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1.
Acta Cir Bras ; 39: e397524, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39383422

RESUMO

PURPOSE: To histologically quantify the different tissues that make up the porcine ureter, (epithelial, connective, and muscular tissue) in the three segments labelled: cranial, middle and caudal, in order to identify the segment most compatible for use as a vascular graft. METHODS: Fifteen porcine ureters were collected, divided into the three segments, and the samples were stained with hematoxylin and eosin, picrosirius red and Weigert's resorcin-fuchsin. The immunohistochemistry technique was applied for alpha-smooth muscle actin. Collagen fibers, muscle, epithelium, and elastic fibers tissue were quantified, in the entire ureter, and divided into hemispheres, comparing the different segments. RESULTS: When comparing hemisphere segments, significant differences were observed (p < 0.01) for collagen and muscle tissue, with the cranial segment presenting the greatest amount of these components when compared to the middle and caudal. No significant difference was observed between the segments when comparing the entire ureters. CONCLUSIONS: After comparing the segments by hemisphere, the cranial segment presented a slight advantage for use as a vascular graft due to presenting greater collagen fiber content.


Assuntos
Colágeno , Ureter , Animais , Ureter/anatomia & histologia , Ureter/cirurgia , Suínos , Colágeno/análise , Imuno-Histoquímica , Prótese Vascular , Xenoenxertos , Tecido Elástico/anatomia & histologia
2.
BMC Surg ; 24(1): 300, 2024 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-39385157

RESUMO

OBJECTIVE: To evaluate the feasibility, safety and efficacy of robot-assisted laparoscopic modified ureteroplasty using a lingual mucosa graft (LMG) or an appendiceal flap (AF) for complex ureteral strictures and summarize our experience. METHODS: A total of 16 patients with complex ureteral strictures (range: 1.5-5 cm) who underwent robotic-assisted laparoscopic-modified ureteroplasty and were admitted to our hospital from May 2022-October 2023 were retrospectively analyzed. We used modified presuture methods in patients who needed the posteriorly augmented anastomotic technique to reduce anastomotic tension. Perioperative variables and outcomes were recorded for each patient. RESULTS: The operation under robot-assisted laparoscopy was successfully performed in all sixteen patients (12 with LMG ureteroplasty and 4 with AF ureteroplasty) without conversion to open surgery. The mean length of the ureteral structure was 2.90 ± 0.90 cm (range: 1.5-5 cm), the mean operation duration was 209.69 ± 26.74 min (range: 170-255 min), the median estimated blood loss was 75 (62.5) ml (range: 50-200 ml), and the duration of postoperative hospitalization was 10.44 ± 2.10 d (range: 7-14 d). The follow-up time in this group was 6 ~ 21 months. The success rate of the surgery was 100%. CONCLUSION: Robot-assisted laparoscopic modified ureteroplasty using AF or LMG is a safe and feasible operation for complex ureteral strictures and deserves to be popularized.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Ureter , Obstrução Ureteral , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Laparoscopia/métodos , Adulto , Procedimentos Cirúrgicos Robóticos/métodos , Obstrução Ureteral/cirurgia , Ureter/cirurgia , Retalhos Cirúrgicos , Estudos de Viabilidade , Procedimentos Cirúrgicos Urológicos/métodos , Mucosa Bucal/transplante , Apêndice/cirurgia , Constrição Patológica/cirurgia , Constrição Patológica/etiologia , Resultado do Tratamento , Idoso
3.
BMC Urol ; 24(1): 220, 2024 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-39385156

RESUMO

OBJECTIVE: The Ureteral Access Sheath (UAS) has notable benefits but may fail to traverse the ureter in some cases. Our objective was to develop and validate a dynamic online nomogram for patients with ureteral stones who experienced UAS placement failure during retrograde intrarenal surgery (RIRS). METHODS: This study is a retrospective cohort analysis using medical records from the Second Hospital of Tianjin Medical University. We reviewed the records of patients with ureteral stones who underwent RIRS in 2022 to identify risk factors associated with UAS placement failure. Lasso combined logistic regression was utilized to identify independent risk factors associated with unsuccessful UAS placement in individuals with ureteral stones. Subsequently, a nomogram model was developed to predict the likelihood of failed UAS placement in this patient cohort. The model's performance was assessed through Receiver Operating Characteristic Curve (ROC) analysis, calibration curve assessment, and Decision Curve Analysis (DCA). RESULTS: Significant independent risk factors for unsuccessful UAS placement in patients with ureteral stones included age (OR = 0.95, P < 0.001), male gender (OR = 2.15, P = 0.017), body mass index (BMI) (OR = 1.12, P < 0.001), history of stone evacuation (OR = 0.35, P = 0.014), and ureteral stone diameter (OR = 0.23, P < 0.001). A nomogram was constructed based on these variables. Model validation demonstrated an area under the ROC curve of 0.789, indicating good discrimination. The calibration curve exhibited strong agreement, and the decision curve analysis revealed a favorable net clinical benefit for the model. CONCLUSIONS: Young age, male sex, high BMI, no history of stone evacuation, and small diameter of ureteral stones were independent risk factors for failure of UAS placement in patients with ureteral stones, and the dynamic nomogram established with these 5 factors was clinically effective in predicting the outcome of UAS placement.


Assuntos
Nomogramas , Falha de Tratamento , Cálculos Ureterais , Humanos , Cálculos Ureterais/cirurgia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Estudos de Coortes , Fatores de Risco , Ureter/cirurgia
4.
J Robot Surg ; 18(1): 361, 2024 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-39367889

RESUMO

The objective is to demonstrate that omitting ureteral stent placement in robotic intracorporeal urinary diversion does not lead to increased risk of perioperative complications, namely ureteral strictures or anastomotic leaks. We retrospectively reviewed the records of 68 consecutive patients who underwent robotic radical cystectomy with ileal conduit creation or orthotopic neobladder by a single surgeon between January 2020 and September 2023. Chronologically, the first cohort of patients had ureteral stents placed to bridge the ureteroenteric anastomosis, and in the second cohort, stenting was omitted. Cohort 1 consisted of 28 patients with surgeries performed between January 2020 and April 2021, while cohort 2 had 40 patients who underwent surgery from April 2021 to September 2023. The cohorts were well matched with regard to patient age, gender, ASA score and rate of neoadjuvant chemotherapy. The choice of urinary diversion was left to surgeon and patient preference, and there was no significant difference in the proportion of ileal conduits versus orthotopic neobladders within each cohort. Estimated blood loss, total operative time, inpatient length of stay and pathologic T and N staging did not statistically differ between the cohorts. Overall, there was no difference in the rates of postoperative ileus, ureteral stricture, anastomotic leak, infectious complications, and 30-day readmission rates between the groups. Tubeless ureteroenteric anastomosis in patients undergoing robotic radical cystectomy with intracorporeal diversion does not appear to increase the risk of anastomotic strictures or postoperative complications. Further prospective evaluation is warranted.


Assuntos
Anastomose Cirúrgica , Cistectomia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos , Ureter , Derivação Urinária , Humanos , Cistectomia/métodos , Cistectomia/efeitos adversos , Derivação Urinária/métodos , Derivação Urinária/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Masculino , Feminino , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/efeitos adversos , Estudos Retrospectivos , Pessoa de Meia-Idade , Constrição Patológica/etiologia , Idoso , Ureter/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Stents , Fístula Anastomótica/etiologia , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/prevenção & controle
5.
Beijing Da Xue Xue Bao Yi Xue Ban ; 56(5): 919-922, 2024 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-39397475

RESUMO

To investigate the initial experience of coated metal ureteral stent (CMUS) for treatment of pelvic lipomatosis induced hydronephrosis (PLH). The clinical and follow-up data of 8 patients who were diagnosed as PLH treated with CMUS in Peking University People's Hospital from August 2018 to February 2021 were retrospectively analyzed. Inclusion criteria included: Imaging evidence of excessive adipose tissue around the bladder in the pelvic cavity, bladder elevation in an "inverted pear shape", and bladder wall thickening; Cystoscopy indicated follicular hyperplasia of bladder mucosa and biopsy pathology indicated glandular cystitis; Unilateral or bilateral hydronephrosis and ureteromegaly. Exclusion criteria included: Ureteral atresia; Recurrent obstruction of the bladder outlet. Preoperative baseline data included age, gender, serum creatinine, pelvis width and ureteric stent symptoms questionnaire (USSQ) score. Intraoperative data included the location and length of ureteral stenosis observed by retrograde urography. Postoperative follow-up data included serum creatinine, pelvis width, and USSQ score. In the study, 8 patients (11 sides) with PLH were all male, with an average age of (38.7±8.6) years. Unilateral hydronephrosis was found in 5 cases and bilateral hydronephrosis in 3 cases. Preoperative mean serum creatinine was (90.0±10.3) µmol/L, and the mean renal pelvis width was (3.0±1.5) cm. The lower ureteral stricture was found in all cases, and the mean stricture length was (1.9±0.9) cm. Before operation, 3 patients had ureteral Double-J stents, with USSQ scores of 97.0, 68.0 and 100.0, respectively. Five patients underwent retrograde CMUS stenting, and 3 patients retrograde and antegrade. At the last follow-up, the average serum creatinine was (82.0±11.1) µmol/L and the mean renal pelvis width was (1.9±0.5) cm, which were significantly lower than those before operation (t=3.12, P=0.02; t=3.23, P=0.02). In the 3 patients with Double-J stent before surgery, the USSQ scores were 87.0, 62.0 and 89.0, respectively, which were significantly improved after CMUS stenting. The average follow-up time was (10.0±6.3) months. During the follow-up, 1 patient developed CMUS related symptoms, and no stent-associated infection and stent encrustation were found. In one case, the stent migrated to the bladder 3 months after operation, and the hydronephrosis disappeared after 3 months follow-up. CMUS stenting for treatment of PLH has certain efficacy and safety, which can explore a new therapeutic method for the long-term treatment of PLH.


Assuntos
Hidronefrose , Lipomatose , Stents , Ureter , Humanos , Hidronefrose/etiologia , Masculino , Adulto , Estudos Retrospectivos , Ureter/cirurgia , Lipomatose/complicações , Lipomatose/cirurgia , Obstrução Ureteral/cirurgia , Obstrução Ureteral/etiologia , Doenças da Bexiga Urinária
6.
World J Urol ; 42(1): 568, 2024 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-39379730

RESUMO

PURPOSE: The aim of the present study is to assess the role of indocyanine green (ICG) to evaluate distal ureteral vascularity during robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion and its impact on the incidence of benign ureteroenteric strictures (UES). METHODS: The study included patients who underwent RARC for bladder cancer between 2018 and 2023. All patients included underwent intracorporeal urinary diversion with ileal conduit or neobladder. Bricker technique was performed in all ureteroenteric anastomosis. ICG was employed during the study period to evaluate ureteral vascularity. We divided patients into 2 groups depending on the utilization of ICG during surgery and compared demographic, clinicopathological and perioperative outcomes, including benign UES rates. RESULTS: We identified 221 patients that underwent RARC with intracorporeal urinary diversion. Ileal conduit was performed in 173 (78.3%) patients and neobladder in 48 (21.7%) cases. A total of 142 (64.3%) and 79 (35.7%) patients were in the non-ICG and ICG group, respectively. With a median follow-up of the entire cohort of 21.1 months, there were no differences in the rate of benign UES after RARC between the non-ICG and the ICG group (p = 0.901). In the non-ICG group, 26 (18.3%) patients developed benign UES and in the ICG group 15 (19.0%) patients. Most of the strictures appeared in the left ureter in both groups (80.8% non-ICG vs. 66.7% ICG, p = 0.599). Median time to stricture diagnosis was 4 months (IQR 3-7.25) for the non-ICG and 3 months (IQR 2-5) for the ICG group (p = 0.091). The ICG group had a slightly greater length of ureter resected compared with the non-ICG group (1.5 vs. 1.3 cm, p = 0.007). CONCLUSION: In our experience, choosing to use ICG intraoperatively to evaluate distal ureteral vascularity may not reduce the rate of benign UES after robot-assisted radical cystectomy with intracorporeal urinary diversion and Bricker ureteroileal anastomosis.


Assuntos
Cistectomia , Verde de Indocianina , Procedimentos Cirúrgicos Robóticos , Ureter , Neoplasias da Bexiga Urinária , Derivação Urinária , Humanos , Derivação Urinária/métodos , Cistectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Ureter/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Corantes , Constrição Patológica/etiologia
7.
J Robot Surg ; 18(1): 371, 2024 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-39412617

RESUMO

Even if vesicoureteral reflux is a common condition in children, there are no guidelines about the best therapeutic approach. This study aims to compare the results of endoscopic injection and ureteral reimplantation in children with grade III, IV and V VUR. A multicenter retrospective study included children with grade III, IV and V VUR treated from 2003 to 2018 at three Departments of Pediatric Surgery. Patients were divided into Group A (endoscopic injections) and Group B (anti-reflux surgery), B1 (open, OUR), B2 (laparoscopic, LUR) and B3 (robot-assisted laparoscopic RALUR). Follow-up was at least 5 years. 400 patients were included, 232 (58%) in group A and 168 (42%) in group B. Mean age at surgery was 38.6 months [3.1-218.7]. Mean follow-up was 177.8 months [60-240]. Group A had shorter operative time than group B (P < 0.01); lower analgesic requirement (p < 0.05), shorter hospital stay (P < 0.05) and lower overall costs (p < 0.05), but higher postoperative PNPs (p < 0.01), lower success rate (p < 0.01) and higher redo-surgery percentage (p < 0.01). No differences in terms of postoperative complications, success rate and mean radiation exposure between the two groups. Endoscopy is associated with shorter operative time, shorter hospitalization and lower cost, also in case of multiple injections. Recurrence rate after surgery is lower meaning lower rate of re-hospitalization and radiation exposure for children.


Assuntos
Análise Custo-Benefício , Procedimentos Cirúrgicos Robóticos , Refluxo Vesicoureteral , Humanos , Refluxo Vesicoureteral/cirurgia , Refluxo Vesicoureteral/economia , Masculino , Feminino , Estudos Retrospectivos , Pré-Escolar , Criança , Lactente , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Adolescente , Tempo de Internação , Reimplante/economia , Reimplante/métodos , Ureter/cirurgia , Duração da Cirurgia , Laparoscopia/métodos , Laparoscopia/economia , Endoscopia/métodos , Endoscopia/economia , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/economia , Injeções , Dextranos/administração & dosagem , Dextranos/economia
8.
Int Braz J Urol ; 50(6): 781-782, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39226447

RESUMO

PURPOSE: Ureteroplasty using buccal or lingual mucosa graft Is feasible for complex proximal ureteral stricture (1, 2). Ileal ureter replacement is considered as the last resort for ureteral reconstruction. Totally intracorporeal robot-assisted ileal ureter replacement can be performed safely and effectively (3). In China, the KangDuo Surgical Robot 2000 Plus (KD-SR-2000 Plus) has been developed featuring two surgeon consoles and five robotic arms. This study aims to share our experience with totally intracorporeal robot-assisted bilateral ileal ureter replacement using KD-SR-2000 Plus. MATERIALS AND METHODS: A 59-year-old female patient underwent a complete intracorporeal robot-assisted bilateral ileal ureter replacement for the treatment of ureteral strictures using KD-SR-2000 Plus. The surgical procedure involved dissecting the proximal ends of the bilateral ureteral strictures, harvesting the ileal ureter, restoring intestinal continuity, and performing an anastomosis between the ileum and the ureteral end as well as the bladder. The data were prospectively collected and analyzed. RESULTS: The surgery was successfully completed with single docking without open conversion. The length of the harvested ileal ureter was 25 cm. The docking time, operation time and console time were 3.4 min., 271 min and 231 min respectively. The estimated blood loss was 50 mL. The postoperative hospitalization was 6 days. No perioperative complications occurred. CONCLUSIONS: It is technically feasible to perform totally intracorporeal robot-assisted bilateral ileal ureter replacement for the treatment of ureteral strictures using KD-SR-2000 Plus. A longer follow-up and a larger sample size are required to evaluate its safety and effectiveness.


Assuntos
Íleo , Procedimentos Cirúrgicos Robóticos , Ureter , Obstrução Ureteral , Humanos , Feminino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Íleo/cirurgia , Resultado do Tratamento , Obstrução Ureteral/cirurgia , Constrição Patológica/cirurgia , Duração da Cirurgia , Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos Urológicos/métodos
9.
J Am Anim Hosp Assoc ; 60(5): 214-218, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39235779

RESUMO

A 7 yr old female French bulldog exhibited recurrent purulent vulvar discharge following an episode of pyometra treated by ovariohysterectomy. The diagnosis of ureteral duplication was established through a combination of ultrasonography, computed tomography scanning, and cystoscopy/vaginoscopy. Despite initial medical intervention, the dog's clinical condition did not improve. Consequently, surgical treatment was pursued to remove the duplicated ureter while preserving the integrity of the urinary tract. Resection of the duplicated ureter was performed from the kidney to the bladder, and the blind ends left in place in the kidney and in the bladder wall were omentalized. Histopathological analysis confirmed the presence of the duplicated ureter. Postoperatively, the dog made a full recovery with no complications or urinary tract dysfunction. Long-term follow-up (11 mo) revealed complete resolution of all clinical signs. Ureteral duplication should be included in the differential diagnosis of vulvar purulent discharge in dogs. Removal of the abnormal ureter resulted in complete resolution of the clinical signs. This case underscores the importance of individualized treatment plans for ureteral duplications in dogs and the potential for successful surgical treatment in selected cases.


Assuntos
Doenças do Cão , Ureter , Animais , Feminino , Cães , Doenças do Cão/cirurgia , Doenças do Cão/diagnóstico , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/congênito , Ureter/anormalidades , Ureter/cirurgia , Piometra/veterinária , Piometra/cirurgia , Resultado do Tratamento
10.
World J Urol ; 42(1): 539, 2024 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-39325196

RESUMO

PURPOSE: To describe urologic complications associated with the surgical management of placenta accreta spectrum and determine their risk factors. METHODS: A retrospective study was conducted on all patients diagnosed with abnormal invasive placentation who underwent surgery and delivered between 2002 and 2023 at a single expert maternity centre. Intra-operative and post-operative complications were described, with a special focus on urologic intra-operative injuries, including vesical or ureteral injuries. Univariate and multivariate analyses were performed to determine risk factors of intra-operative urologic injuries associated with placenta accreta spectrum surgical management. Additionally, using the Clavien-Dindo classification, the effects of intra-operative urologic injury and ureteral stent placement on post-operative outcome were evaluated. RESULTS: A total of 216 patients were included, of which 47 (21.48%) had an intra-operative bladder and/or ureteral injury. Placenta percreta was associated with a higher rate of intra-operative urologic injury than placenta accreta (72.34% vs. 6.38%, p < 0.001). Multivariate analyses showed that patients who had placenta percreta and bladder invasion or emergency hysterectomy were associated with more intra-operative urologic injuries (OR = 8.07, 95% CI [2.44-26.75] and OR = 3.87, 95% CI [1.09-13.72], respectively). Patients with intra-operative urologic injuries had significantly more severe post-operative complications, which corresponds to a Clavien-Dindo score of 3 or more, at 90 days (21.28% vs. 5.92%, p = 0.004). CONCLUSION: Surgical management of placenta accreta spectrum is associated with significant urologic morbidity, with a major impact on post-operative outcomes. Urologic complications seem to be correlated with the depth of invasion and the emergency of the hysterectomy.


Assuntos
Histerectomia , Complicações Intraoperatórias , Placenta Acreta , Complicações Pós-Operatórias , Doenças Urológicas , Humanos , Placenta Acreta/cirurgia , Feminino , Estudos Retrospectivos , Gravidez , Fatores de Risco , Adulto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Doenças Urológicas/etiologia , Doenças Urológicas/cirurgia , Doenças Urológicas/epidemiologia , Histerectomia/efeitos adversos , Ureter/lesões , Ureter/cirurgia , Bexiga Urinária/lesões , Bexiga Urinária/cirurgia
11.
Sci Rep ; 14(1): 21958, 2024 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-39304702

RESUMO

Ureteral obstruction is a prevalent urological condition associated with significant complications. The purpose of our study was to assess the safety and efficacy of a novel self-expanding, large caliber, biocompatible polymer-coated ureteral stent (Allium) for the treatment of ureteral obstructions. We conducted a retrospective analysis of data from patients who underwent Allium ureteral stent placement at our institute between November 2018 and May 2023. Demographic, clinical, and perioperative parameters were collected and analyzed. Logistic regression analyses were performed to identify preoperative factors predicting Allium stent migration. The study cohort comprised 30 patients who received a total of 40 successfully implanted Allium stents. No significant adverse events related to the insertion procedure were observed. During a median follow-up period of 29 months (range: 1-60 months), migration occurred in 11 (27.5%) stents while encrustation was noted in 8 (20%) stents. The median functional duration of the Allium stents was found to be 22 months (range:1-60 months), with an overall functioning rate at last follow-up being recorded as 59.5%. Multivariate analysis revealed that the glomerular filtration rate of the ipsilateral kidney was the sole risk factor predictive of Allium stent migration. With its minimal invasiveness and good tolerability, the Allium stent represents a safe and viable management option for treating ureteric obstructions; however, it should not be considered as definitive treatment but rather as an alternative option for patients unwilling or unsuitable for definitive treatment, particularly high-risk individuals or elderly patients exhibiting decreased ipsilateral glomerular filtration rates.


Assuntos
Stents , Obstrução Ureteral , Humanos , Obstrução Ureteral/terapia , Obstrução Ureteral/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Stents/efeitos adversos , Idoso , Estudos Retrospectivos , Resultado do Tratamento , Adulto , Ureter/cirurgia , Idoso de 80 Anos ou mais , Seguimentos , Taxa de Filtração Glomerular
12.
J Robot Surg ; 18(1): 354, 2024 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-39340614

RESUMO

As robot-assisted laparoscopic techniques continue to advance, becoming increasingly complex and refined, there has been significant progress in the minimally invasive treatment of ureteral strictures. This abstract aims to provide an overview and description of various surgical techniques that utilize robots for repairing ureteral strictures. We have summarized the progression of these surgical methods and highlighted the latest advancements in the procedures. When compared to open surgery, robot-assisted reconstruction techniques demonstrate superior functional outcomes, fewer postoperative complications, and a faster recovery in the treatment of ureteral strictures. This abstract aims to provide an overview and description of various surgical techniques utilizing robots to repair ureteral strictures. Robotic ureteral stricture correction has emerged as a valuable therapeutic option, particularly when endoscopic procedures are not feasible. Compared to traditional open surgery, robotic methods exhibit superior therapeutic effectiveness, fewer postoperative complications, and accelerated recovery. Reconstructive procedures such as reimplantation, psoas hitch, Boari flap, ureter-to-ureter anastomosis, appendix graft, buccal mucosa graft (BMG), ileal transplantation, or kidney autotransplantation can be performed depending on the extent and location of the stricture. Robotic surgical techniques also offer advantages, such as an expanded field of vision and the incorporation of supplementary technologies such as FireflyTM, indocyanine green (ICG), and near-infrared fluorescence (NIRF) imaging. However, further long-term, multicenter investigations are necessary to validate the positive findings reported in existing case series. Compared with open surgery, robot-assisted reconstruction techniques yield superior functional outcomes, fewer postoperative complications, and accelerated recovery for the treatment of ureteral strictures.


Assuntos
Procedimentos Cirúrgicos Robóticos , Ureter , Obstrução Ureteral , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Constrição Patológica/cirurgia , Obstrução Ureteral/cirurgia , Ureter/cirurgia , Complicações Pós-Operatórias , Procedimentos de Cirurgia Plástica/métodos , Anastomose Cirúrgica/métodos , Laparoscopia/métodos , Mucosa Bucal/cirurgia , Apêndice/cirurgia , Transplante de Rim/métodos , Íleo/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos , Reimplante/métodos
13.
Arch Esp Urol ; 77(7): 805-810, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39238306

RESUMO

OBJECTIVE: Currently, the factors influencing poor drainage of ureteral stents after radical cystectomy with cutaneous ureterostomy are still unclear. Therefore, the aim of this study was to determine the risk factors for poor drainage of ureteral stents after radical cystectomy with cutaneous ureterostomy and to provide evidence for the prevention of this complication. METHODS: This retrospective study included 86 patients who underwent periodic replacement of ureteral stents following radical cystectomy with cutaneous ureterostomy between October 2017 and March 2024. The general data and related indicators of the patients were collected, the risk factors were identified through univariate and multivariate logistic regression analyses, and corresponding interventions were proposed. RESULTS: Among the 86 patients, 26 had poor drainage of ureteral stents, with an incidence rate of 30.23%, and no serious consequences occurred after timely and effective treatment. Univariate and multivariate logistic regression analyses revealed that body mass index (BMI) (p = 0.003, odds ratio (OR) = 2.909, 95% CI: 1.435-5.898), diabetes mellitus (p = 0.012, OR = 14.073, 95% CI: 1.770-111.889), urinary tract infection (p = 0.004, OR = 16.792, 95% CI: 2.402-117.411), and foreign body blockage (p = 0.048, OR = 5.277, 95% CI: 1.012-27.512) were independent risk factors for poor drainage of ureteral stents. CONCLUSIONS: The incidence of poor drainage of ureteral stents after radical cystectomy with cutaneous ureterostomy is relatively high. Maintenance of a healthy weight, strict management of blood glucose levels, active prevention of urinary tract infections, and timely detection and removal of small foreign bodies that may be present are essential to prevent this complication.


Assuntos
Cistectomia , Drenagem , Complicações Pós-Operatórias , Stents , Ureterostomia , Humanos , Estudos Retrospectivos , Cistectomia/métodos , Cistectomia/efeitos adversos , Masculino , Stents/efeitos adversos , Feminino , Ureterostomia/métodos , Fatores de Risco , Idoso , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Pessoa de Meia-Idade , Ureter/cirurgia
15.
Cancer Med ; 13(17): e70229, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39267462

RESUMO

BACKGROUND: Benign uretero-ileal anastomotic stricture (UIAS) is a potentially serious complication that can arise after radical cystectomy (RC) and subsequent urinary diversion. To preserve residual renal function and improve prognosis, it is crucial to derive insights from experience and tailor individualized treatment strategies for different patients. PATIENTS AND METHODS: From October 2014 to June 2021, a total of 47 patients with benign UIAS underwent endoscopic management (n = 19) or reimplantation surgery (n = 28). The basic data, perioperative conditions, and postoperative outcomes of the two groups were compared and analyzed to evaluate efficacy. RESULTS: Comparing preoperative and postoperative clinical efficacy within the same group, the endoscopic group showed no significant differences in creatinine and blood urea nitrogen (BUN) levels before surgery or after extubation (p > 0.05). However, significant differences were observed in glomerular filtration rate (GFR) levels on the affected side before surgery and after extubation (p < 0.05). In contrast, the laparoscopic reimplantation group did not exhibit significant differences in creatinine, BUN, or GFR levels of affected side before surgery and after extubation (p > 0.05). Postoperative clinical efficacy showed no significant difference in creatinine and BUN levels between the two groups (p > 0.05). However, GFR values of affected side in the endoscopic treatment group decreased more than those in the laparoscopic reimplantation group (p < 0.05). Additionally, the laparoscopic reimplantation group was able to remove the single-J tube earlier than the endoscopic treatment group (p < 0.05), had a lower recurrence rate of hydronephrosis after extubation (p < 0.05), and experienced a later onset of hydronephrosis compared to the endoscopic treatment group (p < 0.05). CONCLUSIONS: Based on our experience in treating UIAS following RC combined with urinary diversion, laparoscopic reimplantation effectively addresses the issue of UIAS, allowing for the removal of the ureteral stent relatively soon after surgery. This approach maintains long-term ureteral patency, preserves residual renal function, reduces the risk of ureteral restenosis and hydronephrosis, and has demonstrated superior therapeutic outcomes in this study.


Assuntos
Anastomose Cirúrgica , Cistectomia , Complicações Pós-Operatórias , Ureter , Derivação Urinária , Humanos , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos , Cistectomia/efeitos adversos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Anastomose Cirúrgica/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Ureter/cirurgia , Taxa de Filtração Glomerular , Íleo/cirurgia , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/cirurgia , Resultado do Tratamento , Creatinina/sangue , Laparoscopia/efeitos adversos , Obstrução Ureteral/cirurgia , Obstrução Ureteral/etiologia
16.
World J Urol ; 42(1): 524, 2024 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-39276215

RESUMO

PURPOSE: Aim of this study is to summarize medical device reports (MDRs) between 2012 and 2022 relating to ureteral stents within the Manufacturer and User Facility Device Experience (MAUDE) database maintained by The Food and Drug Administration (FDA). METHODS: MAUDE was analyzed for all MDRs relating to each FDA-approved ureteral stent. Event descriptions were reviewed and characterized into specific event types. Outcome measures include specific ureteral stent and reported events as detailed by the MDRs. Data is presented as number of specific event/total events. Pooled Relative risk was used to compare data. RESULTS: 2652 reports were retrieved in 10 years and a progressive rise in reported events was recorded. 831/2652 (31%) were reported as injury while 1810/2652 (68%) as malfunction of the ureteral stent and 4 events of death. The most frequently reported adverse events (AEs) were stent break (627/2652: 23%); material problems (384/2652: 14%); calcification (222/2652: 8%); difficulty to insert, advance or remove the device (155/2652: 6%). Bard stents were associated with most material problems (19%), Resonance stents were associated with most difficulty to insert, advance or remove the device (9%) and calcification (15%) while filiform double pigtail stent set were associated with most breakage reports (56%) when compared to the other stents (PRR > 1, p < 0,05). CONCLUSIONS: According to MAUDE database the most frequent complications related to ureteral stents are breakage, material problems, calcification and difficulty to insert/advance/remove the device. As well Resonance ureteral stents seem to be associated with a higher risk of device problems.


Assuntos
Bases de Dados Factuais , Stents , United States Food and Drug Administration , Ureter , Stents/efeitos adversos , Humanos , Estados Unidos/epidemiologia , Ureter/cirurgia , Incidência , Falha de Prótese , Falha de Equipamento/estatística & dados numéricos , Vigilância de Produtos Comercializados
17.
Taiwan J Obstet Gynecol ; 63(5): 777-780, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39266165

RESUMO

OBJECTIVE: Our objective was to propose a laparoscopic modified simple ureteroneocystostomy for repairing iatrogenic ureteral injuries. In laparoscopic modified simple ureteroneocystostomy, the highest point of the bladder was found by cystoscopy, then we implanted a "fish mouth" ureter end into the bladder, leaving at least 1 cm of ureter end in the bladder as an anti-reflux procedure. CASE REPORT: We retrospectively reviewed a case series of lower third iatrogenic ureter injury during gynecology surgery of 11 patients who received laparoscopic modified simple ureteroneocystostomy at Da Lin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, from January 2011 to December 2020. One patient needs percutaneous nephrotomy due to infection and had the ureteroneocystostomy two months later. No obstruction, ureter stenosis/stricture, bladder leakage or other renal complications were noted after repair. CONCLUSION: Laparoscopic modified simple ureteroneocystostomy is technically feasible for repairing lower third ureter injuries, with no major complications.


Assuntos
Cistostomia , Doença Iatrogênica , Laparoscopia , Ureter , Humanos , Feminino , Ureter/lesões , Ureter/cirurgia , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Estudos Retrospectivos , Adulto , Cistostomia/métodos , Cistostomia/efeitos adversos , Pessoa de Meia-Idade , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos
18.
World J Urol ; 42(1): 528, 2024 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-39302463

RESUMO

OBJECTIVE: The management of long-segment ureteral stenosis has posed a significant challenge for urologists. Ureteroplasty with oral mucosal graft has emerged as an effective approach for treating long-segment ureteral stenosis and defects. A key step in replacement repair surgery involves suturing the surrounding tissue with an adequate blood supply around the reconstructed ureter. The current study aims to evaluate the potential practical application of the "perinephric fat wrapping" technique in laparoscopic ureteroplasty with oral mucosal graft. METHODS: Between July 2018 and February 2023, 26 patients with ureteral stenosis underwent laparoscopic ureteroplasty with oral mucosal graft at the Second Affiliated Hospital of Anhui Medical University. We used traditional omental wrapping technique (OW group) or perinephric fat wrapping technique (PFW group) to enhance ureter repair. Perioperative and follow-up data for both groups were collected retrospectively and compared. RESULTS: There were 10 patients in OW group, including 4 males and 6 females, with BMI of 23.5±2.8 kg/m2 and stenosis length of 3.6±1.6 cm. There were 16 patients in the PFW group, including 10 males and 6 females, with a BMI of 26.1±3.3 kg/m2 and a median stenosis length of 2.3 cm (range, 1.2~6.0 cm). The operation of both groups was successfully completed, and no serious complications occurred during the operation. The mean operating time (OT) in the OW group was 200.6±41.9 min, the estimated amount of blood loss (EBL) was 25 ml (range, 10~30ml), and the median length of postoperative hospital stay (LHS) was 7.5 days (range 4.0~14.0 days). In the PFW group, the mean operating time (OT) was 211.9±38.3 min, the estimated blood loss (EBL) was 25 ml (range, 5~150ml), and the postoperative hospital stay (LHS) was 6.8±2.0 d. There was no significant difference between the two groups in the above indexes. Postoperative anal exhaust time was 1.0 d (range, 1.0~2.5d) in the PFW group and 1.9±0.5 d in the OW group, with significant difference between the two groups (P=0.009). The mean follow-up time was 36.8±15.9 months, and there was no significant difference between OW group and PFW group in the curative effect of operation. CONCLUSION: Perinephric fat wrapping technique not only avoids the potential effects of using omentum on abdominal organs, it is also as safe and effective as omentum wrapping technique in repairing and reconstructing the ureter using oral mucosal grafts.


Assuntos
Mucosa Bucal , Procedimentos de Cirurgia Plástica , Ureter , Obstrução Ureteral , Procedimentos Cirúrgicos Urológicos , Humanos , Masculino , Feminino , Mucosa Bucal/transplante , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos/métodos , Pessoa de Meia-Idade , Ureter/cirurgia , Adulto , Obstrução Ureteral/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Tecido Adiposo/transplante , Laparoscopia/métodos
19.
World J Urol ; 42(1): 533, 2024 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-39302474

RESUMO

PURPOSE: To develop a novel adaptation of the Whitaker test for assessing the surgical effects of ileal ureter replacement (IUR), and to evaluate its feasibility and effect in the postoperative evaluation. PATIENTS AND METHODS: From November 2021 to September 2023, patients undergoing the modified Whitaker test following IUR were prospectively enrolled. The relative pressure was defined as the pelvis pressure minus the bladder pressure. Successful nephrostomy removal was defined as absence of symptoms and improved or stable hydronephrosis. RESULTS: The 51 ureters from 39 patients underwent the modified Whitaker test after IUR. The modified Whitaker test was performed successfully on all patients without any reported discomfort. The relative pressure of 47 ureters kept steady (< 15 cmH2O) throughout the examination with well ileal ureter peristalsis and was classified into type I. The relative pressure of 2 ureters increased with perfusion reaching a range of 15-22 cmH2O, with well ileal ureteral peristalsis observed (type II). The relative pressure of 2 ureters increased along with perfusion, with weakening of ileal ureter peristalsis or a leakage of contrast medium, and the relative pressure surpassed 22 cmH2O (type III). Nephrostomy tubes were promptly removed for type I and type II ureters, while removal for type III ureters occurred after a 2-month period. None of the 39 patients required additional interventions for recurrent obstruction. CONCLUSION: The modified Whitaker test was a safe and effective approach for the evaluation of surgical effects of IUR, offering additional evidence to assess the safety of nephrostomy tube removal.


Assuntos
Íleo , Ureter , Humanos , Ureter/cirurgia , Pessoa de Meia-Idade , Feminino , Íleo/cirurgia , Masculino , Estudos Prospectivos , Idoso , Adulto , Estudos de Viabilidade , Pressão , Técnicas de Diagnóstico Urológico
20.
Minerva Urol Nephrol ; 76(5): 606-617, 2024 10.
Artigo em Inglês | MEDLINE | ID: mdl-39320251

RESUMO

BACKGROUND: Using a large population-based dataset, we primarily sought to compare postoperative complications, health-care expenditures, and re-intervention rates between patients diagnosed with ureteropelvic junction obstruction (UPJO) undergoing stented vs. non-stented pyeloplasty. The secondary objective was to investigate factors that influence the timing of DJ stent removal. METHODS: Patients ≥18 years old with UPJO treated with primary open or minimally-invasive pyeloplasty were identified using the Merative™ Marketscan® Databases between 2007-2021. Multivariable modeling was implemented to investigate the association between Double-J (DJ) stent placement and post-pyeloplasty complications, hospital costs, and re-intervention rates and the role of the perioperative predictors on time to DJ stent removal. Subgroup analyses stratified by ureteral stenting duration were additionally performed. RESULTS: Out of 4872 patients who underwent primary pyeloplasty, 4154 (85.3%) had DJ placement. Postoperative complications were rare (N.=218, 4.47%) and not associated with ureteral stenting (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.55-1.12). The median cost for in-hospital charges was $21,775, with DJ stent placement independently increasing the median aggregate amount (OR: 1.29, 95% CI: 1.09-1.53). Overall, re-interventions were performed in 21.18% of patients, with DJ stenting found to be protective (OR: 0.79, 95% CI: 0.66-0.96). Higher Charlson Comorbidity Index, longer hospital stay, and open surgical approach were independent predictors for prolonged DJ stenting time to removal. CONCLUSIONS: Our study suggests that patients undergoing stent-less pyeloplasty did have a higher rate of secondary procedures, but not higher complications when compared to those undergoing stented procedures. Concurrently, the non-stented approach is associated with decreased health-care expenditures, despite the increased rates of secondary procedures.


Assuntos
Remoção de Dispositivo , Pelve Renal , Complicações Pós-Operatórias , Reoperação , Stents , Obstrução Ureteral , Procedimentos Cirúrgicos Urológicos , Humanos , Obstrução Ureteral/cirurgia , Obstrução Ureteral/economia , Masculino , Feminino , Stents/economia , Stents/efeitos adversos , Estados Unidos/epidemiologia , Adulto , Remoção de Dispositivo/economia , Remoção de Dispositivo/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/economia , Pelve Renal/cirurgia , Reoperação/economia , Reoperação/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos/economia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos , Custos de Cuidados de Saúde/estatística & dados numéricos , Ureter/cirurgia , Fatores de Tempo , Estudos Retrospectivos , Adulto Jovem , Idoso , Revisão da Utilização de Seguros
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