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1.
Urologiia ; (1): 95-102, 2021 Mar.
Artigo em Russo | MEDLINE | ID: mdl-33818943

RESUMO

BACKGROUND: pneumovesicoscopic approach gives new possibilities for endovideosurgical correction of congenital ureteral and bladder pathology. AIM: To increase the efficiency of ureteral reimplantation in patients with vesicoureteral reflux (VUR), obstructive megaureter and bladder pathology by using pneumovesicoscopic access. MATERIALS AND METHODS: For the period 2014 - 2020 a total of 52 children aged from 10 months up to 15 years (median 2.5 years) were treated. In all patients, pneumovesicoscopic ureteral reimplantation according to the Cohen technique was performed, and in six cases bilateral procedure was done. 30 patients with obstructive megaureter (32 ureters) were treated, and intravesical suturing with ureteral plication was performed in 9 patients. Reimplantation for grade 3-5 VUR was performed in 22 patients (26 ureters), in combination with excision of the bladder diverticulum was done in 3 patients, while 3 children were undergone to simultaneous excision of the ureterocele. An original technique for fixation of the mobilized dilated ureter with a ligature to the bladder neck is proposed to simplify its intravesical suturing according to the Starr technique. RESULTS: The mean operation time was 142 (83-235 minutes). Conversion to open surgery was required in 1 (1.9%) child during the learning curve. The length of stay was 5-6 days, with an average of 5.21 days. According to ultrasound data, after 1, 3, 6 months there was a decrease in the size of the collecting system and ureter in all cases. At cystography after 6-12 months, VUR was detected in 3 (5.7%) children: in 2 (9%) patients with grade 3-5 VUR and in 1 (3.3%) patient with obstructive megaureter and ureteral suturing. CONCLUSION: Pneumovesicoscopic access for ureteral reimplantation in patients with VUR, obstructive megaureter, bladder diverticulum and ureterocele has proven its efficiency and reliability with a minimal complication rate (5.7%). Our proposed method of fixing the mobilized ureter with a ligature to the bladder neck helps to simplify the suturing of the ureter and to shorten the operation time.


Assuntos
Ureter , Refluxo Vesicoureteral , Idoso , Criança , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Ureter/diagnóstico por imagem , Ureter/cirurgia , Refluxo Vesicoureteral/diagnóstico por imagem , Refluxo Vesicoureteral/cirurgia
2.
Urologiia ; (1): 107-111, 2021 Mar.
Artigo em Russo | MEDLINE | ID: mdl-33818945

RESUMO

A description of the successful surgical treatment of a patient with irreversible changes in both ureters and bladder resulting from a severe form of Ormond's disease and interstitial cystitis, resulting in contracted bladder, is presented. For the first time in clinical practice, a one-stage cystectomy, a bilateral ureterectomy with complete replacement of both ureters and the bladder with two isoperistaltic small bowel segment was performed. The postoperative course was uneventful. Follow-up contrast-enhanced computed tomography of the kidneys and newly formed urinary tract revealed good excretory function. The patient was discharged in a satisfactory condition on the 22nd day after the procedure with recommendations for taking 10 g of an aqueous solution of soda daily. At the follow-up after 3 months, she had complaints of slight weakness and voided voluntary up to 8 times a day; clinical and biochemical blood tests were normal. This clinical observation indicates the presence of two different diseases in one patient, namely interstitial cystitis and Ormond's disease. The possibility of one-stage complete replacement of both ureters and the bladder with a good immediate result is shown.


Assuntos
Fibrose Retroperitoneal , Ureter , Neoplasias da Bexiga Urinária , Derivação Urinária , Coletores de Urina , Cistectomia , Feminino , Humanos , Íleo , Ureter/diagnóstico por imagem , Ureter/cirurgia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/cirurgia
3.
Urologiia ; (1): 126-130, 2021 Mar.
Artigo em Russo | MEDLINE | ID: mdl-33818948

RESUMO

The article describes such fundamental and applied aspects of pathogenesis and clinical manifestations of such rare disease as endometriosis of ureters. Frequent involvement of left ureter in its pelvic part, close to distal colon, associated with its inflammatory diseases followed by leaky gut syndrome with bacterial spread to the fallopian tube causing its inflammation and dysfunction, provoking menstrual reflux and predisposing to affection of left ovary, peritoneum and contact spread of endometriosis to ureteral wall. This mechanism fits to the regurgitation theory of endometriosis. Surgery is the gold standard for endometriosis treatment and more beneficial, comparing with conservative treatment and essential for prevention of such dangerous complications as hydronephrosis and renal failure. But the early and in-time diagnostic of endometriosis depend on gynecologists, not urologist, that characterizes endometriosis as significant interdisciplinary problem. In the article symptoms, that must cause concern for this rare pathology are thoroughly described.


Assuntos
Endometriose , Hidronefrose , Laparoscopia , Ureter , Doenças Ureterais , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/etiologia , Hidronefrose/cirurgia , Ureter/diagnóstico por imagem , Ureter/cirurgia , Doenças Ureterais/etiologia , Doenças Ureterais/cirurgia
4.
Medicine (Baltimore) ; 100(12): e25187, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761700

RESUMO

INTRODUCTION: Duplicate kidneys are the most common congenital abnormality of the urinary system. The location of duplicate kidneys varies. We report a case of an adolescent with upper and lower kidneys that are arranged vertically and approximately T-shaped. PATIENT CONCERNS: A 16-year-old male teenager was examined for pain in the left side of the waist. The Computed Tomography scan revealed that the left kidney was incompletely duplicated and fused; the left upper urinary tract was incompletely obstructed. DIAGNOSIS: The abdominal tomography confirmed the diagnosis of incomplete duplicate kidney. INTERVENTIONS: The patient underwent laparoscopic surgery. The failure to ligate the renal pedicle resulted in increased bleeding during the operation and an open ureteral stump. OUTCOMES: No urine leakage occurred after the operation. Doppler ultrasound of the urinary system showed no hydronephrosis, and the patient was asymptomatic. CONCLUSION: Through this case report, we found that the duplicate kidneys could be arranged in a T-shape under laparoscopy. Although only the supply of the duplicate renal arteries can be ligated during surgical resection, the renal pedicle must also be ligated during the operation if there is a lot of bleeding.


Assuntos
Rim/anormalidades , Rim/cirurgia , Laparoscopia/métodos , Nefrectomia/métodos , Adolescente , Perda Sanguínea Cirúrgica , Humanos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Pelve Renal/anormalidades , Pelve Renal/cirurgia , Laparoscopia/efeitos adversos , Dor Lombar/etiologia , Masculino , Nefrectomia/efeitos adversos , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Ureter/anormalidades , Ureter/cirurgia
5.
Hinyokika Kiyo ; 67(1): 17-22, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33535292

RESUMO

A 74-year-old woman was transported to an emergency room of a general hospital with sudden left flank pain. After examination, the pain was attributed to left hydronephrosis resulting from left retroperitoneal fibrosis (RF). The pain and renal function improved after left ureteral stenting. Four months after the transportation, she was referred to our hospital for further examination. Her renal function deteriorated again despite successful release of ureteral obstruction. Consequently, the left kidney developed end-stage renal dysfunction at 15 months after symptom onset. Pathological examination of the left dysfunctional kidney removed by laparoscopic surgery to avoid infectious pyelonephritis revealed numerous IgG4-positive plasma cells invading the renal parenchyma. The pathological findings suggested that the renal dysfunction was due to IgG4-related tubulointerstitial nephritis (IgG4-TIN) rather than ureteral obstruction. In the case of RF with decreased renal function, not only retroperitoneal lesion biopsy but also renal biopsy should be considered to diagnose IgG4-TIN and start steroid treatment if necessary.


Assuntos
Nefrite Intersticial , Fibrose Retroperitoneal , Ureter , Obstrução Ureteral , Idoso , Feminino , Humanos , Imunoglobulina G , Rim/patologia , Nefrite Intersticial/complicações , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia
6.
Hinyokika Kiyo ; 67(1): 27-30, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33535294

RESUMO

A 41-year-old female who suffered local recurrence of cervical cancer after receiving chemoradiotherapy underwent radical hysterectomy, radical vaginal resection, and pelvic and paraaortic lymph node dissection. After surgery, bilateral hydronephrosis due to right ureteral stenosis and left uretero-vaginal fistula occurred. We therefore placed a bilateral ureteral stent. Thereafter, we continued to replace the bilateral ureteral stent once every 3 months, but the replacement of the right ureteral stent became impossible three years after the initial placement. We thus performed bilateral upper urinary tract reconstruction using an ileal ureter with the aim of both eliminating the left ureteral vaginal fistula and resolving the right ureteral stricture.


Assuntos
Hidronefrose , Ureter , Obstrução Ureteral , Adulto , Constrição Patológica , Feminino , Humanos , Íleo , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia
7.
J Cancer Res Clin Oncol ; 147(4): 1115-1123, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33492493

RESUMO

PURPOSE: To evaluate the safety and feasibility of a newly designed 125I brachytherapy ureteral stent (BUS) in normal dogs. METHODS: A BUS loaded with 10 125I seeds (Group A: 0.8 mCi, Group B: 0.4 mCi, Group C: 0 mCi) was designed and tested in 27 normal beagle dogs. Routine blood tests, gross observations, cumulative radiation doses, tissue reaction assessed by hematoxylin-eosin/Masson staining, mRNA analysis by RT-qPCR and protein expression of Caspase-3, Collagen I, PCNA, and α-SMA were performed at 2, 4 and 8 weeks. RESULTS: The BUS was implanted successfully in all dogs (27/27) without surgery-related death. The ureter diameter and radiation injury score increased along with radiation accumulation (p < 0.05). Histopathologic analysis showed necrotic tissue and lateral fibrosis to different extents in the ureteral walls that gradually increased in all groups (p < 0.05); however, epithelial cell proliferation in groups A and B was lighter than that in the control group (p < 0.05). CONCLUSION: Placement of the newly designed 125I BUS was safe and feasible in dogs, and clinical studies are required to test its use in humans.


Assuntos
Braquiterapia/métodos , Radioisótopos do Iodo/uso terapêutico , Stents , Ureter/cirurgia , Doenças Ureterais/radioterapia , Animais , Cães , Relação Dose-Resposta à Radiação , Feminino , Masculino , Doenças Ureterais/patologia
8.
Zhonghua Fu Chan Ke Za Zhi ; 56(1): 27-33, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33486925

RESUMO

Objective: To study the anatomical relationship among uterosacral ligament and ureter or rectum by using MRI three-dimensional reconstruction model in pelvic organ prolapse (POP) patients. Methods: According to the research standard, 67 POP patients were enrolled, who accepted pelvic MRI before surgery in Nanfang Hospital, Southern Medical University during May 2015 to March 2020. Three-dimensional model of uterosacral ligament was reconstructed. The intersection point of the fitting curve of uterosacral ligament and ischial spine level marked point P0, every 1 cm increasing from P0 towards the sacrum marked points P1, P2, and P3. Distances were measured between rectum or ureter to uterosacral ligament respectively at the P0-P3 horizontal levels. Results: (1) The distances between the left ureter and the left uterosacral ligament were (15.45±7.46) to (19.31±11.38) mm, and the distances between the right ureter and the right uterosacral ligament were (13.77±8.16) to (14.78±9.18) mm. At the P1 horizontal level ureters were the closest to uterosacral ligaments, and the right ureter was the closest to right uterosacral ligament [(13.45±9.34) mm] at P2 horizontal level in severe POP group. The farthest distance presented at the P3 horizontal level between bilateral ureters and uterosacral ligaments. (2) At the P0 horizontal level, the rectum was the closest to the bilateral uterosacral ligaments [left: (20.62±9.99) mm, right: (16.82±9.63) mm; P=0.026], and the rectum was closer to the right uterosacral ligament. There were no significant differences in the distance between rectum and bilateral uterosacral ligaments in mild POP group (P>0.05), and the results of severe POP group also showed the rectum was closer to the right uterosacral ligament [(15.64±10.31) mm at P0 horizontal level]. Conclusions: Right ureter and rectum are closer to the right uterosacral ligament. Gynecologists should pay more attention to avoid damaging the right ureter and rectum during the operation of the right uterosacral ligament in POP patients.


Assuntos
Ligamentos/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Prolapso de Órgão Pélvico/patologia , Reto/anatomia & histologia , Reto/diagnóstico por imagem , Sacro/anatomia & histologia , Sacro/diagnóstico por imagem , Ureter/anatomia & histologia , Ureter/diagnóstico por imagem , Adulto , Feminino , Humanos , Ligamentos/anatomia & histologia , Ligamentos/patologia , Ligamentos/cirurgia , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/diagnóstico por imagem , Prolapso de Órgão Pélvico/cirurgia , Reto/cirurgia , Sacro/cirurgia , Ureter/cirurgia
9.
J Urol ; 205(1): 152-158, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32716743

RESUMO

PURPOSE: Early surgical intervention is an attractive option for acute ureteral colic but existing evidence does not clarify which patients benefit. We compared treatment failure rates in patients receiving early intervention and patients offered spontaneous passage to identify subgroups that benefit from early intervention. MATERIALS AND METHODS: We used administrative data and structured chart review to study consecutive patients attending 9 emergency departments in 2 Canadian provinces with confirmed 2.0 to 9.9 mm ureteral stones. We described patient, stone and treatment characteristics, and performed multivariable regression to identify factors associated with treatment failure, defined as intervention or hospitalization within 60 days. Our secondary outcome was emergency department revisit rate. RESULTS: Overall 1,168 of 3,081 patients underwent early intervention. Those with stones smaller than 5 mm experienced more treatment failures (31.5% vs 9.9%, difference 21.6%, 95% CI 16.9 to 21.2) and emergency department revisits (38.5% vs 19.7%, difference 18.8%, 95% CI 13.8 to 23.8) with early intervention than with spontaneous passage. Patients with stones 7.0 mm or larger experienced fewer treatment failures (34.7% vs 58.6%, risk difference 23.9%, 95% CI 11.3 to 36.6) and similar emergency department revisit rates with early intervention. Patients with 5.0 to 6.9 mm stones had fewer treatment failures with intervention (37.4% vs 55.5%, risk difference 18.1%, 95% CI 7.1 to 28.9) if stones were in the proximal or middle ureter. CONCLUSIONS: Early intervention improves outcomes for patients with large (greater than 7 mm) ureteral stones or 5 to 7 mm proximal or mid ureteral stones. Early intervention may increase morbidity for patients with stones smaller than 5 mm. These findings could help inform future guidelines.


Assuntos
Cólica/cirurgia , Tempo para o Tratamento/normas , Triagem/normas , Cálculos Ureterais/cirurgia , Adulto , Canadá , Cólica/diagnóstico , Cólica/etiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Remissão Espontânea , Medição de Risco/estatística & dados numéricos , Fatores de Tempo , Falha de Tratamento , Ureter/cirurgia , Cálculos Ureterais/complicações , Cálculos Ureterais/diagnóstico
10.
J Urol ; 205(1): 68-77, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32856981

RESUMO

PURPOSE: Encrustation is a common phenomenon that can occur following placement of a ureteral stent into the urinary tract, and it can lead to serious complications. The following review addresses the mechanism of encrustation, the management of these stents and the newest technology developed to mitigate this issue. MATERIALS AND METHODS: We performed a comprehensive literature search on stent encrustation including peer-reviewed publications, public product listings, and material on current and future stent technology. RESULTS: The mechanism of encrustation is complex and multifaceted, including dwell time, patient specific risk factors, conditioning film formation, biofilm formation and mineral deposition. Several technological developments in stent materials and coatings may have a role in reducing the risk of stent encrustation. It is important to identify the extent of stent encrustation and plan treatment strategies accordingly. We propose a novel treatment algorithm for the management encrusted ureteral stents. CONCLUSIONS: The ubiquity of ureteral stents in urology practice mandates updated knowledge about the prevention of stent encrustation, identification of high risk patients and preparedness for removal using multimodal techniques.


Assuntos
Calcinose/cirurgia , Remoção de Dispositivo/métodos , Complicações Pós-Operatórias/cirurgia , Stents/efeitos adversos , Ureter/cirurgia , Calcinose/epidemiologia , Calcinose/etiologia , Calcinose/prevenção & controle , Cistoscopia , Dilatação/efeitos adversos , Dilatação/instrumentação , Humanos , Litotripsia , Masculino , Nefrostomia Percutânea , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese , Fatores de Risco , Tecnologia , Tomografia Computadorizada por Raios X , Ultrassonografia , Ureter/diagnóstico por imagem , Ureter/microbiologia , Ureter/patologia , Obstrução Ureteral/cirurgia , Ureterolitíase/etiologia , Ureterolitíase/prevenção & controle
11.
Urol Clin North Am ; 48(1): 113-125, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218586

RESUMO

Almost 30 years have passed since the inception of minimally invasive surgery in urology and specifically in pediatric urology. Laparoscopy has now become an essential tool in the pediatric urologic armamentarium. The application of robot-assisted surgery in pediatrics has allowed for widespread utilization for common reconstructive procedures such as pyeloplasty and ureteral reimplantation. Understanding the implementation, technical considerations, and outcomes are critical for continued success and adoption. This has allowed for increased use in more complex urologic procedures such as redo pyeloplasty, dismembered ureteral reimplantation, catheterizable channel creation, and bladder augmentation.


Assuntos
Pelve Renal/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Anestesia , Criança , Previsões , Humanos , Curva de Aprendizado , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/tendências , Reimplante , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/tendências , Obstrução Ureteral/cirurgia , Doenças Urológicas/congênito , Procedimentos Cirúrgicos Urológicos/tendências , Refluxo Vesicoureteral/cirurgia
12.
Urol Clin North Am ; 48(1): 71-80, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218595

RESUMO

Upper tract urothelial carcinoma is a rare malignancy for which surgery provides definitive management. Open radical nephroureterectomy was the gold standard treatment, but laparoscopic and robot-assisted approaches are alternative options. Kidney-sparing approaches are feasible for carefully selected patients with ureteral cancer. This article discusses the evaluation of patients with upper tract urothelial carcinoma and definitive management using robot-assisted surgical approaches. Patients with urothelial carcinoma of the upper tract can be treated with robot-assisted nephroureterectomy, distal ureterectomy, and segmental ureterectomy.


Assuntos
Carcinoma de Células de Transição/cirurgia , Neoplasias Renais/cirurgia , Nefroureterectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Ureterais/cirurgia , Anastomose Cirúrgica , Humanos , Reimplante/métodos , Ureter/cirurgia , Neoplasias Urológicas/cirurgia
13.
Urol Clin North Am ; 48(1): 91-101, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218597

RESUMO

Robotically assisted laparoscopic techniques may be used for proximal and distal ureteral strictures. Distal strictures may be approached with ureteroneocystotomy, psoas hitch, and Boari flap. Ureteroureterostomy, buccal mucosa graft ureteroplasty, and appendiceal flap ureteroplasty are viable techniques for strictures anywhere along the ureter. Ileal ureteral substitution is reserved for more extensive disease, and autotransplantation is reserved for salvage situations.


Assuntos
Constrição Patológica/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Algoritmos , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Árvores de Decisões , Humanos , Íleo/transplante , Mucosa Bucal/transplante , Assistência Perioperatória , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Reimplante , Retalhos Cirúrgicos , Ureter/anatomia & histologia , Ureter/irrigação sanguínea , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/etiologia , Procedimentos Cirúrgicos Urológicos/instrumentação
14.
Acta Cir Bras ; 35(11): e351108, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33331458

RESUMO

PURPOSE: To develop a model for simulated training of ureteropyelic anastomosis in laparoscopicpyeloplasty. METHODS: Longitudinal and experimental study, with 16 participants. A synthetic instrument was produced to simulate the renal pelvis and the proximal portion of the ureter positioned on a platform within laparoscopic simulators, thereby resulting in the realistic simulation of the ureteropelvic anastomosis. A step-by-step guide was also developed for the accomplishment of the ureteropelvic anastomosis training model. RESULTS: In the evaluation of all participants' suture training, a decrease was found in the time needed to perform the anastomosis, with a median of 17.83 min in the 1st step and 14.21 min in the last one (p = 0.01). Regarding the knots, in the 1st step, 5% of them were considered firm, with an evolution to 30% in the last step (p = 0.011). CONCLUSION: We noticed improvement in the ability to perform the ureteropelvic anastomosis by participants with no experience with it. Therefore, even unexperienced participants can improve their skills with this training. Moreover, we observed the effectiveness of the model use, confirmed by the participants' opinion and its validation by expert surgeons.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Reconstrutivos , Ureter , Obstrução Ureteral , Anastomose Cirúrgica , Humanos , Pelve Renal/cirurgia , Ureter/cirurgia , Obstrução Ureteral/cirurgia
15.
Urologiia ; (6): 75-80, 2020 12.
Artigo em Russo | MEDLINE | ID: mdl-33377683

RESUMO

INTRODUCTION: Distal ureter strictures are complications of surgical interventions for obstetric, gynecological, urological, vascular and oncological diseases. Reconstructive plastic correction of these strictures is a complex urological procedure. The choice of a technique is associated with the localization and extent of the stricture. Boari flap ureteroneocystostomy is one of the main operations to choose from. Its implementation in open and laparoscopic versions in recent history required special analysis. OBJECTIVE: to analyze the experience of ureteral reimplantation according to the Boari technique with a detailed description of its open and laparoscopic approaches. MATERIALS AND METHODS: In 2010-2019, 30 patients underwent surgery using the Boari technique. 17 patients underwent open surgery (group 1) and 13 patients underwent surgery using laparoscopic techniques (group 2). A comparative analysis of the two groups was carried out considering clinical and intraoperative data. Complications were studied, as well as immediate and long-term results with a follow-up period of 6-120 months. RESULTS: Patients of the two groups showed similar clinical characteristics. Patients had an equal extent of lesion in the groups (p>0.05). However, the lesions were located more proximally from the bladder in group 1, which required the use of longer flaps (p=0.024). Blood loss volume was identical, and the duration of laparoscopic operations was significantly shorter (p=0.019). Postoperative complications occurred in 26.7% of cases in the next 3 months, which required a temporary percutaneous puncture nephrostomy (IIIa degree according to Clavien-Dindo) in 2 cases and conservative therapy (II degree according to Clavien-Dindo) in 6 cases. Clinical vesicoureteral reflux was determined in only one case during a one-year follow-up period. CONCLUSION: Open and laparoscopic Boari techniques have an equally high ureteral recovery efficiency without the need for a re-operation in all cases. Refluxing flap ureteral anastomosis is extremely rarely accompanied by a clinic of vesicoureteral reflux. The ureter can be restored using a laparoscopic Boari technique in all cases.


Assuntos
Laparoscopia , Ureter , Obstrução Ureteral , Humanos , Retalhos Cirúrgicos , Ureter/cirurgia , Obstrução Ureteral/cirurgia
16.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1474-1477, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191709

RESUMO

Objective: To summarize the research progress of ureteral injury in oblique lumbar interbody fusion (OLIF). Methods: The literature about incidence, clinical manifestations, diagnosis, and treatment of ureteral injury complications in OLIF was reviewed. Results: OLIF surgery poses a risk of ureteral injury because its surgical approach is anatomically adjacent to the left ureter. Ureteral injuries in OLIF are often insidious and have no specific clinical manifestations. CT urography is a common diagnostic method. The treatment of ureteral injury depends on a variety of factors such as the time of diagnosis, the location and degree of injury, and the treatment methods range from endoscopic treatment to replacement reconstruction. Conclusion: Surgeons should pay attention not to damage the ureter and find the abnormality in time during OLIF. High vigilance of abnormalities is conducive to the early diagnosis of ureteral injury. Furthermore, it is important to be familiar with ureter anatomy and gentle operation to prevent ureteral injury.


Assuntos
Fusão Vertebral , Ureter , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral , Complicações Pós-Operatórias , Fusão Vertebral/efeitos adversos , Ureter/cirurgia
17.
Urologiia ; (5): 78-81, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185352

RESUMO

A 50-year-old female presented to our department of urology with nephrostomy drain in the right kidney been placed because of an acute obstructive pyelonephritis. Nephrostogram revealed an intra-renal pelvis with no passage of contrast into the ureter. Retrograde pyelography identified the extended ureteric stricture and need for a substitution. Laparoscopic ileocalicostomy was performed to achieve a communication between the lower calyx and bladder. Video describing surgical technique is available on https://youtu.be/bIW_m3lwXWY. Due to thick and full-blooded renal parenchyma, a partial nephrectomy of the lower pole had to perform to get an access to the renal calyx. It took 25 min of warm ischemia. At that, sutures of renorrhaphy should have provided reliable hemostasis on the one hand, and free outflow of urine via an isolated calyx on the other. To reduce the length of ileoureter a bladder psoas hitch maneuver was used. A 25-cm-long segment of ileum was isolated and rotated in isoperistaltic manner. Double J stent was held through it. Ileocalicostomy by interrupted and ileovesicostomy by continuous sutures were performed one after another. There were no intraop complications. OR time - 300min. EBL - 200ml. Postoperative course was uneventful. Ten days after surgery, nephrostogram and cystography confirmed the patency of the neoureter and the tightness of both anastomoses. Nephrostomy drain was removed first, ureteral - one day after. "JJ" stood for 3 weeks. The patient is doing well at more than 12 months of follow-up with a stable renal and ileoureteral function. In comparison with open procedure our surgery is significantly less invasive, per contra robotic - not so expensive. As far as we known, this is the first case report of conventional laparoscopic intracorporeal ileocalicostomy with long-term good functional results demonstration.


Assuntos
Laparoscopia , Ureter , Obstrução Ureteral , Feminino , Humanos , Pelve Renal , Pessoa de Meia-Idade , Ureter/diagnóstico por imagem , Ureter/cirurgia , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos
19.
Medicine (Baltimore) ; 99(33): e21727, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872054

RESUMO

INTRODUCTION: Reports pertaining to ureteral injury sustained during lumbar disc surgery are rare; most ureteral injuries in this setting involve laceration or transection. PATIENT CONCERNS: We report a rare case of a 55-year-old man who presented with complete left ureteral necrosis 20 days after sustaining ureteral transection during lumbar disc surgery. DIAGNOSIS: The patient presented with seroperitoneum caused by left ureteral injury; post-operative histopathological examination of surgical specimen after discectomy had revealed ureter-like tissue. Exploratory laparoscopic surgery revealed necrosis of a long segment of ureter, which was not amenable to treatment with conventional methods. INTERVENTION: We used a spiral bladder muscle flap with vascular pedicles to repair the ureteral defect. OUTCOMES: Post-operative period was uneventful and the patient showed good recovery. CONCLUSION: Spiral bladder muscle flap with vascular pedicles may be used to repair extensive ureteric injury.


Assuntos
Discotomia/efeitos adversos , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/etiologia , Ureter/lesões , Angiografia por Tomografia Computadorizada , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Necrose , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Ureter/diagnóstico por imagem , Ureter/patologia , Ureter/cirurgia , Urografia
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