Ileal ureteral replacement for the management of ureteral avulsion during ureteroscopic lithotripsy: a case series

Yuan, Changwei; Li, Zhihua; Wang, Jie; Zhang, Peng; Meng, Chang; Li, Dan; Gao, Jingjing; Guan, Hua; Zhu, Weijie; Lu, Bao-Liang; Zhang, Zhichao; Feng, Na; Yang, Kun‐Lin; Li, Xuesong; Zhou, Liqun

doi:10.1186/s12893-022-01690-0

Cited by 11 publications

(13 citation statements)

References 30 publications

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“…Based on our abundant experience with ileum ureteral replacement and > 100 robotic ureteral reconstructive surgical procedures, we designed a surgical technique involving robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation. We have shared our experience of ileal ureteral replacement for the management of ureteral avulsion during ureteroscopy lithotripsy [27]. Manipulation of the ileal segment was performed extracorporeally, which has its own advantages.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series

Fan

Han

et al. 2022

Preprint

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Background Complete intracorporal robotic ileal ureteric replacement is challenging. We aim to present the surgical technique of robotic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures. Methods From March 2019 to March 2021, 18 patients underwent robotic ileal ureter replacement with extracorporeal ileal segment preparation by one experienced surgeon. The demographic, perioperative, and follow-up data were recorded. Success was defined as resolution of the presenting symptom, a stable estimated glomerular filtration rate and unobstructive drainage in imaging examination. Results All 18 surgeries were successfully completed without conversion. The median length of the intestinal tube used was 20(12–30) cm. The median operative time was 248(170–450) min, the median estimated blood loss was 50(10–200) mL, and the median postoperative hospital stay was 7 (5–27) days. At a median follow-up of 16(13–28) months, all patients were symptom-free. No or mild hydronephrosis was confirmed in 17 patients; 1 patient had moderate hydronephrosis without peristalsis of the ileal ureter. The renal function was stable in all patients. The overall success rate was 100%. Postoperative complication including 4 cases of urinary infection (Grade I), 1 case of incision hernia (Grade I), 4 cases of kidney stone formation (Grade I), 6 cases of metabolic acidosis (Grade I), 4 cases of incomplete ileus (Grade II) and 1 case of incision infection (Grade IIIb). Conclusions Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation is safe, feasible, and effective for the treatment of long ureteral strictures.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series

Fan

Han

et al. 2022

Preprint

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“…A D-J stent was inserted intraoperatively in all surgeries and was removed in 2 months. All 18 patients were followed for a median of 16 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) months. The median postoperative eGFR was 90 (42-118) ml/min/1.73 m 2 , which was stable.…”

Section: Resultsmentioning

confidence: 99%

“…Based on our abundant experience with ileum ureteral replacement and > 100 robotic ureteral reconstructive surgical procedures, we designed a surgical technique involving robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation. We have reported our experience of ileal ureteral replacement for the management of ureteral avulsion during ureteroscopy lithotripsy [ 27 ]. Manipulation of the ileal segment was performed extracorporeally, which has its own advantages.…”

Section: Discussionmentioning

confidence: 99%

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Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series

Fan

Han

et al. 2022

BMC Surg

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Background Complete intracorporal robotic ileal ureteric replacement is challenging. We aimed to present the surgical technique of robotic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures. Methods From March 2019 to March 2021, 18 patients underwent robotic ileal ureter replacement with extracorporeal ileal segment preparation by one experienced surgeon. The demographic, perioperative, and follow-up data were recorded. Success was defined as the resolution of the presenting symptom, a stable estimated glomerular filtration rate and unobstructive drainage on imaging examination. Results All 18 surgeries were successfully completed without conversion. The median length of the intestinal tube used was 20 (12–30) cm. The median operative time was 248 (170–450) min, the median estimated blood loss was 50 (10–200) ml, and the median postoperative hospital stay was 7 (5–27) days. At a median follow-up of 16 (13–28) months, all patients were symptom-free. No or mild hydronephrosis was confirmed in 17 patients; 1 patient had moderate hydronephrosis without peristalsis of the ileal ureter. The renal function was stable in all patients. The overall success rate was 100%. Postoperative complications, including 4 cases of urinary infections (Grade I), 1 case of an incision hernia (Grade I), 4 cases of kidney stone formation (Grade I), 6 cases of metabolic acidosis (Grade I), 4 cases of incomplete ileus (Grade II), and 1 case of an incision infection (Grade IIIb). Conclusions Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation is safe, feasible, and effective for the treatment of long ureteral strictures, especially in high-volume tertiary referral centers with extensive robotic surgery experience capable of managing severe peri-operative complications.

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“…Albeit not challenging in general, it may occasionally result in severe complications, of which complete or full-length ureteral avulsion may be the most disastrous. Treatment options for this complication typically include ileal ureteral substitution, renal autotransplantation, Boari flap technique, and even nephrectomy; however, there has been no consensus regarding the hierarchy of treatment selection[ 1 , 2 ]. Moreover, all of these treatments are challenging.…”

Section: Introductionmentioning

confidence: 99%

Long-term results of extended Boari flap technique for management of complete ureteral avulsion: A case report

Zhong¹,

Huang²,

Huang³

et al. 2022

World J Clin Cases

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BACKGROUND Ureteroscopy is well-established as a primary treatment modality for urolithiasis. Ureteral avulsion, particularly complete or full-length avulsion with a resultant long segment of the ureter left attached to the ureteroscope, is a rare but devastating complication of the procedure. Management of this complication is challenging. Moreover, general consensus regarding the optimal management is undetermined. We report our experience of managing a complete ureteral avulsion case via an extended Boari flap technique with long-term results. CASE SUMMARY A 41-year-old female patient subjected to complete ureteral avulsion caused by ureteroscopy was referred to our hospital. A modified, extended Boari flap technique was successfully performed to repair the full-length ureteral defect. Maximal mobilization of the bladder and affected kidney followed by psoas hitch and downward nephropexy maximized the probability of a tension-free anastomosis. Meticulous blood supply preservation to the flap also contributed to the success. During the 4-year study period, no complications except for a mild urinary frequency and a slightly lower maximum urinary flow rate were reported. The patient was satisfied with the surgical outcomes. CONCLUSION The extended Boari flap procedure is a feasible and preferred technique to manage complete ureteral avulsion, particularly in emergencies.

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Ileal ureteral replacement for the management of ureteral avulsion during ureteroscopic lithotripsy: a case series

Cited by 11 publications

References 30 publications

Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series

Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series

Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series

Long-term results of extended Boari flap technique for management of complete ureteral avulsion: A case report

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