Stentless repair of left urethral defect with appendiceal interposition: A case report

Avci, Emran Kuzey; Atıcı, Semra Demirli; Uylaş, Ufuk; Kamer, Erdinç

doi:10.1016/j.ijscr.2022.106805

Cited by 3 publications

(3 citation statements)

References 14 publications

(30 reference statements)

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“…When a ureteral stricture is radiation-induced, the appendix may have been excluded from the field of radiation, allowing for replacement of the ureter with tissue that is non-irradiated and thus healthier ( 72 ). While many urologic surgeons would place a stent to maintain patency following robotic ureteral reconstruction with the appendix, recent reports of stentless appendiceal ureteroplasty have also yielded promising results ( 66 , 67 , 73 ).…”

Section: Resultsmentioning

confidence: 99%

Narrative review of flaps and grafts in robotic reconstructive urologic surgery

Doersch,

Hines,

Ajay

2024

Ann Laparosc Endosc Surg

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Background and Objective: Flaps and grafts are used for filling dead space, ureteral substitution, and as mesh alternatives. The surgical robot is invaluable in urologic reconstructive surgery due to the ability of the robot to reach the deep pelvis, its minimally invasive access, the ability to use indocyanine green to identify structures and assess tissue perfusion and viability, and ergonomics for the surgeon. Robotic reconstruction can involve tissue transfer in the form of flaps and grafts to provide form and function to organs that have been damaged by iatrogenic injuries, trauma, infections, cancer, radiation injury, or congenital abnormalities. Common flaps and grafts can be readily adapted to the robotic approach. In this literature review, we examine the robotic use of flaps and grafts in reconstructive urology. Methods: A thorough literature review was conducted via a PubMed search for predefined terms. Key Content and Findings: Flaps and grafts in reconstructive urology are used for interposition, ureteral substitution, and as mesh alternatives. Omental flaps are used for tissue interposition, or to provide structure and nutrients, and are easily employed with the robot. Various robotic applications of peritoneal flaps have been described. Vascular rectus abdominis musculocutaneous flaps are well-vascularized flaps that occupy dead space and provide structural support, which can be harvested readily with the robot. Sigmoid epiploica are an excellent flap for pelvic reconstruction. Gracilis flaps and fascia lata grafts are well-tolerated and provide space occupying tissue. Boari flaps aid in robotic ureteral reconstruction, especially in the setting of long defects. Oral mucosa is excellent for ureteral or bladder neck reconstruction. Rectal mucosa is well-tolerated and easy to harvest robotically for a variety of urinary tract reconstructive applications. The appendix or ileum can be interposed for repair of damaged ureters. Conclusions: Various flaps and grafts have been adapted for robotic reconstructive urology. As the field develops, refinement of techniques and innovation in flaps and employment of the robot will propel this field forward. More studies, especially comparative studies, are needed to elucidate the flaps and grafts that are most likely to be successful with the least morbidity for each use case.

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Section: Resultsmentioning

confidence: 99%

Narrative review of flaps and grafts in robotic reconstructive urologic surgery

Doersch,

Hines,

Ajay

2024

Ann Laparosc Endosc Surg

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“…While ureteral reconstruction can also be performed using small and large intestine, the appendix offers several advantages over other intestinal conduits. Advantages include the match in size, less absorptive surface with less metabolite absorption and a lower risk of electrolyte disorders, and avoidance of intestinal resection and anastomosis [ 2 , 6–7 ]. Limitations to this operation include the finite length of the appendix and the inability to perform the operation if the appendix is absent, inflamed or damaged [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…An appendiceal graft is more suitable for right-sided ureteral reconstruction due to its inherent ipsilateral location. The use of an appendiceal graft for left-sided ureteral reconstruction has been reported but it is less common due to its higher complication rate [ 6 , 8 ]. The long-term success of appendiceal ureteral replacement in terms of satisfactory transport of urine and maintaining good renal function, has been documented [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Ureteral reconstruction with appendiceal interposition graft following resection of retroperitoneal leiomyosarcoma

Williams

Diallo

Issa

et al. 2023

Journal of Surgical Case Reports

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Ureteral defects can be repaired using a variety of different techniques that depend on the length and position of the defect. Here we describe a case where a long, upper-ureteral defect was successfully reconstructed using an appendiceal interposition graft. A 60-year-old female patient underwent resection of a right-sided retroperitoneal leiomyosarcoma that was encasing the entire upper ureter and obstructing the right kidney. The mass was resected en bloc, leaving behind an 11 cm ureteral defect. The defect was successfully reconstructed with an appendiceal interposition graft. Appendiceal interposition grafts are a feasible and effective approach for ureteral reconstruction in adults following oncologic resection. We describe various technical aspects that optimize the success of ureteral reconstruction.

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Complete left ureter replacement using appendiceal interposition

Ghenassia,

Baptiste Bedel,

Surlemont

et al. 2023

J Case Rep Images Urol

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Introduction: Emergency ureteral replacement for large defect, especially in dilapidated abdominal cancer surgery remains an important surgical challenge. Several methods have been described. Here we aimed to present the complete left ureter replacement using appendix interposition, after a large resection of a rectosigmoid mass invading both ureter and iliac artery. Case Report: A 64-year-old male patient diagnosed of a rectosigmoid hinge lesion invading the ureter and iliac artery. He underwent a large tumor resection. The left ureter was cut during the surgery below the renal pelvis with a loss of substance of more than 12 cm. The procedure involved replacement of the ureter by appendix interposition, with wire drainage by transvesicoparietal catheter and a bladder catheter. Neither ureterohydronephrosis nor urinary fistula was observed at the 2-month follow-up computed tomography. Conclusion: In our experience, appendiceal interposition in extensive left ureteral defect is a feasible and safe surgical option.

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Stentless repair of left urethral defect with appendiceal interposition: A case report

Cited by 3 publications

References 14 publications

Narrative review of flaps and grafts in robotic reconstructive urologic surgery

Narrative review of flaps and grafts in robotic reconstructive urologic surgery

Ureteral reconstruction with appendiceal interposition graft following resection of retroperitoneal leiomyosarcoma

Complete left ureter replacement using appendiceal interposition

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