Reconstruction of full-length ureter defects by laparoscopic bladder flap forming

Abstract

To evaluate the safety and efficacy of laparoscopic bladder muscle flap reconstruction in the treatment of extensive ureteral avulsion. Patients with full-length (re length > 20 cm) and upper ureteral (avulsion length > 10 cm) defects were eligible. All patients were treated with laparoscopic bladder muscle flap reconstruction. Peri-operative information and post-operative complications were recorded. The kidney function, urinary ultrasound or computed tomography (CT), sun-renal function tests emission computed tomography (ECT) and cystography after operation were recorded. Ten patients were included (7 with full-length and 3 with upper ureteral defects). Median age was 56 years and 70% of them were female. The average operation time and blood loss was 124 min and 92.2 ml. There was no treatment-related adverse effects including urinary leakage, renal colic, fever, etc. The median follow-up was 18.5 months (3–39 months). The surgery did not significantly alter the renal function and separation degree of the renal pelvis during long-term follow-up. Double J stents were removed in nine patients (90%) within six months after operation. Only one case was diagnosed with post-operative anastomotic stricture, and subsequently received laparoscopic ipsilateral nephrectomy one year after the reconstruction operation. All cases had normal voiding and pear-shaped cystography. Laparoscopic bladder flap repair is a safe and effective treatment approach together with several advantages for patients with full-length or upper ureteral avulsion.

Iatrogenic Ureteral and Colonic Injuries During Emergency Cesarean Section: A Lesson Learned from a Surgical Catastrophe – A Case Report

“…However, it may reduce bladder capacity and is ineffective for longer ureteral defects (more than 15 cm). 14 In our case, the defect was in the med ureter, the procedure was successful, and postoperative bladder capacity and ureteral caliber were acceptable.…”

“…Psoas bladder hitch, ureter replacement, renal auto-transplantation, Boari flap, and nephrectomy are all suggested surgical procedures. 14 Boari flap procedure is usually used in affected distal or mid ureter without needing bowel segment resection or bladder augmentation. However, it may reduce bladder capacity and is ineffective for longer ureteral defects (more than 15 cm).…”

Laparoscopic ureteroneocystostomy with bladder flap for benign ureteral stenosis: our initial experience

“…Boari bladder flap is usually used for bridging long defect up to 15cm 20 , 21 . Bai et alreported their laparoscopic reconstructive experience with bladder muscle flap for treating full-length ureteral defect, and the longest length was 21 cm 22 . In our study, the median defect length was 6 cm, ranging from 5 to 17 cm.…”

“…Compared with open surgery, laparoscopic reconstructive technique superior in terms of less blood loss, fewer complications, and better cosmetic outcomes 1 , 23 . Numerous studies have demonstrated satisfactory outcomes and acceptable complications of laparoscopic bladder flap surgery 21 , 22 , 24 , 25 . Laparoscopy has specificities of magnifying effect and extremely clear vision, which could avoid excessive dissection of the healthy ureter, achieve effect of mucosa -mucosa anastomosis and maximize protection of the ureteral blood supply.…”

Laparoscopic onlay lingual mucosal graft ureteroplasty combined with ureterovesical reimplantation for one-stage reconstruction of complex ureteral strictures: a case report

“…The anastomotic stoma was covered with the greater omentum during the operation. Not only can the greater omentum reduce the occurrence of urine leakage, but its blood supply can also increase the nutritional supply of the anastomosis and reduce the chance of necrosis and stenosis (18). The laparoscopic onlay of LMG ureteroplasty combined with ureterovesical reimplantation for one-stage reconstruction of unilateral complex ureteral strictures, as compared with traditional IUR and kidney autotransplantation, shortens the operation time and reduces the incidence of complications, which is beneficial to the rapid recovery of patients after operation.…”