Calciphylaxis or calcific uremic arteriolopathy (CUA) is a potentially life-threatening vasculopathy involving the skin and subcutaneous tissues. It is usually associated with chronic kidney disease (CKD) and rarely with acute renal failure or predialysis patients. The clinical diagnosis of calcific uremic arteriolopathy relies on high index of suspicion. CUA is commonly associated with secondary hyperparathyroidism and high serum calcium and phosphate products. Moreover, using biopsy as a diagnostic tool is controversial, due to the high risk of poor wound healing and sepsis. Radiological studies usually reveal extensive calcification of branching vessels such as penile arteries, eventually leading to gangrene formation in extremities and penis. Histopathological analysis confirms the diagnosis of calcific uremic arteriolopathy and rules out the presence of malignancy. CUA is a systematic disease that involves multiple organs, and to the best of our knowledge this is the first reported case involving the penis, bladder, and eyes.
Background and Objective: The usage of permanent thermo-expandable stents and the definitive surgical treatment, like the ileal ureter replacement (IUR), both represent alternatives to repeated endourological stenting of long ureteral strictures.We aimed to assess the long-term outcomes and complications of the IUR compared to the use of Memokath® 051 for ureteral reconstruction.Material and Methods: In the last 10 years, two groups of patients with ureteral strictures (benign or malig-nant) have been followed up retrospectively. The first group presented with ureteral obstruction and was treated with an endoureteral thermo-expandable stent Memokath®, whereas the second group received an IUR as an alternative treatment method. All patients received follow-up examinations on an outpatient basis 3-4 weeks after hospital discharge, annual controls for long-term monitoring, and routine laboratory analysis and imaging of the upper urinary tract. The main outcome measure was the rate of successful upper tract decompression.Results: Mean patient age for the first group was 59 years and 55 years for the second group. In the first group (17 patients, 27 renal units), long-term upper tract decompression was successful in 6 renal units (35%); the remaining patients required auxiliary measures and further interventions. In the second group (27 patients, 32 renal units), upper tract decompression was achieved in 24 (88.8%) patients. Secondary complications occurred in 4 (14.8%) patients. Renal function remained stable in 25 of the 27 patients, and metabolic acidosis was not observed.Conclusion: The IUR is an effective reconstructive measure of the upper urinary tract with a low complication rate and decent long-term functional results. The IUR should be preferred to the Memokath, which can be seen as an alternative niche solution.
The insertion of two thermoformable ureteral titanium spiral stents (Memokath® 051) through ileal conduit due to bilateral ureteral stenosis distally has not been described in the English literature so far. We present the case of a young female patient with a history of ileal conduit urinary diversion due to congenital urinary bladder exstrophy, who had multiple previous surgeries and the insertion of two Memokath® ureteral stents in both ureters due to distal ureteral stenosis.
INTRODUCTION AND OBJECTIVES: Robot-assisted surgery represents a feasible and less challenging minimally-invasive option for complex urological reconstructive procedures, including ureteral reimplantation with psoas hitch. Published experience in this field is still limited. We report our 10-year experience of this technique from a tertiary care center. METHODS: All patients that underwent ureteral reimplantation with psoas hitch technique between 2006 and 2016 at our institution were included in this study. The robotic system was used in 4-arm configuration with the addition of 2 assistant ports. The transperitoneal approach and tunneled nonrefluxing ureteral anastomosis was performed in all patients. The psoas hitch was performed using a 1-0 suture. The perioperative complications were described according to Clavien-Dindo classification. RESULTS: 21 patients (11 men and 10 women) underwent robot-assisted ureteral reimplantation with psoas hitch technique. The median age was 66 years (IQR 41,73), body mass index 24 kg/m 2 (IQR 23,28) and Charlson Comorbidity Index 1 (IQR 0,2). In 2 (9,5%) patients the procedure was performed for bilateral pathology. 11 (52,4%) patients were symptomatic; of these 7 (33,3%) had pain, 2 (9,5%) hematuria and 2 (9,5%) pyelonephritis. 17 (81,0%) patients had hydronephrosis at the diagnosis. Indication for surgery was distal ureteral tumor in 7 (33,3%) patients, iatrogenic ureteral injury in 7 (33,3%), external ureteral compression in 4 (19,1%), vesicoureteral reflux in 2 (9,5%) and 1 (4,8%) patient had distal ureteral fibrosis of unknown origin. 13 (61,9%) patients had previous surgery near the distal ureter. Median operative time was 150 minutes (IQR 120,180). Mean blood loss was 30 mL (IQR 30,50). The all grade complication rate was 28,6%; five grade 1 (two prolonged pain, two transient paresthesia of the thigh and one urinary tract infection) and one grade 3 complication (bleeding required surgical revision) occurred. Median hospital stay was 5 days (IQR 4,7) and catheter time 7 days (IQR 6,10). Ureteral stent was placed in 13 patients and left in place for a median time of 30 days (IQR 20,42). After a median follow-up of 15 months (IQR 15,23) all patients were asymptomatic with no signs of hydronephrosis. Most of the patients improved renal function and none of them had a significant postoperative worsening of it. CONCLUSIONS: This series represents the largest singleinstitution experience with robot-assisted ureteral reimplantation with psoas hitch technique and long follow-up. It represents a safe and effective technique with excellent outcomes and limited morbidity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.