Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy
AbstractPurposeTo present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios.MethodsFrom March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2 –6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, whi le appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures.ResultsA total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2–6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time (P = 0.008), shorter postoperative hospital stay (P = 0.011) but higher hospital cost (P
Conclusion: Spiral bladder muscle flap with vascular pedicles may be used to repair extensive ureteric injury.
CONCLUSION: Though surgically challenging with increased recurrence rates according to the literature we reviewed. However, our data failed to show any significant difference between the primary and redo RALP perhaps due to the smaller size in the redo RALP group. PMID: 32748388 [PubMed - as supplied by publisher]
Conclusion: Current evidence suggests the effectiveness, safety and increasing incorporation of minimally invasive techniques for complex stricture repair and reconstruction.
We report on two cases treated with our standardized laparoscopic technique using only three 5-mm trocars. The proposed approach could be considered as the first-line treatment for RCU. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | open access Full text
We report a case of ureteral diverticulum due to ureterosciatic hernia in an 85-year-old woman admitted for septic shock. Computed tomography and retrograde ureterography revealed obstructive ureterosciatic hernia. During intraoperative laparoscopic mesh repair for the hernia after urosepsis treatment, we noted ureteral diverticulum that was also detected endoscopically at the herniated ureter wall.
Conclusions: Robotic transperitoneal approach may shorten the operative time enabling a greater comfort in repair of RCU.
CONCLUSION: In the L/R R of the VVF, the Extravesicaltechnique offers technical and perioperative advantages,so it must be the technique of choice for most VVFwith indication of abdominal approach. Transvesicaltechnique should be reserved for recurrent, recurrent,inflammatory fistulas, with difficulties identifying the fistulous orifice, close to ureteric orifice and with imminent need for ureteral reimplantation. PMID: 32124839 [PubMed - in process]
We will present two cases which suffered from ureteral vaginal fistula after hysterectomy and underwent repair at our institute.
Bochdalek hernia (BH) is a postero-lateral diaphragmatic congenital defect. Although most commonly diagnosed at birth, 0.17-6% of cases can also be seen in adults.A third of the cases may contain abdominal organs like small bowel, kidney or spleen.In our literature search we only found 3 reported cases of urinary obstruction secondary to herniation of the renal pelvis through a BH. Here we describe a rare case of upper urinary tract obstruction caused by a BH successfully treated by laparoscopic surgery in our center.
Bochdalek hernia (BH) is a posterolateral diaphragmatic congenital defect. Although most commonly diagnosed at birth, 0.17%-6% of cases can also be seen in adults.A third of the cases may contain abdominal organs like small bowel, kidney, or spleen.In our literature search, we only found 3 reported cases of urinary obstruction secondary to herniation of the renal pelvis through a BH. Here we describe a rare case of upper urinary tract obstruction caused by a BH successfully treated by laparoscopic surgery in our center.