Totally Intracorporeal Replacement of the Ureter Using Whole-Mount Ileum (original) (raw)
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Robotic Ileal Ureter: A Completely Intracorporeal Technique
Urology, 2014
The first laparoscopic case of ileal interposition was reported in 2000, proving the feasibility of the procedure in a minimally invasive fashion by duplicating the principles of open surgery. Robotic applications in urology are expanding worldwide, given the unique features of the robotic platform, which facilitates more advanced laparoscopic procedures. In this study, we report a case of completely intracorporeal robotic ileal ureter and thoroughly describe our technique for this complex minimally invasive procedure. A 50-year-old gentleman with a history of right renal stones underwent multiple right ureteroscopies and thereafter developed 2 proximal ureteral strictures of 5 mm. Preoperative estimated glomerular filtration rate was 71 mL/min/1.73 m(2). Renal scan showed preserved function. The treatment options were discussed, and the patient elected to undergo a robotic ileal ureter interposition. Total operative time was 7 hours, the estimated blood loss was approximately 50 mL, and the patient progressed to regular diet on postoperative day 4 without any problem, being discharged without complications. On the postoperative day 12, a cystogram demonstrated no extravasation, and the Foley catheter was removed. After 1 month, renal scan showed the left kidney with 60.1% and the right kidney with 39.9% of total renal function. At 2 years follow-up, his serum creatinine was 1.14 and estimated glomerular filtration rate was 70 mL/min/1.73 m(2). Robot-assisted laparaoscopic ileal ureter with a completely intracorporeal technique is feasible and appears to be safe. A larger number of procedures using this technique and longer follow-up are needed to further define its role in the treatment of ureteral strictures.
Long‐term results of ileal ureteric replacement: a 25‐year single‐centre experience
BJU International, 2017
ObjectiveTo report the long‐term outcomes of ileal ureteric replacement (IUR) in complex reconstruction of the urinary tract.Patients and MethodsFrom 1991 to 2016, IUR was performed in 157 patients with structural or functional ureteric loss. In 52 patients, bilateral IUR became necessary. Implantation sites where either the native urinary bladder (n = 79) or intestinal reservoirs (n = 78). In the latter group, the technique was used at the time of primary urinary diversion (n = 34), in a secondary approach (n = 29), and in undiversion or conversion procedures (n = 15). Anti‐refluxive implantation was performed in 37 patients. In eight patients the ileal ureter was implanted into the cutis as an ileal conduit. All patients were followed prospectively according to a standardised protocol.ResultsThe mean follow‐up was 54.1 months. In 114 patients with dilatation of the upper urinary tract before surgery a significant improvement of the dilatation was confirmed in 98 patients. Serum cr...
Journal of Urology, 1960
Preservation of renal function, after destruction of the ureter by trauma or disease, requires either replacement of the ureter or external diversion of urine. Attempts have been made, experimentally, to replace the ureter entirely or in part with transplanted arteries, veins, skin tubes, fascial tubes, free peritoneal flaps, free ureteral autografts, pedieled flaps of abdominal wall, pedicled segments of fallopian tube, appendix, and with prostheses of various types. 1 Failure has been usual and may have resulted from lack of peristaltic function in the substituted segment, an unsuitable epithelial lining, lack of viability, inadequate blood supply, infection, or other factors. The upper end of the ureter can be reconstructed, successfully, by using flaps of renal pelvis and the lower end by using flaps of bladder. Longer portions of the ureter can be replaced by pedicled segments of the terminal ileum, with 2 or without 3-13 surgical reduction in the caliber of
Case Report: Complex ureteral stenosis treated with ileal substitution
F1000Research, 2018
Ileal substitution of the ureter is a complex procedure, considered a surgery of the last resort in ureteral repair and is useful in the presence of an extensive ureteral stricture. It is indicated in cases of long or multiple ureteral stenosis. There are few large studies in the literature reporting the outcome of this procedure. We present a case report of a patient with long ureteral stenosis surgically treated with ileal substitution of the right ureter, with an isoperistaltic ileal segment of 22 cm, with no detubularization. The patient had no perioperative complications and presented normal renal function. Currently, after 20 months of follow-up, the patient is asymptomatic, presents no urinary infections, no relapse of stenosis and has preserved renal function. In conclusion, ileal substitution of the ureter is a surgical technique that should be considered in cases of long, proximal or multiple ureteral stenosis, when there is no other surgical option.
Long-Term Results of Ileum Interposition for Ureteral Obstruction
European Urology, 2002
Objective: To present the long-term results of ileum interposition in the ureter for uni-or bilateral ureteral obstruction. Patients and Methods: Between 1981 and 2000, a total of 22 patients received an ileal segment interposition as a substitution for the ureter, of whom 18 were available for analysis. The mean age was 54 years (range 29±73). Patients were followed for a mean period of 65 months (range 2±196). Assessment included clinical examination, serum creatinine levels, renal ultrasonography, intravenous pyelography and isotopic renography. In eight patients, the ileal-ureteral substitution was the ®rst reconstructive procedure. The other patients underwent up to four previous reconstructions of different types. Fourteen patients were treated for unilateral ureteral obstruction, four of whom had a functional or anatomical solitary kidney, the other four patients had bilateral obstruction. Results: In 16 patients renal function improved after ileal-ureteral substitution. One patient underwent a nephrectomy because of a decreased renal function due to an obstruction at the level of the uretero-ileal anastomosis. One patient had a nephrectomy because of recurrent macroscopic hematuria caused by multiple arterio-venous malformations. Overall, 15 patients (83%) had a good functioning kidney after a mean period of 65 months. In three patients an early reintervention was necessary because of bleeding, small bowel obstruction and urinary leakage from a pyelo-ileal anastomosis. Six patients required a reintervention in the long-term: two had a nephrectomy, three had a re-anastomosis between the renal pelvis and the proximal ileal segment, while the sixth patient underwent a PNL for a kidney stone. Recurrent urinary tract infections were seen in six patients, of whom three had to undergo a reintervention. Metabolic acidosis was detected in two patients and was treated with sodium bicarbonate substitution. Conclusion: Ileal-ureteral substitution is a valuable procedure with good long-term results and an acceptable rate of secondary interventions in patients for whom other alternatives are not feasible.
Urology, 2012
OBJECTIVE To present our experience and outcomes with robotic mid and distal ureteral reconstruction and to compare these results with our previous laparoscopic series. METHODS In an institutional review board-approved retrospective study, 16 patients underwent robotic mid and distal ureteral repair (13 ureteral reimplantations and 3 ureteroureterostomies) at our institution from August 2008 to September 2011. Proximal ureteral stricture, extrinsic obstruction, and ureteropelvic junction obstruction cases were excluded. The demographic, perioperative, and postoperative data were reviewed in the reimplantation and ureteroureterostomy robotic groups. These data were compared with the outcomes from our previously published series on laparoscopic ureteral reimplantation. RESULTS The data from 16 robotic procedures were included in the present study, including 2 open conversions because of excessive scar tissue. A symptomatic bowel injury (Clavien grade IIIb) occurred in 1 case. In our previous series, 5 of the 6 laparoscopic procedures were performed completely laparoscopically with 1 open conversion for anastomosis completion. No major complications occurred. The mean robotic surgery time was 258.6 minutes (range 146-450) compared with 276.5 minutes (range 180-360) for the laparoscopic group. The mean robotic hospital stay was 2.5 days (range 1-8) compared with 2.7 days (range 2-5) for the laparoscopic group. The mean robotic estimated blood loss was 171 mL (range 30-500) compared with 150 mL (range 50-250) for the laparoscopic group. All cases were clinically and radiographically successful at the last follow-up examination. CONCLUSION Although early in our experience, the robotic repair of mid and distal ureteral strictures appears to be an efficacious approach comparable to laparoscopy for such conditions. UROLOGY 80: 596-601, 2012.