Managing Mid and Lower Ureteral Benign Strictures: The Laparoscopic Way

Ghosh, Bastab; Jain, Pritesh; Pal, Dilip Kumar

doi:10.1089/lap.2017.0256

Cited by 13 publications

(22 citation statements)

References 19 publications

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“…As techniques have developed, minimally invasive methods have been widely used in ureteral reconstruction. Several teams have performed ureteral reimplantation involving the Boari flap in laparoscopic approaches, as shown in Table 4 (6,19,(21)(22)(23)(24)(25). In our research, the first laparoscopic Boari flap-psoas hitch procedure was performed in November 2015, and more patients have been treated using laparoscopic procedures in recent years.…”

Section: B a D Cmentioning

confidence: 99%

Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures

Ding¹,

Cheng²,

Li³

et al. 2021

Transl Androl Urol

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Background: To summarize our experience with the Boari flap-psoas hitch and compare the indications, perioperative data and outcomes between open and laparoscopic procedures. Methods: This study retrospectively reviewed 35 patients with complex distal ureteral stricture between January 2015 and April 2019. All patients were treated with Boari flap-psoas hitch by either an open or a laparoscopic procedure. Selection criteria were based on the etiology, comorbidities, medical history, and patient preference. Results: All surgeries were performed successfully. The median operation time was 201 min (range, 120 to 300 min), and the median estimated blood loss was 50 mL (range, 20 to 400 mL). The median postoperative hospitalization was 9 days (range, 3 to 46 days). Nineteen patients were treated by the open procedure, and 16 were treated by the transperitoneal laparoscopic procedure. The surgical indication of open surgery was broader than that for laparoscopic surgery. For patients experiencing iatrogenic injury and ureterovesical reimplantation failure, no significant differences in sex, laterality, operative time, ASA score or postoperative hospitalization stay were observed between the two groups. The median estimated blood loss was lower in the laparoscopic group than in the open group (P=0.047). Patients in the open group had more surgical complications than patients in the laparoscopic group (P=0.049). The postoperative follow-up showed the radiological resolution of hydronephrosis in 33 patients. Conclusions: With the appropriate surgical considerations, Boari flap-psoas hitch is a valid method to bridge distal ureteral defects. For select patients, laparoscopic surgery had advantages being a minimal invasive surgery with less estimated blood loss and fewer surgical complications.

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Section: B a D Cmentioning

confidence: 99%

Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures

Ding¹,

Cheng²,

Li³

et al. 2021

Transl Androl Urol

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“…Реконструктивно-пластические лапароскопические операции на мочевыводящих путях трансплантированной почки на различных уровнях (в области лоханки, на протяжении мочеточника, в области анастомоза) по сравнению с открытыми хирургическими вмешательствами являются менее травматичными, в послеоперационном периоде пациент минимально нуждается в обезболивающих препаратах, происходит ранняя активизация больного, сокращаются сроки госпитализации, снижен риск развития нежелательных послеоперационных осложнений (инфицирование послеоперационной раны, послеоперационные вентральные грыжи) [8][9][10].…”

Section: заключениеunclassified

“…В зависимости от расположения и протяженности стриктур (в 73% случаях -в дистальной части, в 12% -в средней, в 15% -в проксимальной) наиболее распространенными методами их лечения являются бужирование, эндоскопическое рассечение холодным ножом, баллонная дилатация или хирургическая коррекция зоны стриктуры мочеточника трансплантата [2,5].…”

Section: Introductionunclassified

“…Лапароскопическая коррекция урологических осложнений на трансплантированной почке редко используется в клинической практике из-за сложности выполнения данной техники. Несмотря на это, обладает значительными преимуществами по сравнению с остальными методами лечения: лучшая визуализация, возможность прецизионной идентификации всех структур, что, в свою очередь, выражается в ускоренной реабилитации реципиентов почки после операции [5][6][7].…”

Section: Introductionunclassified

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Laparoscopic ureteral reconstruction in a kidney transplant: successful clinical cases

Saydulaev

Садовников

Биктимиров³

et al. 2021

RJTAO

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Treatment of ureteral strictures in the long-term post-transplant period is a complex surgical procedure. We present successful clinical cases of developed laparoscopic ureteral stricture reconstruction methods at three levels (in the pelvis, along the ureter, in the anastomosis area). These methods have shown their clinical efficacy: they are less traumatic, there are no adverse events in the early and long-term postoperative periods, and there is accelerated rehabilitation of recipients after surgery.

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“…These methods are used to repair ureteral defects of 4-5 and 6-10 cm respectively (3). In addition, other urinary tract reconstructive approaches, including ureteroureterostomy, ureteroneocystostomy with or without a psoas hitch and ureteral reimplantation with or without a psoas hitch, have been proven to be effective in repairing distal USD (4,5). However, tight adhesion and periureteral fibrosis greatly reduce the success rate of these treatments.…”

Section: Introductionmentioning

confidence: 99%

Terminal augmented ureteroplasty with bladder onlay flap technique for recurrent distal ureteral stricture after ureteroneocystostomy: an initial case series

Zhu

Yang

et al. 2021

Transl Androl Urol

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Background: Bladder flap has been shown to be a feasible treatment for distal ureteral stenosis; this technique has been improved such that it can be used to address complex urinary tract obstructions. The purpose of the present study was to describe a surgical technique of ureteroplasty with a bladder onlay flap, which consists of a nontransecting and terminal augmented anastomosis, for repairing recurrent distal strictures of the ureter.Methods: We retrospectively reviewed 6 patients who underwent this procedure between May 2018 and November 2019. These patients were diagnosed with distal ureteral stenosis and had previously undergone ureteroneocystostomy (one with a Boari flap) but suffered recurrence of flank pain. Patient characteristics, perioperative data and follow-up outcomes were gathered. The success of the operation was judged by symptomatic relief (subjective success) and improved radiographic imaging and renal function (objective success).Results: Preoperative computed tomography urography (CTU) showed hydronephrosis in all patients: severe hydronephrosis was observed in 83.3% of patients (5/6), and moderate hydronephrosis was observed in 16.7% (1/6). The mean stricture length was 2 cm. The mean operating time, estimated blood loss and postoperative hospital stays of the six patients were 193.3 min (160-270 min), 41.5 mL (10-58 mL) and 8.2 days (6-11 days), respectively. No serious complications (Clavien-Dindo grade ≥3) occurred during or after the operations. The mean follow-up time was 24.5 months (range, 14 to 29). The objective success rate was 83.3% (5/6), and the subjective success rate was 100%. Conclusions:Our technique of ureteroplasty with a bladder onlay flap by nontransecting and terminal augmented anastomosis is feasible and improves the recovery rate after the repair of recurrent distal ureteral stenosis. Patients who have had previous unsuccessful surgeries might benefit from this approach.

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Managing Mid and Lower Ureteral Benign Strictures: The Laparoscopic Way

Abstract: Laparoscopic treatment of benign ureteral strictures imparted excellent outcomes without major complications with the advantage of the minimally invasive technique.

Cited by 13 publications

References 19 publications

Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures

Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures

Laparoscopic ureteral reconstruction in a kidney transplant: successful clinical cases

Terminal augmented ureteroplasty with bladder onlay flap technique for recurrent distal ureteral stricture after ureteroneocystostomy: an initial case series

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