Urinary anastomotic complications following renal transplantation cause significant patient morbidity. In ureteric reconstruction, different techniques are used to reduce complications (such as leakage or obstruction). In this study, we suggested two aspects of management of the complications of ureteral anastamosis: ureteral spatulation more than 10 mm for prevention and percutaneous nephrostomy and balloon dilatation as the first steps of treatment. A sequential double-blind random trial with 170 kidney transplant recipients was performed, dividing the patients into two groups: group 1 patients had ureteral spatulation length ≤ 10 mm (70 recipients) and group 2 patients had ureteral spatulation ≥ 10 mm (100 recipients). In patients with ureteral stenosis, percutaneous nephrostomy (PCN) and balloon dilatation were used as the first step of treatment. The mean age was 44 ± 4.2 years. Before and after removing the double J stent, ureteral complications that needed surgical intervention occurred in 16/70 recipients in group 1 (20.3%) and in eight/100 recipients in group 2 (8%). There is a significant difference between the two groups (P < 0.05). PCN and balloon dilatation were performed in 24 patients with ureteral stenosis. Eleven patients had a good response and 13 patients underwent surgical procedures (in four of theses patients, ileal interposition was used for repairing the ureteral defects). In conclusion, ureteral spatulation more than 10 mm in prevention of ureteral stenosis and use of PCN and balloon dilatation in the first step of treatment of ureteral obstruction should be the management choice for these patients.
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- * Results showed that EUSSS-MLP significantly reduced the time needed for ureteral preparation and double-J stenting (5.7 minutes vs. 19.2 minutes) and had a lower overall surgery duration compared to the traditional method.
- * There were no notable differences in postoperative complications or success rates between the two groups, indicating that EUSSS is a safe and effective option for pediatric laparoscopic pyeloplasty
Background: At our center, surgical modifications to the conventional kidney transplant technique were developed with two goals in mind: to minimize the risk of developing post-transplant urologic/vascular/other surgical complications, and to simultaneously eliminate the need for initial ureteral stent placement and surgical drainage.
Methods: Here, the authors describe these modifications along with (what we believe are) their advantages over the conventional technique: creating an abdominal flap for easier abdominal closure (reflecting the parietal peritoneum from the abdominal wall), mobilizing the bladder before transplant (creating more space for bladder dissection, allowing it to move upward during abdominal wall closure), minimizing the dissection of iliac vessels to only anterior lymphatic tissue (attempting to minimize the incidence of fluid collections), using plastic arterial vascular bulldog clamps (causing less trauma to the iliac artery), performing vascular anastomosis of the renal artery first (making it easier for the surgeon to perform the anastomoses), creating longer ureteral spatulation, and inclusion of bladder mucosa along with some detrusor muscle layer in performing the ureteral anastomosis (attempting to minimize the incidence of urologic complications). Of note, no initial ureteral stent placement or surgical drainage was used.
Robotic Ureter Reimplantation After Urinary Diversion.
Urology
July 2024
Department of Urology, Kantonsspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland; Department of Urology, Kantonsspital Münterlingen, Spital Thurgau AG, Münsterlingen, Switzerland.
Introduction: Benign ureterointestinal anastomotic stricture (UIAS) is a recognized long-term complication following radical cystectomy with urinary diversion (UD). The incidence of UIAS following robotic-assisted radical cystectomy varies, with reported rates ranging from 6.5%-25.
View Article and Find Full Text PDFRobot-Assisted Ureteroplasty with Labial Mucosal Onlay Grafting for Long Left-Sided Proximal Ureteral Stenosis in Children and Adolescents: Technical Tips and Functional Outcomes.
J Endourol
March 2024
Department of Pediatric Urology, Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China.
To evaluate functional outcomes of robot-assisted ureteroplasty with labial mucosa grafting for long proximal ureteral stenosis (LPUS) in children and adolescents. Included in this study were 15 patients who underwent robot-assisted ureteroplasty with labial mucosal grafting in our center between July 2017 and September 2021. The left affected stenotic ureter was repaired using labial mucosal grafting.
View Article and Find Full Text PDFA Pilot Study to Determine the Role of Spatulating the Ureter During Pyeloplasty in Children for Ureteropelvic Junction Obstruction in the Robotic Era.
J Laparoendosc Adv Surg Tech A
February 2024
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Spatulation during ureteropelvic junction obstruction repair was evaluated in children treated by robot-assisted retroperitoneal pyeloplasty anastomosis (RRPA). Intraoperative video recordings (IVRs) of RRPA ( = 22 ureters) performed at a single institute between 2018 and 2022 were reviewed blindly by 5 independent surgeons for perceived difficulty of suturing (DOS; 5 = impossible; 4 = difficult; 3 = tedious; 2 = slow; 1 = easy) and spatulation ranking as superior (+1), inferior (-1), or unnecessary (0). The retroperitoneal space was accessed in the lateral decubitus position using a closed technique under direct vision to avoid air leakage and subcutaneous emphysema.
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