Ureteral Replacement and Onlay Repair with Reconfigured Intestinal Segments

Ordorica, Raul; Wiegand, Lucas; Webster, J. Christopher; Lockhart, Jorge L.

doi:10.1016/j.juro.2013.11.027

Cited by 43 publications

(22 citation statements)

References 16 publications

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“…Recent work to mitigate metabolic derangements and mucus production includes a report on the use of reconfigured intestines as an onlay flap on a preserved ureter, which minimizes necessary bowel length. 26 …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…In addition, this patient's appendix vermiformis was not long enough to compensate for the lost ureteral tissue without performing nephrectomy. IPAV was previously described for ureteral injuries that require replacement, but not in association with simultaneous RAT [24,25]. To the best of our knowledge, this is the first report combining RAT with IPAV.…”

Section: Discussionmentioning

confidence: 94%

Renal Autotransplantation at Three Academic Institutions in Turkey

et al. 2016

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Objective: The objective of this study is to present the experience of 3 institutions performing renal autotransplantation (RAT) and to discuss surgical techniques employed and the results in the light of the medical literature. Materials and Methods: A total of 14 patients (11 male and 3 female) with a mean age of 47 ± 8 years (35-61 years), who underwent RAT procedure at 3 different institutions between October 2006 and November 2014, in Turkey, were evaluated retrospectively. Indications for RAT procedure are ureteral avulsion, renal artery aneurysm and intimal dissection caused by percutaneous transluminal renal artery angioplasty (PTRA). Twelve patients with ureteral avulsion, 1 patient with renal artery aneurysm and 1 patient with intimal dissection caused by PTRA were followed-up for 103 months. Seven (50%) open and 7 (50%) laparoscopic nephrectomies were performed. Nine patients (64.3%) were right-sided and 5 patients (35.7%) were left-sided. Complications of grade III and above as per Clavien-Dindo classification were assessed. Results: Mean time from injury to RAT was 21.2 ± 40.1 days. However, 5 (35.7%) patients were treated on the same day of the injury. As per Clavien-Dindo classification, 2 (14.2%) grade IVa and 1 (7.1%) grade IIIa complications were reported. However, no significant correlation was observed between the complications and graft loss regarding type and side of the nephrectomy performed (p = 0.462 and p = 0.505, respectively) and timing of the intervention (p = 0.692). Conclusion: RAT is a safe procedure in combination with minimally invasive laparoscopic technique in carefully selected patients; however, it requires expertise and proficiency in laparoscopy, reconstructive urology and transplantation. Nevertheless RAT should be considered as the last resort, when other modalities fail.

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“…The frequently used grafts for urethroplasty include small intestine [2] and autografts derived from the buccal mucosa and foreskin [71,72]. Other grafts for urethroplasty include human tissues (i.e., lingual mucosa, bladder mucosa, and appendix) or biomaterials (e.g., acellular collagen matrix and small intestine submucosa) [73][74][75].…”

Section: Urethral Surgeriesmentioning

confidence: 99%

Pericardium in Reconstructive Urologic Surgeries: A Systematic Review and Meta-Analysis

Hosseini

et al. 2018

Urol Int

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Introduction: The use of pericardium has been expanded into different surgical modalities; however, there are scarce data regarding the feasibility of the pericardium in reconstructive urologic surgeries. We systematically reviewed the literature on the effectiveness of the pericardial tissue for reconstructive urologic surgeries. Materials and Methods: PubMed and Scopus were searched online for evidence on the use of the pericardium in urologic surgeries. Through the methodology recommended by the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 38 of 4,071 studies were identified. Results: A total of 715 patients and 139 animals underwent reconstructive urologic surgeries using the pericardium. Bladder, urethral, and renal reconstructions were successful in 100% of the human cases. The rates of dissatisfaction, glans hypoesthesia, and penile shortening were comparable between the pericardial graft surgeries and the other operations during penile straightening, but there was a trend among the patients with pericardial grafts toward having a more penile curvature at follow-up (risk ratio [RR] 2.03, 95% CI 0.90–4.61, p = 0.09; I² = 0%). Among the animal studies, there were 4 reports of penile reconstruction, 7 studies of bladder reconstruction, and 1 study of urethroplasty. Bladder reconstruction and urethroplasty were successful in 83 and 20% of the animals, respectively. The pooled result of the stimulated intracorporeal pressure 5 V significantly favored pericardial grafts during penile reconstruction (RR 2.61, 95% CI 1.26–3.97, p = 0.0002; I² = 0%). Conclusions: Our systematic review demonstrates the feasibility of the pericardium, regardless of its type, in urologic surgeries. It, however, seems that urethral substitution needs further investigation. Given the lower cost, easier handling, and less immunogenicity of the pericardium, further studies are required to examine its pros and cons.

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Ureteral Replacement and Onlay Repair with Reconfigured Intestinal Segments

Cited by 43 publications

References 16 publications

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

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

Renal Autotransplantation at Three Academic Institutions in Turkey

Pericardium in Reconstructive Urologic Surgeries: A Systematic Review and Meta-Analysis

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