[Laparoendoscopic single site (LESS) ureteral reimplantation.] / Reimplante ureteral laparoscópico por puerto único.

OBJECTIVE: To present in detail our surgical technique and to show our initial experience with ureteral reimplantation using the transumbilical LESS approach to treat patients with ureteral stenosis secondary to various diseases and surgical complications. METHODS: We performed 7 ureteral reimplantations from February 2012, using the multichannel Richard- Wolf (KeyPort) platform placed transumbilical by a small 2-2,5 cm transversal incision. We always use a 3.5 mm minilaparoscopy accessory trocar in the right iliac fossa, that is crucial to perform the laparoscopic suturing safely for the patient and in an optimal time. The etiology of ureteral lesions was: 1 endometriosis, 1 symptomatic ureterocele not responding to endoscopic treatment, 1 ureteral lesion after ureteroscopy for lithiasis, 1 ureteral lesion after radical prostatectomy and 3 gynecologic iatrogenic lesions (1 laparoscopically assisted vaginal hysterectomy, 2 radical hysterectomies with double anexectomy for cervix carcinoma). 5 ureteral reimplantations were left and 2 right sides. Before surgery, 5 patients had nephrostomy tubes inserted and the patient with endometriosis had a double J catheter. The patient with ureterocele did not require urinary diversion before the operation and endoscopic intraoperative catheterization was not feasible. RESULTS: We present the operative and postoperative results of the patients undergoing surgery. They had a mean age of 49.3 [28-78] years. Mean intraoperative estimated blood loss was 132.1 [100-250] ml, with no transfusions required. Mean operative time was 127.4 [120-210] minutes, with no conversions to laparoscopic or open surgery required. Mean hospital stay was 2.1 [2-3] days and all patients had drainage removed at 48 hours. There were minor Clavien-Dindo complications in one patient presenting urinary tract infection 10 days after the operation. All patients had double J catheters that were removed with a mean of 34.3 [30-45] days. Mean time for bladder catheter removal was 7.8 [7-10] días. With a mean follow up of 32.6 [14-54] months no ureteral stenosis recurrence has been observed. CONCLUSIONS: LESS ureteral reimplantation, in our initial experience, shows a low complication rate, similar to current laparoscopic series, offering less postoperative pain and abdominal wall aggression with great cosmetic results that are perceived by patients very positively, in addition to rapid recovery and return to normal daily life.

Reimplante ureteral laparoscópico por puerto único / Laparoendoscopic single site (LESS) ureteral reimplantation

OBJETIVO: Explicar de manera detallada nuestra técnica quirúrgica y mostrar nuestra experiencia inicial con la reimplantación ureteral utilizando el abordaje laparoendoscópico transumbilical por puerto único para tratar pacientes con estenosis ureteral producida por distintas patologías y complicaciones quirúrgicas. MÉTODOS: Se realizaron 7 reimplantaciones ureterales desde febrero de 2012, utilizando la plataforma multicanal de Richard-Wolf (KeyPort) colocada transumbilical mediante una pequeña incisión transversal de 2-2,5 cm. Utilizamos siempre un trocar accesorio de minilaparoscopia de 3,5 mm que se coloca en fosa iliaca derecha y que es fundamental para realizar la sutura laparoscópica de una manera segura para el paciente y en un tiempo óptimo. La etiología de las reimplantaciones ureterales fueron: 1 endometriosis, 1 ureterocele sintomático que no respondió al tratamiento endoscópico, 1 lesión ureteral post-ureteroscopia por litiasis, 1 lesión ureteral post-prostatectomía radical y 3 iatrogenias ginecológicas (1 histerectomía vaginal asistida por laparoscópica, 2 histerectomías radicales con doble anexectomía por Ca de cérvix). 5 reimplantaciones ureterales fueron del lado izquierdo y 2 del lado derecho. Previamente a la cirugía se realizó colocación de nefrostomía percutánea a 5 pacientes, y colocación de doble J a la paciente de la endometriosis. El paciente del ureterocele no precisó derivación urinaria previa a la cirugía y no se pudo cateterizar por endoscopia intraoperatoriamente. RESULTADOS: Se muestran los resultados peri y postoperatorios de los pacientes intervenidos que tenían una edad media de 49,3 [28-78] años. El sangrado medio intraoperatorio fue de 132,1 [100-250] ml, siendo la tasa de transfusión del 0%. El tiempo medio operatorio fue de 127,4 [120-210] minutos, no precisando ningún paciente reconversión a cirugía laparoscópica ni abierta. La estancia media fue de 2,1 [2-3] días y a todos los pacientes se les retiró el drenaje a las 48 horas. Hubo complicaciones menores de Clavien-Dindo en 1 paciente que presento infección urinaria a los 10 días de la cirugía. En todos los pacientes se dejó doble J que se retiró con una media de 34,3 [30-45] días. La media de retirada de sonda vesical fue de 7,8 [7-10] días. Con un seguimiento medio de 32,6 [14-54] meses no se ha objetivado recidiva de la estenosis ureteral en ningún paciente. CONCLUSIÓN: La reimplantación ureteral por puerto único, en nuestra experiencia inicial, muestra una tasa baja de complicaciones, similar a las series de laparoscopia actuales, ofreciendo menos dolor postoperatorio y agresión de la pared abdominal con unos resultados estéticos estupendos que son percibidos por los pacientes de manera muy positiva, además de una rápida recuperación e incorporación a la vida cotidiana

OBJECTIVE: To present in detail our surgical technique and to show our initial experience with ureteral reimplantation using the transumbilical LESS approach to treat patients with ureteral stenosis secondary to various diseases and surgical complications. METHODS: We performed 7 ureteral reimplantations from February 2012, using the multichannel Richard-Wolf (KeyPort) platform placed transumbilical by a small 2-2,5 cm transversal incision. We always use a 3.5 mm minilaparoscopy accessory trocar in the right iliac fossa, that is crucial to perform the laparoscopic suturing safely for the patient and in an optimal time. The etiology of ureteral lesions was: 1 endometriosis, 1 symptomatic ureterocele not responding to endoscopic treatment, 1 ureteral lesion after ureteroscopy for lithiasis, 1 ureteral lesion after radical prostatectomy and 3 gynecologic iatrogenic lesions (1 laparoscopically assisted vaginal hysterectomy, 2 radical hysterectomies with double anexectomy for cervix carcinoma). 5 ureteral reimplantations were left and 2 right sides. Before surgery, 5 patients had nephrostomy tubes inserted and the patient with endometriosis had a double J catheter. The patient with ureterocele did not require urinary diversion before the operation and endoscopic intraoperative catheterization was not feasible RESULTS: We present the operative and postoperative results of the patients undergoing surgery. They had a mean age of 49.3 [28-78] years. Mean intraoperative estimated blood loss was 132.1 [100-250] ml, with no transfusions required. Mean operative time was 127.4 [120-210] minutes, with no conversions to laparoscopic or open surgery required. Mean hospital stay was 2.1 [2-3] days and all patients had drainage removed at 48 hours. There were minor Clavien-Dindo complications in one patient presenting urinary tract infection 10 days after the operation. All patients had double J catheters that were removed with a mean of 34.3 [30-45] days. Mean time for bladder catheter removal was 7.8 [7-10] días. With a mean follow up of 32.6 [14-54] months no ureteral stenosis recurrence has been observed. CONCLUSIONS: LESS ureteral reimplantation, in our initial experience, shows a low complication rate, similar to current laparoscopic series, offering less postoperative pain and abdominal wall aggression with great cosmetic results that are perceived by patients very positively, in addition to rapid recovery and return to normal daily life

[Ureteroenteric strictures: endourological treatment]. / Estenosis ureterointestinales: tratamiento endourológico.

OBJECTIVES: To review the outcomes of the ureteroenteric strictures treated by endourological techniques in our department, and to compare our long-term results with other reported series with similar follow-up and number of patients. METHODS: We retrospectively reviewed 27 ureteroenteric strictures treated from March 1994 to June 2003, with a mean follow-up of 30.2 months (1 day-53 months). 13 cases underwent ballon dilation + permanent double J catheter (3 of them antegrade) 8 patients underwent endoscopical incision + double J catheter (5 of them with Acucise). RESULTS: 12/21 (57,14%) renal units improved and/or remained stable. We emphasize the absence of peroperative complications except 1 case that had a very poor oncological prognosis and died of septicemia 1 day after balloon dilation. CONCLUSIONS: Endourological treatment of ureteroenteric strictures has demonstrated to provide good fuctional results on the short and mid-term in patients that open surgery, although being the treatment of choice, would be too aggressive due to their disease, age, morbid conditions,....

Estenosis ureterointestinales: tratamiento endourológico / Ureteroenteric strictures: endourological treatment

OBJETIVO: El objetivo de éste estudio hasido revisar el resultado de las estenosis ureterointestinalestratadas de forma endourológica y compararnuestros resultados a largo plazo, con lo publicado enotras series de similares características en tiempo deseguimiento y número de pacientes.MÉTODOS: Desde Marzo de 1994 a Junio de 2003,hemos revisado de forma retrospectiva, el tratamientode 27 estenosis ureterointestinales, con un seguimientomedio de 30.2 meses (1 día - 53 meses).En 6 casos, no se culminó tratamiento endourológico.Se realizaron 13 dilataciones + catéter doble J permanente(3 de forma anterógrada).Tratamos 8 casos con endoureterotomías + catéterdoble J (5 con Acucise*).RESULTADOS: Conseguimos mejorar y/o estabilizar lafunción renal en 12/21 unidades renales (57.14%). Adestacar la ausencia de complicaciones en el intra ypostoperatorio inmediato excepto 1 paciente con dilatación+ c. doble J y muy mal pronóstico oncológico,que falleció al día siguiente por sepsis.CONCLUSIONES: El tratamiento endourológico hademostrado proporcionar buenos resultados funcionalesa corto y medio plazo, en pacientes que por supatología de base, edad, comorbilidad... la cirugíaabierta, sería una opción terapéutica más agresiva,pese a ser el tratamiento de elección en situaciones ideales

OBJECTIVES: To review the outcomes of the ureteroenteric strictures treated by endourological techniques in our department, and to compare our long-term results with other reported series with similar follow-up and number of patients. METHODS: We retrospectively reviewed 27 ureteroenteric strictures treated from March 1994 to June 2003, with a mean follow-up of 30.2 months (1 day-53 months). 13 cases underwent ballon dilation + permanent double J catheter(3 of them antegrade) 8 patients underwent endoscopical incision + double J catheter (5 of them with Acucise®) RESULTS: 12/21(57,14%) renal units improved and/or remained stable. We emphasize the absence of peroperative complications except 1 case that had a very poor oncological prognosis and died of septicemia 1 day after balloon dilation. CONCLUSIONS: Endourological treatment of ureteroenteric strictures has demonstrated to provide good fuctional results on the short and midterm in patients that open surgery, although being the treatment of choice, would be too aggressive due to their disease, age, morbid conditions,…