and oncologic outcomes in selected patients with non-metastatic UTUC.

Use of indocyanine green to minimise uretero-enteric strictures after robotic radical cystectomy.

To evaluate the impact of indocyanine green (ICG) for assessing ureteric vascularity on the rate of uretero-enteric stricture formation after robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD). We identified 179 patients undergoing RARC and ICUD between January 2014 and May 2017, and divided the patients into two groups based on the utilisation of ICG for the assessment of ureteric vascularity (non-ICG group and ICG group). We retrospectively reviewed the medical records to identify the length of ureter excised. Demographic, perioperative outcomes (including 90-day complications and readmissions), and the rate of uretero-enteric stricture were compared between the two groups. The two groups were compared using the t-test for continuous variables and the chi-squared test for categorical variables. A P<0.05 was considered statistically significant. A total of 132 and 47 patients were in the non-ICG group and the ICG group, respectively. There were no differences in baseline characteristics and perioperative outcomes including operating time, estimated blood loss, and length of stay. The ICG group was associated with a greater length of ureter being excised during the uretero-enteric anastomosis and a greater proportion of patients having long segment (>5cm) ureteric resection. The median follow-up was 14 and 12months in the non-ICG and ICG groups, respectively. The ICG group was associated with no uretero-enteric strictures compared to a per-patient stricture rate of 10.6% and a per-ureter stricture rate of 6.6% in the non-ICG group (P=0.020 and P=0.013, respectively). The use of ICG fluorescence to assess distal ureteric vascularity during RARC and ICUD may reduce the risk of ischaemic uretero-enteric strictures. The technique is simple, safe, and reproducible. Larger studies with longer follow-up are needed to confirm our findings.

The efficacy and safety of ureteral stent after Electrocision of bladder tumor involving the ureteral mouth

Objective To investigate the efficacy and safety of ureteral stent placement after electrocision of bladder tumor involving the ureteral mouth. Methods From June 2014 to June 2016, 95 cases of bladder tumor resection involving the ureteral mouth were received in our hospital were selected. According to whether the ureteral stent was placed after operation, they were divided into two groups. 49 cases in the observation group were placed ureteral stent after operation, and 46 cases in the control group. No ureteral stent was placed after operation. The general data of operation, changes of hemoglobin level before and after operation, VAS score, complication incidence and satisfaction of each group were observed and compared between the two groups. Results There was no significant difference in the operation time, postoperative hospital stay and hemoglobin before and after surgery between the two groups (P>0.05). There was no significant difference in VAS score between the two groups on the first day after operation (P>0.05), the VAS score of the observation group on the 7th day after operation (0.94 ± 0.24)points and on the 14th day after operation (0.53±0.12)points was significantly lower than that of the control group [(1.89±0.41) points, (1.42±0.44) points], the difference between the two groups was statistically significant (P<0.05). The incidence of postoperative complications in the observation group was significantly lower than that of the control group (8.16% vs. 23.91%), and the difference between the two groups was statistically significant (P<0.05). The satisfaction rate of the patients in the observation group was significantly higher than that of the control group (93.88% vs. 76.09%), and the difference between the two groups was statistically significant (P<0.05). Conclusions Bladder tumor involving the ureteral orifice surgical resection of the ureteral stent can reduce the degree of pain, reduce the incidence of complications such as ureteral stricture and postoperative recurrence, and no risk of retrograde transplanting the upper urinary tract after operation Promote the application. Key words: Cystectomy; Urinary Catheterization

Transcaval Ureter

Transcaval ureter is a rare condition caused by abnormality in the embryogenesis of the inferior vena cava (IVC). It results from a segmental duplication of the IVC which creates a venous ring that encircles the right ureter. Here, we report a case of a 42-year-old female who presented to us with a history of right flank pain for 2 years. Ultrasonography, intravenous urogram, and contrast-enhanced computed tomography (CECT) scan of the abdomen suggested it to be a retrocaval ureter. On exploration, contrary to the report of imaging, the ureter was found to transverse in between two segments of IVC and thus on table, a diagnosis of the right transcaval ureter as the cause of obstruction was made. The patient underwent segmental ureteral resection followed by ureteroureterostomy. Follow-up CECT scan was done to document two segments of IVC and thus confirm our intraoperative finding.

Association of Irrigation Fluid Used and Serum Electrolyte Changes in Trans Ureteral Resection of Prostate (Turp) at Dr. Hedgewar Rugnalaya, Aurangabad

Introduction: Trans Urethral Resection of the Prostate as a gold standard treatment for benign prostatic hyperplasia is performed with fluid irrigation that may cause electrolyte disturbance due to excessive fluid absorption; and may lead to electrolyte imbalance crises. It can cause hemolysis and changes in hematocrit value. Here in this study we primarily focused on electrolytic disturbances only. Different types of irrigation fluid are used for Trans-Urethral Resection of Prostate (TURP) procedure worldwide. In our institute we used sterile water as an irrigation fluid. The advantage of using sterile water are-Easily available, cheap, electrically inert, nontoxic, transparent, and easy to sterile and disadvantage is it is hypotonic. Ideal irrigation fluid should be isotonic, nonhemolytic, electrically inert, nontoxic, transparent and easy to sterile and should be inexpensive. Objective: This study is to determine the incidence of changes in electrolyte level in TURP procedure. Materials and methods: A descriptive retrospective study was conducted at Dr. Hedgewar Hospital, Aurangabad between January to December 2017. The subjects were BPH patients who underwent TURP surgery at Dr. Hegdewar Rugnalaya. Data were retrieved from medical records. We used sterile water as an irrigation fluid in TURP procedures. We had performed pre and post-operative electrolyte level, weight of prostate, amount of irrigation fluid used. Results: 76 subjects, the mean age was 70.77 years and the mean weight of the prostate was 47.56 grams. No significant change in levels of Sodium, Potassium and chloride noted post operatively (mean changes in electrolytes are Na+-0.51, K+-0.05, CL--1.03 respectively). Conclusion: Serum electrolyte levels were not significantly changes after surgery.

Diagnosis and management of cases with deep infiltrating endometriosis affecting the urinary tract

Objective: The goal of this paper is to present the management of cases of deep endometriosis that affects the bladder, the ureters and the kidney. Materials and method: In this review we analyzed the sensitivity and specificity of imaging techniques for diagnosing deep infiltrating endometriosis, the optimal surgical technique and the surgical approach. Results: In patients with pelvic endometriosis in advanced stages the urinary tract is frequently involved. Preoperative work-up of patients with deep infiltrating endometriosis is aimed at evaluating the extension of the lesions in order to assess the complexity of the intervention and to choose the optimal approach. Conclusions: Laparoscopic and robotic management of these cases are good therapeutic alternatives. Ultrasound, sonovaginography with gel and MRI are useful imaging techniques for evaluating patients with deep infiltrating endometriois. The surgical management of patients with deep infiltrating endometriosis that involves the urinary tract consists of partial bladder resections, ureterolysis, ureteral resection and anastomosis and ureteral reimplantation.

Parametrial endometriosis with ureteral involvement: A case report of a conservative approach without ureteral resection

Introduction: Parametrial endometriosis could often involve the ureter and periureteral tissue causing hydronephrosis and distortion of the normal ureteral course and position. The treatment in the case of hydronephrosis could be ureterolysis (with or without the positioning of a stent) or a ureteral resection. Materials and methods: This is the case of left parametrial endometriosis with hydronephrosis in a young woman. The preoperative work-up showed a deep infiltrating endometriosis of the left parametria, the left uterosacral ligament, and the left ureter which caused hydronephrosis. The patient was symptomatic (dysmenorrhea, dysuria, and pelvic pain). In this video, we focused on ureterolysis: all the endometriotic tissues were removed, the ureter was completely released, and the decision was to place a stent in the ureter without ureteral resection. Results: The post-operative course was normal, the stent was changed after 1 week (from mono-J to double-J) and removed 1 month after surgery. Follow-up at 3 and 8 months after stent removal was normal, and renal function was normal. The last follow-up, after 13 months, showed no hydronephrosis, no signs of deep infiltrating endometriosis, and normal renal function. The patient continues with oral contraception. Conclusion: Ureterolysis could be an effective alternative to ureteral resection in cases of deep infiltrating endometriosis even when the ureter is involved with hydronephrosis.

P189 - Termino-terminal ureteral anastomosis vs segmental resection of distal pelvic ureter with bladder cuff removal and ureteral reimplantation for urothelial carcinoma of the ureter: A multicenter study

P189 - Termino-terminal ureteral anastomosis vs segmental resection of distal pelvic ureter with bladder cuff removal and ureteral reimplantation for urothelial carcinoma of the ureter: A multicenter study

Лапароскопическая сегментарная уретерэктомия с заместительной кишечной пластикой при уротелиальной карциноме мочеточника

Ureteral resection for the mid-ureter urothelial carcinoma is the operation of choice in patients with low-grade tumors. However, extensive excision within normal tissues may lead to difficulty in appropriate apposition of the ends of the ureter, while incomplete resection increases the risk of oncological progression. This article describes the first experience with laparoscopic segmental ureteral resection with the ileal - ureter substitution for mid-ureter urothelial carcinoma. In this case, a short non-reconfigurated segment of the ileum was interposed between the distal and proximal ends of the resected ureter. Operative time was 230 min, and blood loss was less than 100 ml. No complications were observed. The patients postoperative hospital stay was seven days. Follow-up examination 12 months after surgery showed no evidence of the disease progression and preserved normal renal function. The proposed method may be considered as an alternative treatment for carefully selected patients.

Patterns of complications following urinary tract reconstruction after multivisceral surgery in colorectal and anal cancer

BackgroundMulti-visceral resection, including parts of the urinary tract, is sometimes warranted to achieve cancer clear resection margins and optimize survival in patients with locally advanced colorectal and anal cancer. The aim of this study was to assess morbidity after urinary tract reconstruction dictated by colorectal and anal malignancy and to identify potential predictors of urological complications. MethodsAll patients undergoing surgery for colorectal or anal malignancy, including urinary tract resection and synchronous reconstruction, performed at the Karolinska University Hospital during 2004–2015 were included in this retrospective cohort study. Data was collected from medical records with follow-up until at least one year after the index surgery. Complications were graded according to the Clavien-Dindo classification system of surgical complications. ResultsThe study included 189 patients; 121 underwent cystectomy and 68 partial ureter resection. The rate of high grade urological complications was 22%. The risk of major urological complications was significantly higher in patients subjected to ureter resection compared to after cystectomy (OR 2.60, 95% CI 1.23–5.49). Also, preoperative radiotherapy and intestinal anastomotic dehiscence significantly increased the risk of high grade urological complications. ConclusionTo achieve potentially curative resections with uninvolved margins in patients with locally advanced colorectal and anal cancer, multi-visceral resection including urinary tract reconstruction can be performed with reasonable morbidity.