Introduction:The main goal of managing an obstructed megaureter(OMU)is to preserve the function of the affected kidney.To preserve the upper urinary tract,end cutaneous ureterostomy(ECU)seems to be a promising tempori...Introduction:The main goal of managing an obstructed megaureter(OMU)is to preserve the function of the affected kidney.To preserve the upper urinary tract,end cutaneous ureterostomy(ECU)seems to be a promising temporizing option.We aimed to evaluate our experience with ECU in patients with primary and secondary OMU and to demonstrate an efficacy of robot-assisted laparoscopic takedown ureterostomy and subsequent extravesical ureteric reimplantation.Materials and methods:Retrospective analysis of patients that underwent ECU due to primary or secondary megaureter between 2003 and 2020.Nineteen patients(12 males,7 females)with a mean age of 4.2±3.5 months(mean±standard deviation)underwent ECU of 27 renal units.Of those,11(57.9%)had primary OMU and 8(42.1%)had secondary OMU.Undiversion was performed in 16(84%)out of 19 patients(20 renal units out of 27[74%]).Results:In the vast majority of the cases,we have observed improvement in the hydronephrosis and renal function after ureterostomy.After reimplantation ultrasonography showed either stable or further improvement in hydronephrosis in 80%of patients.Robot-assisted laparoscopic patients had shorter admission period and indwelling catheter time after the surgery.Conclusions:End cutaneous ureterostomy is a safe and effective temporary procedure for the treatment of progressive primary and secondary megaureters.Robot-assisted laparoscopic takedown of ureterostomy with subsequent reimplantation seems to be a good alternative for undiversion and subsequent reimplantation in these patients.展开更多
Purpose:To summarize our experience in the management of congenital anomalies in the kidney and urinary tract(CAKUT)in adults.Materials and methods:We conducted a retrospective chart review of all adult patients who u...Purpose:To summarize our experience in the management of congenital anomalies in the kidney and urinary tract(CAKUT)in adults.Materials and methods:We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021.Results:The study included 102 patients with a median age of 25(interquartile range,23-36.5).Of these,85(83.3%)patients reported normal prenatal ultrasound,and the remaining 17(16.7%)patients were diagnosed with antenatal hydronephrosis.These patients were followed-up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care.All studied adult patients presented with the following pathologies:67 ureteropelvic junction obstructions,14 ectopic ureters,9 ureteroceles,and 6 primary obstructive megaureters,and the remaining 6 patients were diagnosed with vesicoureteral reflux.Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles.Notably,67%of patients underwent pyeloplasty,9%underwent endoscopic puncture of ureterocele,3%underwent ureteral reimplantation,6%underwent endoscopic correction of reflux,7%underwent partial nephrectomy of non-functioning moiety,and the remaining 9%underwent robotic-assisted laparoscopic ureteroureterostomy.The median follow-up period after surgery was 33 months(interquartile range,12-54).Post-operative complications occurred in 5 patients(Clavien-Dindo 1-2).Conclusions:Patients with CAKUT present clinical symptoms later in life.Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility,and children should be appropriately counseled when they enter adolescence.Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.展开更多
文摘Introduction:The main goal of managing an obstructed megaureter(OMU)is to preserve the function of the affected kidney.To preserve the upper urinary tract,end cutaneous ureterostomy(ECU)seems to be a promising temporizing option.We aimed to evaluate our experience with ECU in patients with primary and secondary OMU and to demonstrate an efficacy of robot-assisted laparoscopic takedown ureterostomy and subsequent extravesical ureteric reimplantation.Materials and methods:Retrospective analysis of patients that underwent ECU due to primary or secondary megaureter between 2003 and 2020.Nineteen patients(12 males,7 females)with a mean age of 4.2±3.5 months(mean±standard deviation)underwent ECU of 27 renal units.Of those,11(57.9%)had primary OMU and 8(42.1%)had secondary OMU.Undiversion was performed in 16(84%)out of 19 patients(20 renal units out of 27[74%]).Results:In the vast majority of the cases,we have observed improvement in the hydronephrosis and renal function after ureterostomy.After reimplantation ultrasonography showed either stable or further improvement in hydronephrosis in 80%of patients.Robot-assisted laparoscopic patients had shorter admission period and indwelling catheter time after the surgery.Conclusions:End cutaneous ureterostomy is a safe and effective temporary procedure for the treatment of progressive primary and secondary megaureters.Robot-assisted laparoscopic takedown of ureterostomy with subsequent reimplantation seems to be a good alternative for undiversion and subsequent reimplantation in these patients.
文摘Purpose:To summarize our experience in the management of congenital anomalies in the kidney and urinary tract(CAKUT)in adults.Materials and methods:We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021.Results:The study included 102 patients with a median age of 25(interquartile range,23-36.5).Of these,85(83.3%)patients reported normal prenatal ultrasound,and the remaining 17(16.7%)patients were diagnosed with antenatal hydronephrosis.These patients were followed-up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care.All studied adult patients presented with the following pathologies:67 ureteropelvic junction obstructions,14 ectopic ureters,9 ureteroceles,and 6 primary obstructive megaureters,and the remaining 6 patients were diagnosed with vesicoureteral reflux.Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles.Notably,67%of patients underwent pyeloplasty,9%underwent endoscopic puncture of ureterocele,3%underwent ureteral reimplantation,6%underwent endoscopic correction of reflux,7%underwent partial nephrectomy of non-functioning moiety,and the remaining 9%underwent robotic-assisted laparoscopic ureteroureterostomy.The median follow-up period after surgery was 33 months(interquartile range,12-54).Post-operative complications occurred in 5 patients(Clavien-Dindo 1-2).Conclusions:Patients with CAKUT present clinical symptoms later in life.Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility,and children should be appropriately counseled when they enter adolescence.Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.
