Ureteral Reconstruction With Bowel Segments: Experience With Eight Patients in a Single Institute

Takeuchi, Mio; Masumori, Naoya; Tsukamoto, Taiji

doi:10.4111/kju.2014.55.11.742

Cited by 22 publications

(15 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…23 Other series have small numbers and short followup. 24 Although successful in most, bowel substitution can be limited by complications resulting from the violation of the gastrointestinal tract and can be catastrophic. 25 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability

et al. 2015

View full text Add to dashboard Cite

Purpose Laparoscopic nephrectomy with autotransplantation is a viable option when renal preservation is required or ureteral reconstruction is impossible. In this study we report on our long-term experience with laparoscopic nephrectomy with autotransplantation. Materials and Methods A retrospective review of data from all patients who underwent laparoscopic nephrectomy with autotransplantation since 2000 revealed data for 52 of 59 patients after study exclusions. Indications for laparoscopic nephrectomy with autotransplantation included ureteral stricture disease (41), renal malignancy (7), ptotic kidney (1), chronic flank pain (1), renal artery aneurysm (1) and renovascular hypertension (1). Followup included ultrasonography, nuclear renography and computerized tomography. Complications analyzed were Clavien-Dindo grade III or higher. Results A total of 52 patients (30 women, 57.6%) underwent laparoscopic nephrectomy with autotransplantation at a median age of 48 years (range 12 to 76). At a median followup of 73.5 months 47 patients (90.3%) had long-term function of the autotransplanted renal unit including 3 of 4 (75%) solitary kidneys. There were 5 patients (9.7%) who experienced renal unit failure at a median of 15 months. Of these patients 3 required nephrectomy of autotransplant unit secondary to renal vein thrombosis (1 day), pseudoaneurysm (15 months) and chronic pain (48 months). Overall 4 patients had early complications and 8 had late complications. In the tumor group 4 patients had disease progression and all are alive. Conclusions Laparoscopic nephrectomy with autotransplantation is an excellent long-term surgical option (greater than 90% success rate with longer than 6-year median followup) for complex ureteral and renal conditions that necessitate preservation of renal parenchyma. However, tumor progression is possible after ex vivo tumor excision. Therefore, careful patient selection and followup are mandatory. This report supports the safety, efficacy and durability of laparoscopic nephrectomy with autotransplantation in experienced hands.

show abstract

Section: Discussionmentioning

confidence: 99%

“…24 Harvesting bowel necessitates restoring bowel continuity, which exposes the patient to the risks of strictures at the bowel anastomosis, and small bowel obstructions. 25 The problems with bowel interposition are widely known.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability

et al. 2015

View full text Add to dashboard Cite

show abstract

“…There is risk of fistula formation[ 6 7 8 ] and anastomotic leak. [ 1 ] However, none of such complications were encountered in our study which included five patients with prior history of radiation for pelvic malignancy. This might be due to use of proximal healthy ileum with minimal grossly visible radiation changes.…”

Section: Discussionmentioning

confidence: 93%

“…These defects are classified as simple or complex on the basis of length of the involved segment and associated nephropathy. [ 1 ] This classification is important because the surgical options for management of complex long-segment ureteral defects are limited. Use of ileal segment is indicated in these cases; however, the technique is challenging and outcomes need to be assessed in detail.…”

Section: Introductionmentioning

confidence: 99%

Use of ileum for complex ureteric reconstruction: Assessment of long-term outcome, complications, and impact on renal function

et al. 2018

View full text Add to dashboard Cite

Introduction:Defect in ureteral continuity can be due to various etiologies. The surgical options for management of complex long-segment ureteric defects are limited. Use of ileum is indicated in these cases; however, the technique is challenging and outcomes need to be assessed in detail.Material and Methods:It is an observational study conducted over 4 years. After preoperative optimization, ureteric reconstruction was performed using standard techniques of ileal interposition in cases of unilateral and bilateral long-segment ureteric defects. Patients were followed up at regular interval to assess outcomes and see for complications.Results:A total of 14 patients were studied. Two most common indications for performing ileal ureter were iatrogenic injury and radiation-induced strictures (5–5 cases). Most common site of ureteric involvement was lower and midureter seen in 6 cases. The mean length of the ileum used was 11.2 cm. Mean preoperative nadir creatinine level was 1.57 mg/dL in this study. Average postoperative creatinine level at 4-week follow-up was 1.75 mg/dL and 1.45 mg/dL and 1.37 mg/dL, at 3 and 12 months, respectively. The most common short-term complication was paralytic ileus and long-term complication was recurrent urinary tract infection UTI. There was no mortality.Conclusion:Ileal ureter is found to be relatively easy and safe surgery even in patients with borderline high creatinine. There was no worsening of renal function attributable to the conduit in this study. In patients with limited surgical options, it is a suitable alternative, rather than keeping patient on permanent percutaneous nephrostomy or regular stent change. Metabolic acidosis and mucous-associated complications such as pain, infection, and stone formation can be minimized by adherence to strict protocol.

show abstract

“…In the case of extensive ureteral resection, surgical reconstruction by means of end-to-end anastomoses remains a major issue. Various surgical techniques were employed such as the psoas hitch (Warwick and Worth, 1969 ), the Boari flap (Boari, 1894 ) and the downward mobilization of the respective kidney (Sullivan et al, 1982 ), as well as the replacement of the ureters with ileal or bladder tissue or even nephrectomy (del Pizzo et al, 1998 ; Corvin et al, 2004 ; Schlote et al, 2004 ; Wolff et al, 2011 ; Takeuchi et al, 2014 ). These surgical techniques were frequently accompanied by serious complications, ranging from mucus formation, stenosis, and infection to renal failure (Corvin et al, 2004 ; Schlote et al, 2004 ; Wolff et al, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

Tissue Engineering of Ureteral Grafts: Preparation of Biocompatible Crosslinked Ureteral Scaffolds of Porcine Origin

Koch

Hammer

Oßmann

et al. 2015

Front. Bioeng. Biotechnol.

View full text Add to dashboard Cite

The surgical reconstruction of ureteric defects is often associated with post-operative complications and requires additional medical care. Decellularized ureters originating from porcine donors could represent an alternative therapy. Our aim was to investigate the possibility of manufacturing decellularized ureters, the characteristics of the extracellular matrix (ECM) and the biocompatibility of these grafts in vitro/in vivo after treatment with different crosslinking agents. To achieve these goals, native ureters were obtained from pigs and were decellularized. The success of decellularization and the ECM composition were characterized by (immuno)histological staining methods and a DNA-assay. In vitro: scaffolds were crosslinked either with carbodiimide (CDI), genipin (GP), glutaraldehyde, left chemically untreated or were lyophilized. Scaffolds in each group were reseeded with Caco2, LS48, 3T3 cells, or native rat smooth muscle cells (SMC). After 2 weeks, the number of ingrown cells was quantified. In vivo: crosslinked scaffolds were implanted subcutaneously into rats and the type of infiltrating cells were determined after 1, 9, and 30 days. After decellularization, scaffold morphology and composition of ECM were maintained, all cellular components were removed, DNA destroyed and strongly reduced. In vitro: GP and CDI scaffolds revealed a higher number of ingrown 3T3 and SMC cells as compared to untreated scaffolds. In vivo: at day 30, implants were predominantly infiltrated by fibroblasts and M2 anti-inflammatory macrophages. A maximum of MMP3 was observed in the CDI group at day 30. TIMP1 was below the detection limit. In this study, we demonstrated the potential of decellularization to create biocompatible porcine ureteric grafts, whereas a CDI-crosslink may facilitate the remodeling process. The use of decellularized ureteric grafts may represent a novel therapeutic method in reconstruction of ureteric defects.

show abstract

Ureteral Reconstruction With Bowel Segments: Experience With Eight Patients in a Single Institute

Cited by 22 publications

References 20 publications

Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability

Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability

Use of ileum for complex ureteric reconstruction: Assessment of long-term outcome, complications, and impact on renal function

Tissue Engineering of Ureteral Grafts: Preparation of Biocompatible Crosslinked Ureteral Scaffolds of Porcine Origin

Contact Info

Product

Resources

About