Introduction:Distal ureteral obstruction has classically been managed by ureteroneocystostomy(UNC).The feasibility and success of robotic primary ureteroureterostomy(UU)for benign obstruction appears promising with se...Introduction:Distal ureteral obstruction has classically been managed by ureteroneocystostomy(UNC).The feasibility and success of robotic primary ureteroureterostomy(UU)for benign obstruction appears promising with several benefits over UNC but is poorly studied.Robotic repair offers superior visualization and precision,allowing for minimal ureteral dissection.Here we report on our experience and short-term outcomes.Materials and Methods:We identified patients who underwent robotic distal ureteroureterostomy for benign distal ureteral obstruction at our institution from 2020–2024.Etiology,stricture length,and post-operative outcomes were recorded.All patients had renal ultrasound(US),diuretic renography,or cross-sectional imaging within 6 months of repair.Results:Seven patients underwent distal UU from 2020–2024,with one case of bilateral repair for a total of 8 anastomoses.Iatrogenic injury from hysterectomy represented 5/8 injuries.The mean time between injury and repair was 3.5 months.All defects were 1–1.5 cm in length.At follow-up imaging,there was no evidence of obstruction in any patient with a median follow-up of 10 months,including diuretic renography in 5 of 7 patients.One patient had mild hydronephrosis on their initial renal US but with normal drainage on subsequent diuretic renography.All patients reported no flank pain at follow-up.Conclusions:Robotic UU is feasible for short,benign distal ureteral obstruction in carefully selected patients.Advantages over traditional UNC include a significantly shorter catheter time,no risk of vesicoureteral reflux,no effect on bladder capacity or function,and the ability to retain the native ureteral orifice.Continued research will elucidate the long-term efficacy of this approach.展开更多
Malignant ureteral obstruction may lead to renal function damage,renal colic,and infection.The impact of obstructive development on ureteral peristalsis was rarely studied,which requires further investigation.This stu...Malignant ureteral obstruction may lead to renal function damage,renal colic,and infection.The impact of obstructive development on ureteral peristalsis was rarely studied,which requires further investigation.This study used theoretical biomechanical methods to study the motion characteristics of the ureteral wall and obtained the radial motion equation of the ureteral wall.The motion equation was solved by 4-5th order Runge Kutta method.Analyze the motion equation of the ureteral wall,derive the expression for malignant obstructive ureteral pressure,as well as the analytical expressions for radial displacement and circumferential stress of the ureteral wall.By analyzing the radial motion equation of the ureter,it can be found that peristalsis is influenced by the pressure difference between inside and outside.The analytical solutions for radial displacement and stress contained exponential terms.Under the condition of 50%obstruction,the displacement and stress of the ureter were reduced by 90.53%and 81.10%,respectively.This study established the radial motion equation of the ureter and provided analytical solutions for the radial displacement and stress of the obstructed ureter.Based on the radial motion equation of the ureter,the radial motion characteristics of the ureteral wall were explored,including peristalsis and disappearance of peristalsis.This study provided a quantitative relationship between ureteral obstruction and peristalsis.As the degree of obstruction increased,ureteral peristalsis gradually weakened or even disappeared.展开更多
Objective:To present the surgical technique of robotic buccal ureteroplasty for strictures after laser lithotripsy and its outcomes.Methods:This was a retrospective study conducted at the Department of Urology,Apollo ...Objective:To present the surgical technique of robotic buccal ureteroplasty for strictures after laser lithotripsy and its outcomes.Methods:This was a retrospective study conducted at the Department of Urology,Apollo Hospitals,Chennai,India from October 2012 to October 2022.Indications for surgery included worsening hydronephrosis,declining renal function,and recurrent urinary tract infections with obstruction.Apart from liberal exposure of the stricture,we stress upon use of indocyanine green to assess vascularity and quilting of the graft to bare area of the psoas muscle to increase graft vascularity.Results:Among the 15 patients,ureteropelvic junction strictures were observed in eight(53%),while five(33%)had proximal ureteric strictures,and two(13%)had mid-ureteral strictures.Notably,eight of the 15 patients(53%)had previous unsuccessful double-J stenting.The median stricture length was 3.5(range:2.0–5.0)cm,with a mean operative time of 167(range:126–214)min and estimated blood loss of 60(range:40–100)mL.After a median follow-up of 12(range:4–32)months,13 out of the 15 patients(87%)showed significant improvement in their follow-up functional scans.Conclusion:Robotic buccal ureteroplasty is a very effective technique for the management of laser-induced ureteral strictures with good long-term results and minimal morbidity.The results are comparable irrespective of previous failed stenting.展开更多
Objective:To examine differences in outcomes of semi-rigid ureteroscopy(URS)with or without a modified-ureteral-access-sheath(mUAS)to treat large upper ureteral stones.Methods:Patients with single,radio-opaque large u...Objective:To examine differences in outcomes of semi-rigid ureteroscopy(URS)with or without a modified-ureteral-access-sheath(mUAS)to treat large upper ureteral stones.Methods:Patients with single,radio-opaque large upper ureteral stone(≥10 mm)treated using semi-rigid URS between August 2013 and October 2016 were retrospectively evaluated.The stone-free status was determined from Kidney-ureter-bladder(KUB)X-ray films taken on postoperative Day 1 and after 1 month.Results:Of 103 patients meeting inclusion criteria,43(41.75%)and 60(58.25%)were treated with semi-rigid URS with and without mUAS,respectively.The immediate stone-free rate(SFR)for the mUAS group was significantly higher than the non-mUAS group(40[93.0%]vs.46[76.7%];p=0.033).The SFR at 1 month was also high for patients treated using mUAS,but not statistically different from patients not treated with mUAS(41[95.3%]mUAS vs.51[85.0%]non-mUAS;p=0.115).Auxiliary procedure rates were significantly lower for mUAS patients compared to non-mUAS patients(2[4.7%]vs.14[23.3%];p=0.01).There were no significant differences in surgical duration and hospital stays,and the overall complication rates were statistically similar for mUAS patients compared to non-mUAS patients(1[2.3%]vs.3[5.0%];p=0.638).展开更多
Objective:To determine the feasibility of decellularized small intestinal submu-cosa(5IS)matrix in repairing ureteral strictures.Methods:Two patients with ureteral stenoses underwent ureteral reconstruction with SIS m...Objective:To determine the feasibility of decellularized small intestinal submu-cosa(5IS)matrix in repairing ureteral strictures.Methods:Two patients with ureteral stenoses underwent ureteral reconstruction with SIS ma-trix at the Zhejiang Provincial Corps Hospital of Chinese People's Armed Forces between June 2014 and June 2016.The ureteral stenoses were repaired with a semi-tubular SIS matrix and the postoperative recoveries were observed.Results:Both operations were successfully completed.The average operative time was 90 min and the average length of hospital stay was 15 days.No fevers,incision infections,intestinal obstruction,graft rejection,or other serious complications were noted.After 2 months,ure-teroscopic examinations showed that the surfaces of the original patches were covered by mu-Cosa and there were no apparent stenoses in the lumens.The ureteral stents were replaced every 2 months postoperatively and removed 12 months postoperatively.No infections or uri-nary leakage occurred after removal of the stents.Intravenous urography was performed 6 and 12 months postoperatively.The results showed that the ureters were not obstructed and there was no apparent stenosis at the anastomosis sites.The average follow-up time was>12 months.Long-term follow-up is still ongoing,and computed tomography examin ations of the urinary tract have been conducted in the outpatient department of our hospital 1,3,and 6 months after removal of the double-J stents,suggesting the absence of hydronephrosis.The serum creatinine levels remained stable during the follow-up.Conclusion:SIS matrix reconstruction is a feasible method to repair ureters stenosis.展开更多
Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral...Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.展开更多
Objective Ureteral lesions caused by impacted ureteral stones are likely to result in postoperative ureteral stricture.On this basis,the study aimed to investigate if dual-energy spectral computed tomography can predi...Objective Ureteral lesions caused by impacted ureteral stones are likely to result in postoperative ureteral stricture.On this basis,the study aimed to investigate if dual-energy spectral computed tomography can predict ureteral hardening caused by impacted stones and to explore the relationship between different types of ureteral lesions and the risk of ureteral stricture.Methods This prospective study collected data of 93 patients with impacted stones from hospital automation system during January 2018 to October 2019.They underwent an abdominal scan on a dual-energy spectral computed tomography.During surgery,the operator used ureteroscopy to identify ureteral lesions,which were classified into four categories:edema,polyps,pallor,and hardening.Seven months later,90 patients were reviewed for the degree of hydronephrosis.Results Endoscopic observations revealed 38(41%)cases of ureteral edema,20(22%)cases of polyps,13(14%)cases of pallor,and 22(24%)cases of hardening.There were significant differences in hydronephrosis,the period of impaction,the calcium concentration of the ureter,and the slope of the spectral Hounsfield unit curve between the four groups.After that,we evaluated the factors associated with ureteral hardening and found that the calcium concentration of the ureter and hydronephrosis remained independent predictors of ureteral hardening.Receiver operating characteristic curve analysis showed that 5.3 mg/cm^(3)calcium concentration of the ureter is an optimal cut-off value to predict ureteral hardening.The result of follow-up showed that 80 patients had complete remission of hydronephrosis,with a complete remission rate of 61.9%(13/21)in the hardening group and 97.1%(67/69)in the non-hardening group(p<0.001).Conclusion Calcium concentration of the ureter is an independent predictor of ureteral hardening.Patients with ureteral hardening have more severe hydronephrosis after ureteroscopic lithotripsy.When the calcium concentration of the ureter is less than 5.3 mg/cm^(3),ureteral lesions should be actively treated.展开更多
Objective:The aim of our study was to examine results of pyeloplasty using the new methoddsubadventitial resection of the ureter with preservation of the ureteral artery proposed by us and the possibility of using thi...Objective:The aim of our study was to examine results of pyeloplasty using the new methoddsubadventitial resection of the ureter with preservation of the ureteral artery proposed by us and the possibility of using this method in one-stage surgery with ureteropelvic junction(UPJ)and ureterovesical junction(UVJ)obstructions or vesicoureteral reflux.Methods:A retrospective analysis of 108 patients with hydronephrosis(including two patients with hydroureteronephrosis)who received treatment from March 1998 to March 2020 was carried out,with an average follow-up period of 36 months.Dismembered pyeloplasty using a subadventitial technique with preservation of ureteral blood supply was performed in 108 patients(including bilateral in two cases).In one patient with UPJ and UVJ obstructions and in one patient with UPJ obstruction and vesicoureteral reflux subadventitial resection of the ureter were performed in both segments.Results:All patients managed to preserve the integrity of the ureteral artery during dismembered pyeloplasty,and two patients simultaneously underwent ureterocystostomy by subadventitial resection of the ureter.The method of pyeloureteroplasty with subadventitial resection of the ureter makes it possible to improve long-term results in patients with hydronephrosis,including those with lesions of the UPJ and UVJ segments.In all cases,it was feasible to achieve a decrease in the degree of hydronephrosis.Postoperative complications were observed in five cases(4.6%),in none of which there were complications associated with the surgical technique,and were eliminated without loss of renal function.Conclusion:Our 22 years of experience shows that the technique of subadventitial resection of the ureter allows us to preserve the ureteral blood circulation during dismembered pyeloplasty and thus creates conditions for prevention of restenosis of UPJ and for single-stage ureteroplasty on the upper and lower ureteral segments.展开更多
Objective:Vesicoureteral reflux(VUR)index is a simple,validated tool that reliably predicts significant improvement and spontaneous resolution of primary reflux in children.The aim of this study was to evaluate and co...Objective:Vesicoureteral reflux(VUR)index is a simple,validated tool that reliably predicts significant improvement and spontaneous resolution of primary reflux in children.The aim of this study was to evaluate and compare the ureter diameter ratio(UDR)and VUR index(VURx)of patients treated with endoscopic injection(EI)and ureteroneocystostomy(UNC)methods in the pediatric age group due to primary VUR.Methods:Patients under the age of 18 years old who underwent EI and UNC with the diagnosis of primary VUR between January 2011 and September 2021 were determined as the participants.The UDR was assessed using voiding cystourethrography,and the VURx score was determined prior to treatment based on hospital records included in the study.Results:A total of 255 patients,60(23.5%)boys and 195(76.5%)girls,with a mean age of 76.5(range 13.0e204.0)months,were included in the study.EI was applied to 130(51.0%)patients and UNC was applied to 125(49.0%)patients due to primary VUR.The optimum cut-off for the distal UDR was obtained as 0.17 with sensitivity and specificity of 73.0%and 63.0%,respectively.The positive and negative predictive values were 66.0%and 70.0%,respectively.Conclusion:When the UDR and VURx score are evaluated together for the surgical treatment of primary VUR in the pediatric age group,it is thought that it may be useful in predicting the clinical course of the disease and evaluating surgical treatment options.展开更多
Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and ...Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and combination therapy with tamsulosin,silodosin,and tadalafil on stone expulsion rate(SER)and stone expulsion time(SET),as well as their comparative safety,numbers of colic pain episodes,and need for analgesics.Methods:Randomized controlled trials were retrieved by searching PubMed,Scopus,and Web of Science up to November 27,2023.Hand-searching was also conducted in Google Scholar to find additional records.Papers in English that compared the safety and efficacy of at least two of the above agents in adults with distal ureteral stones≤10 mm were included.Results:In total,27 studies were identified(six studies through database searches and 21 through checking reference lists and hand-searching in Google Scholar).More than half of them(n=15,56%)were conducted in India.The SER significantly improved with silodosin compared with tamsulosin(odds ratio[OR]2.24,p<0.001),whereas the difference in SET was non-significant.Tadalafil achieved a significantly higher SER compared with tamsulosin(OR 1.42,p=0.042)without any difference in SET.Subgroup analysis of 5-and 10-mg doses of tadalafil showed no significant difference in SER or SET.We found no significant difference in need for analgesics(mean difference(MD−53.73,p=0.2)or the mean number of colic episodes(MD−0.42,p=0.060)between tadalafil and tamsulosin.SER or SET was not significantly different between silodosin and tadalafil.Tadalafil plus tamsulosin led to a significantly higher SER(OR 1.87,p<0.001)and SET(MD−2.99,p=0.002)compared with tamsulosin,without any significant difference in adverse effects.Conclusion:Compared with tamsulosin,SER significantly improved with silodosin,tadalafil,and the combination of tadalafil plus tamsulosin.Meanwhile,the difference in SET was only significant between tadalafil plus tamsulosin versus tamsulosin.It appears that tadalafil and silodosin have similar efficacy in SET and SER.All medical expulsive therapies had comparable safety.展开更多
Objectives:Previous studies have shown conflicting results concerning the optimal duration of ureteral stenting after endourologic treatment of stone disease,its effect on patient comfort,and the necessity for emergen...Objectives:Previous studies have shown conflicting results concerning the optimal duration of ureteral stenting after endourologic treatment of stone disease,its effect on patient comfort,and the necessity for emergent,unscheduled care.This study assessed the impact of stent duration,sex,and other patient-associated factors on reported pain scores using a large,international prospective registry.Methods:A prospective observational patient registry on ureteral stents from 10 institutions in 4 countries(United States,Canada,France,and Japan)from 2020–2023 was assessed.The primary outcome was Patient-Reported Outcomes Measurement Information System(PROMIS)pain intensity scores administered on the day of stent removal,before stent removal.Patients were grouped by indwelling time(short,medium,and long),and pain scores were compared.The impact of sex,height vs.stent length,and presence or absence of tether were assessed.Results:359 patients were enrolled in the database,with outcomes analyzed for 268 patients with a unilateral stent placed after an endourologic procedure for stones.No significant difference was detected in pain scores between the indwelling time groups(p=0.41).Height for a given stent length was not significantly associated with pain scores.There was no difference in pain scores with or without tether.Men reported lower pain scores than women(p=0.018).Conclusions:This study did not detect an overall difference in pain scores reported at stent removal within or between stent duration groups.Men reported less pain than women in this study,suggesting that patient factors may be more important than indwelling time when optimizing pain management.展开更多
Objective To determine the impact of planned preoperative phenazopyridine administration on operative times and costs compared with as-needed intravenous agent use during routine cystoscopy following minimally invasiv...Objective To determine the impact of planned preoperative phenazopyridine administration on operative times and costs compared with as-needed intravenous agent use during routine cystoscopy following minimally invasive hysterectomy for benign indications.Method This prospective cohort study examined patients who underwent laparoscopic or robotic-assisted total or supracervical hysterectomy for benign indications between January 27,2023 and March 11,2024,with one of our minimally invasive gynecologic surgeons at Stony Brook University Hospital.Patients were assigned to the non-phenazopyridine group or the phenazopyridine group.The time needed to visualize the ureteral jets during cystoscopy and the total surgery duration were recorded.A cost analysis was then performed.Results In total,106 patients were included,with 53 patients in each group.Compared with the non-phenazopyridine group,the phenazopyridine group had significantly shorter times from the start of cystoscopy to visualization of the first ureteral jet(31 s vs.42 s,p<0.05).However,there were no significant differences observed for visualization of the second jet,total jet time,or surgery duration.Two patients in the non-phenazopyridine group required the administration of intravenous agents intraoperatively.Routine phenazopyridine was found to be more cost-efficient when medication costs and operative times were examined.Conclusion Routine phenazopyridine use does not significantly shorten overall cystoscopy times,but it is the more cost-efficient option given increased rates of costly intravenous medication use in the non-phenazopyridine group.展开更多
Retrocaval ureter is a very rare congenital malformation. We report a 10 years’ experience in the diagnosis and treatment of retrocaval ureter, a case series of 3 cases in two different countries of the Middle East. ...Retrocaval ureter is a very rare congenital malformation. We report a 10 years’ experience in the diagnosis and treatment of retrocaval ureter, a case series of 3 cases in two different countries of the Middle East. This is a retrospective study that included 3 cases of retrocaval ureters in Egypt and Saudi Arabia. Standard open ureteroureteric anastomosis was performed through a flank incision for each case. Patients’ symptoms were re-evaluated after two to four months. Complete recovery from symptoms occurred, and hydroureter and hydronephrosis regressed in all cases. Early diagnosis and treatment are the keys to prevent hydronephrosis and deterioration of renal functions.展开更多
When compared with maintenance dialysis,renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life.Approximately 9% of patients will develop a major urol...When compared with maintenance dialysis,renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life.Approximately 9% of patients will develop a major urologic complication following kidney transplantation.Ureteral complications are most common and include obstruction(intrinsic and extrinsic),urine leak and vesicoureteral reflux.Ureterovesical anastomotic strictures result from technical error or ureteral ischemia.Balloon dilation or endoureterotomy may be considered for short,low-grade strictures,but open reconstruction is associated with higher success rates.Urine leak usually occurs in the early postoperative period.Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression(nephrostomy tube,ureteral stent,and indwelling bladder catheter).Proximal,large-volume,or leaks that persist despite urinary diversion,require open repair.Vesicoureteral reflux is common following transplantation.Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment.Deflux injection may be considered in recipients with low-grade disease.Grade IV and V reflux are best managed with open reconstruction.展开更多
Objective:Complex ureteral obstruction is refractory to conventional urological intervention.This report describes a case of laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for tr...Objective:Complex ureteral obstruction is refractory to conventional urological intervention.This report describes a case of laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction.Methods:Right-side multiple ureteral stones and complicating ureteral obstruction failed an initial attempt of ureteroscopy lithotripsy with simultaneous percutaneous nephroscopy in a 23-year-old male.Laparoscopic ureterolysis with ureteroscopy and percutaneous nephroscopy was used simultaneously to dissect the periureteral adhesions with the patient placed in the Galdakao-modified supine Valdivia position.The ureter was incised to allow the insertion of a ureteral catheter through the twisted ureter,and a guide wire was advanced into the pelvis using ureteroscopy.A double-J stent was placed into the right-side ureter using antegrade percutaneous nephroscopy.Results:The laparoendoscopic procedure lasted 330 min with an estimated bleeding volume of 100 mL.The patient underwent an uneventful postoperative course,and postoperative followup radiography confirmed good positioning of the double-J stent.The double-J stent was removed 3 months after operation.The patient remained asymptomatic within a 13-month follow-up period.Conclusion:Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy is an effective and safe treatment option for complex ureteral obstruction.展开更多
objective:To assess the utility of trans-vaginal ultrasonography in evaluation of non-pregnant sexually active female patients with lower ureteric calculi.Methods:A prospective study was done from January 2015 to Dece...objective:To assess the utility of trans-vaginal ultrasonography in evaluation of non-pregnant sexually active female patients with lower ureteric calculi.Methods:A prospective study was done from January 2015 to December 2017 including non-pregnant sexually active females with suspected ureteric calculus.Trans-abdominal ultrasound was initially done in all patients.In those patients in whom trans-abdominal ultrasound was inconclusive or there was indirect evidence of lower ureteric calculus in form of ureteral dila-tion but no calculus was evident,trans-vaginal ultrasound was done.The patients with ureteric calculi detected on trans-vaginal ultrasound and kept on conservative management were also followed up with trans-vaginal ultrasound.Non-contrast computed tomography was done in patients with inconclusive trans-vaginal ultrasound.Results:As per the study protocol,156 out of the total 468 patients evaluated by trans-abdominal ultrasound were eligible for trans-vaginal ultrasound.Trans-vaginal ultrasound was done in 149 patients,as seven patients did not give consent.Seventy-nine patients were detected with a lower ureteric calculus on trans-vaginal ultrasound and 27 patients had gyne-cologic or other cause for their symptoms.Forty-three patients had an inconclusive trans-vaginal ultrasound of which 36 underwent non-contrast computed tomography,among them only one patient had a lower ureteric calculus.Stone free status could be easily demonstrated on follow-up trans-vaginal ultrasound.展开更多
BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to...BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful solution.CASE SUMMARY A 35-year-old male presented with flank pain and hematuria following varicocele embolization.Imaging confirmed left ureteral obstruction and hydronephrosis.Laparoscopic ureterolysis successfully removed the embolization coil and repaired the ureter,resolving the patient's symptoms.Follow-up at six months and two years showed sustained improvement.CONCLUSION Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.展开更多
Objective: To evaluate the long term follow-up results of the direct nipple ureteroneocystostomy technique. Materials and Methods: We studied a total of 16 patients (19 renal units) who underwent direct nipple uretero...Objective: To evaluate the long term follow-up results of the direct nipple ureteroneocystostomy technique. Materials and Methods: We studied a total of 16 patients (19 renal units) who underwent direct nipple ureteroneocystostomy. The mean age was 43 years and 3 patients had bilateral disease. In five units the ureters had been ligated during gynecological surgery, 11 renal units were obstructive and three units were reflexive megaureters. The ureters were spatulated for about 2 cm and folded back. Nipples 2 to 2.5 cm long were prepared. In two cases the ureters were thin-walled (2 mm or less) and they were not spatulated but folded back onto themselves. In one case the ureter could not be everted since it had a thick and fibrotic wall. The distal 2 to 2.5 cm segment of this ureter was directly inserted in to the bladder. Postoperative follow-up was at 3 month intervals for the first year at 6 month intervals for 2 - 3 years and yearly thereafter. At the time of follow-up serum creatinine, urine culture, ultrasound, intravenous urography, voiding cystoureterography, nuclear renal scintigraphy and cystometric evaluations were performed. The functions of 11 and 15 renal units were evaluated scintigraphically and stereologically, respectively, in the both preoperative and postoperative first year follow-up. The Wilcoxon Signed Ranks test was used for statistical evaluation and p < 0.05 was considered statistically significant. Results: Mean follow-up was 49 months. Three renal units had Grade III reflux (two of them during voiding) and one unit had Grade IV reflux. At follow-up this patient developed in the ureteral stricture. No patients had urinary tract infection, pyelonephritis or ureteral stricture follow-up period. Between the preoperative and postoperative first year, there was an increase in postoperative split renal function based on renal scintigraphy but this difference was not statistically significant. The stereologically calculated decrease in pelvicaliceal dilatation was statistically significant. Conclusion: Ease of application and no need to taper or plicate the ureter or prepare a submucosal tunnel may be the reasons to consider the direct nipple ureteroneocystostomy technique for megaureters of different etiologies.展开更多
To investigate the best treatment option for large upper ureteral stone,percutaneous nephrolithotomy or laparoscopic ureterolithotomy.We searched three key word of upper ureteral stone,laparoscopic ureterolithotomy,pe...To investigate the best treatment option for large upper ureteral stone,percutaneous nephrolithotomy or laparoscopic ureterolithotomy.We searched three key word of upper ureteral stone,laparoscopic ureterolithotomy,percutaneous nephrolithotomy in PubM ed,Scopus and Ebsco.We found approximately twenty suitable articles about this subject since January 1980 until January2014.All articles studies and reviewed meticulously and brief review of these articles was written and some Ideas of experts was added.In many studies,it is suggested that success rate and complications of laparoscopic ureterolithotomy and percutaneous nephrolithotomy are the same,but percutaneous nephrolithotomy has less hospital stay time,duration of surgery and it is more cost effective.Overall it seems that percutaneous nephrolithotomy for treatment of upper ureteral stones is preferable rather than laparoscopic展开更多
Purpose: Partial resection of the distal ureter is commonly performed during reconstructive surgery in pediatric urology;particularly for correction of vesicoureteral reflux (VUR) and ureterovesical junction obstructi...Purpose: Partial resection of the distal ureter is commonly performed during reconstructive surgery in pediatric urology;particularly for correction of vesicoureteral reflux (VUR) and ureterovesical junction obstruction (UVJO). Many hospitals require pathologic examination of all excised tissues. We examined the pathologic findings in such specimens to evaluate the utility of this practice. Methods: We reviewed the findings on pathologic examination of distal ureteral segments excised during surgical correction of VUR and UVJO in children by a single surgeon over a 13-year period. Results: One hundred and ninety-one specimens from 126 patients were reviewed. None were found to have any significant pathologic findings that impacted therapy. Conclusion: Routine pathological examination of distal ureteral segments excised during surgical correction of VUR and UVJO is not warranted. This presents potential for cost and resource reduction in care of these patients.展开更多
文摘Introduction:Distal ureteral obstruction has classically been managed by ureteroneocystostomy(UNC).The feasibility and success of robotic primary ureteroureterostomy(UU)for benign obstruction appears promising with several benefits over UNC but is poorly studied.Robotic repair offers superior visualization and precision,allowing for minimal ureteral dissection.Here we report on our experience and short-term outcomes.Materials and Methods:We identified patients who underwent robotic distal ureteroureterostomy for benign distal ureteral obstruction at our institution from 2020–2024.Etiology,stricture length,and post-operative outcomes were recorded.All patients had renal ultrasound(US),diuretic renography,or cross-sectional imaging within 6 months of repair.Results:Seven patients underwent distal UU from 2020–2024,with one case of bilateral repair for a total of 8 anastomoses.Iatrogenic injury from hysterectomy represented 5/8 injuries.The mean time between injury and repair was 3.5 months.All defects were 1–1.5 cm in length.At follow-up imaging,there was no evidence of obstruction in any patient with a median follow-up of 10 months,including diuretic renography in 5 of 7 patients.One patient had mild hydronephrosis on their initial renal US but with normal drainage on subsequent diuretic renography.All patients reported no flank pain at follow-up.Conclusions:Robotic UU is feasible for short,benign distal ureteral obstruction in carefully selected patients.Advantages over traditional UNC include a significantly shorter catheter time,no risk of vesicoureteral reflux,no effect on bladder capacity or function,and the ability to retain the native ureteral orifice.Continued research will elucidate the long-term efficacy of this approach.
基金supported by the National Natural Science Foundation of China(Grant Nos.12172034,U20A20390,and 11827803)Beijing Municipal Natural Science Foundation(Grant No.7212205)+1 种基金the 111 project(Grant No.B13003)the Fundamental Research Funds for the Central Universities.
文摘Malignant ureteral obstruction may lead to renal function damage,renal colic,and infection.The impact of obstructive development on ureteral peristalsis was rarely studied,which requires further investigation.This study used theoretical biomechanical methods to study the motion characteristics of the ureteral wall and obtained the radial motion equation of the ureteral wall.The motion equation was solved by 4-5th order Runge Kutta method.Analyze the motion equation of the ureteral wall,derive the expression for malignant obstructive ureteral pressure,as well as the analytical expressions for radial displacement and circumferential stress of the ureteral wall.By analyzing the radial motion equation of the ureter,it can be found that peristalsis is influenced by the pressure difference between inside and outside.The analytical solutions for radial displacement and stress contained exponential terms.Under the condition of 50%obstruction,the displacement and stress of the ureter were reduced by 90.53%and 81.10%,respectively.This study established the radial motion equation of the ureter and provided analytical solutions for the radial displacement and stress of the obstructed ureter.Based on the radial motion equation of the ureter,the radial motion characteristics of the ureteral wall were explored,including peristalsis and disappearance of peristalsis.This study provided a quantitative relationship between ureteral obstruction and peristalsis.As the degree of obstruction increased,ureteral peristalsis gradually weakened or even disappeared.
文摘Objective:To present the surgical technique of robotic buccal ureteroplasty for strictures after laser lithotripsy and its outcomes.Methods:This was a retrospective study conducted at the Department of Urology,Apollo Hospitals,Chennai,India from October 2012 to October 2022.Indications for surgery included worsening hydronephrosis,declining renal function,and recurrent urinary tract infections with obstruction.Apart from liberal exposure of the stricture,we stress upon use of indocyanine green to assess vascularity and quilting of the graft to bare area of the psoas muscle to increase graft vascularity.Results:Among the 15 patients,ureteropelvic junction strictures were observed in eight(53%),while five(33%)had proximal ureteric strictures,and two(13%)had mid-ureteral strictures.Notably,eight of the 15 patients(53%)had previous unsuccessful double-J stenting.The median stricture length was 3.5(range:2.0–5.0)cm,with a mean operative time of 167(range:126–214)min and estimated blood loss of 60(range:40–100)mL.After a median follow-up of 12(range:4–32)months,13 out of the 15 patients(87%)showed significant improvement in their follow-up functional scans.Conclusion:Robotic buccal ureteroplasty is a very effective technique for the management of laser-induced ureteral strictures with good long-term results and minimal morbidity.The results are comparable irrespective of previous failed stenting.
基金This work was financed by grants from the National Natural Science Foundation of China(No.81370804 and No.81670643)Guangzhou Science,Technology and Innovation Commission(No.201604020001,No.201607010162 and No.201704020193).
文摘Objective:To examine differences in outcomes of semi-rigid ureteroscopy(URS)with or without a modified-ureteral-access-sheath(mUAS)to treat large upper ureteral stones.Methods:Patients with single,radio-opaque large upper ureteral stone(≥10 mm)treated using semi-rigid URS between August 2013 and October 2016 were retrospectively evaluated.The stone-free status was determined from Kidney-ureter-bladder(KUB)X-ray films taken on postoperative Day 1 and after 1 month.Results:Of 103 patients meeting inclusion criteria,43(41.75%)and 60(58.25%)were treated with semi-rigid URS with and without mUAS,respectively.The immediate stone-free rate(SFR)for the mUAS group was significantly higher than the non-mUAS group(40[93.0%]vs.46[76.7%];p=0.033).The SFR at 1 month was also high for patients treated using mUAS,but not statistically different from patients not treated with mUAS(41[95.3%]mUAS vs.51[85.0%]non-mUAS;p=0.115).Auxiliary procedure rates were significantly lower for mUAS patients compared to non-mUAS patients(2[4.7%]vs.14[23.3%];p=0.01).There were no significant differences in surgical duration and hospital stays,and the overall complication rates were statistically similar for mUAS patients compared to non-mUAS patients(1[2.3%]vs.3[5.0%];p=0.638).
基金the Fund of Jiaxing Science and Technology Bureau(2014AY21034-2).
文摘Objective:To determine the feasibility of decellularized small intestinal submu-cosa(5IS)matrix in repairing ureteral strictures.Methods:Two patients with ureteral stenoses underwent ureteral reconstruction with SIS ma-trix at the Zhejiang Provincial Corps Hospital of Chinese People's Armed Forces between June 2014 and June 2016.The ureteral stenoses were repaired with a semi-tubular SIS matrix and the postoperative recoveries were observed.Results:Both operations were successfully completed.The average operative time was 90 min and the average length of hospital stay was 15 days.No fevers,incision infections,intestinal obstruction,graft rejection,or other serious complications were noted.After 2 months,ure-teroscopic examinations showed that the surfaces of the original patches were covered by mu-Cosa and there were no apparent stenoses in the lumens.The ureteral stents were replaced every 2 months postoperatively and removed 12 months postoperatively.No infections or uri-nary leakage occurred after removal of the stents.Intravenous urography was performed 6 and 12 months postoperatively.The results showed that the ureters were not obstructed and there was no apparent stenosis at the anastomosis sites.The average follow-up time was>12 months.Long-term follow-up is still ongoing,and computed tomography examin ations of the urinary tract have been conducted in the outpatient department of our hospital 1,3,and 6 months after removal of the double-J stents,suggesting the absence of hydronephrosis.The serum creatinine levels remained stable during the follow-up.Conclusion:SIS matrix reconstruction is a feasible method to repair ureters stenosis.
文摘Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.
文摘Objective Ureteral lesions caused by impacted ureteral stones are likely to result in postoperative ureteral stricture.On this basis,the study aimed to investigate if dual-energy spectral computed tomography can predict ureteral hardening caused by impacted stones and to explore the relationship between different types of ureteral lesions and the risk of ureteral stricture.Methods This prospective study collected data of 93 patients with impacted stones from hospital automation system during January 2018 to October 2019.They underwent an abdominal scan on a dual-energy spectral computed tomography.During surgery,the operator used ureteroscopy to identify ureteral lesions,which were classified into four categories:edema,polyps,pallor,and hardening.Seven months later,90 patients were reviewed for the degree of hydronephrosis.Results Endoscopic observations revealed 38(41%)cases of ureteral edema,20(22%)cases of polyps,13(14%)cases of pallor,and 22(24%)cases of hardening.There were significant differences in hydronephrosis,the period of impaction,the calcium concentration of the ureter,and the slope of the spectral Hounsfield unit curve between the four groups.After that,we evaluated the factors associated with ureteral hardening and found that the calcium concentration of the ureter and hydronephrosis remained independent predictors of ureteral hardening.Receiver operating characteristic curve analysis showed that 5.3 mg/cm^(3)calcium concentration of the ureter is an optimal cut-off value to predict ureteral hardening.The result of follow-up showed that 80 patients had complete remission of hydronephrosis,with a complete remission rate of 61.9%(13/21)in the hardening group and 97.1%(67/69)in the non-hardening group(p<0.001).Conclusion Calcium concentration of the ureter is an independent predictor of ureteral hardening.Patients with ureteral hardening have more severe hydronephrosis after ureteroscopic lithotripsy.When the calcium concentration of the ureter is less than 5.3 mg/cm^(3),ureteral lesions should be actively treated.
文摘Objective:The aim of our study was to examine results of pyeloplasty using the new methoddsubadventitial resection of the ureter with preservation of the ureteral artery proposed by us and the possibility of using this method in one-stage surgery with ureteropelvic junction(UPJ)and ureterovesical junction(UVJ)obstructions or vesicoureteral reflux.Methods:A retrospective analysis of 108 patients with hydronephrosis(including two patients with hydroureteronephrosis)who received treatment from March 1998 to March 2020 was carried out,with an average follow-up period of 36 months.Dismembered pyeloplasty using a subadventitial technique with preservation of ureteral blood supply was performed in 108 patients(including bilateral in two cases).In one patient with UPJ and UVJ obstructions and in one patient with UPJ obstruction and vesicoureteral reflux subadventitial resection of the ureter were performed in both segments.Results:All patients managed to preserve the integrity of the ureteral artery during dismembered pyeloplasty,and two patients simultaneously underwent ureterocystostomy by subadventitial resection of the ureter.The method of pyeloureteroplasty with subadventitial resection of the ureter makes it possible to improve long-term results in patients with hydronephrosis,including those with lesions of the UPJ and UVJ segments.In all cases,it was feasible to achieve a decrease in the degree of hydronephrosis.Postoperative complications were observed in five cases(4.6%),in none of which there were complications associated with the surgical technique,and were eliminated without loss of renal function.Conclusion:Our 22 years of experience shows that the technique of subadventitial resection of the ureter allows us to preserve the ureteral blood circulation during dismembered pyeloplasty and thus creates conditions for prevention of restenosis of UPJ and for single-stage ureteroplasty on the upper and lower ureteral segments.
文摘Objective:Vesicoureteral reflux(VUR)index is a simple,validated tool that reliably predicts significant improvement and spontaneous resolution of primary reflux in children.The aim of this study was to evaluate and compare the ureter diameter ratio(UDR)and VUR index(VURx)of patients treated with endoscopic injection(EI)and ureteroneocystostomy(UNC)methods in the pediatric age group due to primary VUR.Methods:Patients under the age of 18 years old who underwent EI and UNC with the diagnosis of primary VUR between January 2011 and September 2021 were determined as the participants.The UDR was assessed using voiding cystourethrography,and the VURx score was determined prior to treatment based on hospital records included in the study.Results:A total of 255 patients,60(23.5%)boys and 195(76.5%)girls,with a mean age of 76.5(range 13.0e204.0)months,were included in the study.EI was applied to 130(51.0%)patients and UNC was applied to 125(49.0%)patients due to primary VUR.The optimum cut-off for the distal UDR was obtained as 0.17 with sensitivity and specificity of 73.0%and 63.0%,respectively.The positive and negative predictive values were 66.0%and 70.0%,respectively.Conclusion:When the UDR and VURx score are evaluated together for the surgical treatment of primary VUR in the pediatric age group,it is thought that it may be useful in predicting the clinical course of the disease and evaluating surgical treatment options.
文摘Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and combination therapy with tamsulosin,silodosin,and tadalafil on stone expulsion rate(SER)and stone expulsion time(SET),as well as their comparative safety,numbers of colic pain episodes,and need for analgesics.Methods:Randomized controlled trials were retrieved by searching PubMed,Scopus,and Web of Science up to November 27,2023.Hand-searching was also conducted in Google Scholar to find additional records.Papers in English that compared the safety and efficacy of at least two of the above agents in adults with distal ureteral stones≤10 mm were included.Results:In total,27 studies were identified(six studies through database searches and 21 through checking reference lists and hand-searching in Google Scholar).More than half of them(n=15,56%)were conducted in India.The SER significantly improved with silodosin compared with tamsulosin(odds ratio[OR]2.24,p<0.001),whereas the difference in SET was non-significant.Tadalafil achieved a significantly higher SER compared with tamsulosin(OR 1.42,p=0.042)without any difference in SET.Subgroup analysis of 5-and 10-mg doses of tadalafil showed no significant difference in SER or SET.We found no significant difference in need for analgesics(mean difference(MD−53.73,p=0.2)or the mean number of colic episodes(MD−0.42,p=0.060)between tadalafil and tamsulosin.SER or SET was not significantly different between silodosin and tadalafil.Tadalafil plus tamsulosin led to a significantly higher SER(OR 1.87,p<0.001)and SET(MD−2.99,p=0.002)compared with tamsulosin,without any significant difference in adverse effects.Conclusion:Compared with tamsulosin,SER significantly improved with silodosin,tadalafil,and the combination of tadalafil plus tamsulosin.Meanwhile,the difference in SET was only significant between tadalafil plus tamsulosin versus tamsulosin.It appears that tadalafil and silodosin have similar efficacy in SET and SER.All medical expulsive therapies had comparable safety.
文摘Objectives:Previous studies have shown conflicting results concerning the optimal duration of ureteral stenting after endourologic treatment of stone disease,its effect on patient comfort,and the necessity for emergent,unscheduled care.This study assessed the impact of stent duration,sex,and other patient-associated factors on reported pain scores using a large,international prospective registry.Methods:A prospective observational patient registry on ureteral stents from 10 institutions in 4 countries(United States,Canada,France,and Japan)from 2020–2023 was assessed.The primary outcome was Patient-Reported Outcomes Measurement Information System(PROMIS)pain intensity scores administered on the day of stent removal,before stent removal.Patients were grouped by indwelling time(short,medium,and long),and pain scores were compared.The impact of sex,height vs.stent length,and presence or absence of tether were assessed.Results:359 patients were enrolled in the database,with outcomes analyzed for 268 patients with a unilateral stent placed after an endourologic procedure for stones.No significant difference was detected in pain scores between the indwelling time groups(p=0.41).Height for a given stent length was not significantly associated with pain scores.There was no difference in pain scores with or without tether.Men reported lower pain scores than women(p=0.018).Conclusions:This study did not detect an overall difference in pain scores reported at stent removal within or between stent duration groups.Men reported less pain than women in this study,suggesting that patient factors may be more important than indwelling time when optimizing pain management.
文摘Objective To determine the impact of planned preoperative phenazopyridine administration on operative times and costs compared with as-needed intravenous agent use during routine cystoscopy following minimally invasive hysterectomy for benign indications.Method This prospective cohort study examined patients who underwent laparoscopic or robotic-assisted total or supracervical hysterectomy for benign indications between January 27,2023 and March 11,2024,with one of our minimally invasive gynecologic surgeons at Stony Brook University Hospital.Patients were assigned to the non-phenazopyridine group or the phenazopyridine group.The time needed to visualize the ureteral jets during cystoscopy and the total surgery duration were recorded.A cost analysis was then performed.Results In total,106 patients were included,with 53 patients in each group.Compared with the non-phenazopyridine group,the phenazopyridine group had significantly shorter times from the start of cystoscopy to visualization of the first ureteral jet(31 s vs.42 s,p<0.05).However,there were no significant differences observed for visualization of the second jet,total jet time,or surgery duration.Two patients in the non-phenazopyridine group required the administration of intravenous agents intraoperatively.Routine phenazopyridine was found to be more cost-efficient when medication costs and operative times were examined.Conclusion Routine phenazopyridine use does not significantly shorten overall cystoscopy times,but it is the more cost-efficient option given increased rates of costly intravenous medication use in the non-phenazopyridine group.
文摘Retrocaval ureter is a very rare congenital malformation. We report a 10 years’ experience in the diagnosis and treatment of retrocaval ureter, a case series of 3 cases in two different countries of the Middle East. This is a retrospective study that included 3 cases of retrocaval ureters in Egypt and Saudi Arabia. Standard open ureteroureteric anastomosis was performed through a flank incision for each case. Patients’ symptoms were re-evaluated after two to four months. Complete recovery from symptoms occurred, and hydroureter and hydronephrosis regressed in all cases. Early diagnosis and treatment are the keys to prevent hydronephrosis and deterioration of renal functions.
文摘When compared with maintenance dialysis,renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life.Approximately 9% of patients will develop a major urologic complication following kidney transplantation.Ureteral complications are most common and include obstruction(intrinsic and extrinsic),urine leak and vesicoureteral reflux.Ureterovesical anastomotic strictures result from technical error or ureteral ischemia.Balloon dilation or endoureterotomy may be considered for short,low-grade strictures,but open reconstruction is associated with higher success rates.Urine leak usually occurs in the early postoperative period.Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression(nephrostomy tube,ureteral stent,and indwelling bladder catheter).Proximal,large-volume,or leaks that persist despite urinary diversion,require open repair.Vesicoureteral reflux is common following transplantation.Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment.Deflux injection may be considered in recipients with low-grade disease.Grade IV and V reflux are best managed with open reconstruction.
基金supported by grants from the Shanghai Municipal Hospitals’Project for Emerging and Frontier Technology(No.SHDC12010115)Chinese Military Major Project for Clinical High-tech and Innovative Technology(No.2010gxjs057)the Project for the Key Discipline of Shanghai(No.2013046).
文摘Objective:Complex ureteral obstruction is refractory to conventional urological intervention.This report describes a case of laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction.Methods:Right-side multiple ureteral stones and complicating ureteral obstruction failed an initial attempt of ureteroscopy lithotripsy with simultaneous percutaneous nephroscopy in a 23-year-old male.Laparoscopic ureterolysis with ureteroscopy and percutaneous nephroscopy was used simultaneously to dissect the periureteral adhesions with the patient placed in the Galdakao-modified supine Valdivia position.The ureter was incised to allow the insertion of a ureteral catheter through the twisted ureter,and a guide wire was advanced into the pelvis using ureteroscopy.A double-J stent was placed into the right-side ureter using antegrade percutaneous nephroscopy.Results:The laparoendoscopic procedure lasted 330 min with an estimated bleeding volume of 100 mL.The patient underwent an uneventful postoperative course,and postoperative followup radiography confirmed good positioning of the double-J stent.The double-J stent was removed 3 months after operation.The patient remained asymptomatic within a 13-month follow-up period.Conclusion:Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy is an effective and safe treatment option for complex ureteral obstruction.
文摘objective:To assess the utility of trans-vaginal ultrasonography in evaluation of non-pregnant sexually active female patients with lower ureteric calculi.Methods:A prospective study was done from January 2015 to December 2017 including non-pregnant sexually active females with suspected ureteric calculus.Trans-abdominal ultrasound was initially done in all patients.In those patients in whom trans-abdominal ultrasound was inconclusive or there was indirect evidence of lower ureteric calculus in form of ureteral dila-tion but no calculus was evident,trans-vaginal ultrasound was done.The patients with ureteric calculi detected on trans-vaginal ultrasound and kept on conservative management were also followed up with trans-vaginal ultrasound.Non-contrast computed tomography was done in patients with inconclusive trans-vaginal ultrasound.Results:As per the study protocol,156 out of the total 468 patients evaluated by trans-abdominal ultrasound were eligible for trans-vaginal ultrasound.Trans-vaginal ultrasound was done in 149 patients,as seven patients did not give consent.Seventy-nine patients were detected with a lower ureteric calculus on trans-vaginal ultrasound and 27 patients had gyne-cologic or other cause for their symptoms.Forty-three patients had an inconclusive trans-vaginal ultrasound of which 36 underwent non-contrast computed tomography,among them only one patient had a lower ureteric calculus.Stone free status could be easily demonstrated on follow-up trans-vaginal ultrasound.
文摘BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful solution.CASE SUMMARY A 35-year-old male presented with flank pain and hematuria following varicocele embolization.Imaging confirmed left ureteral obstruction and hydronephrosis.Laparoscopic ureterolysis successfully removed the embolization coil and repaired the ureter,resolving the patient's symptoms.Follow-up at six months and two years showed sustained improvement.CONCLUSION Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.
文摘Objective: To evaluate the long term follow-up results of the direct nipple ureteroneocystostomy technique. Materials and Methods: We studied a total of 16 patients (19 renal units) who underwent direct nipple ureteroneocystostomy. The mean age was 43 years and 3 patients had bilateral disease. In five units the ureters had been ligated during gynecological surgery, 11 renal units were obstructive and three units were reflexive megaureters. The ureters were spatulated for about 2 cm and folded back. Nipples 2 to 2.5 cm long were prepared. In two cases the ureters were thin-walled (2 mm or less) and they were not spatulated but folded back onto themselves. In one case the ureter could not be everted since it had a thick and fibrotic wall. The distal 2 to 2.5 cm segment of this ureter was directly inserted in to the bladder. Postoperative follow-up was at 3 month intervals for the first year at 6 month intervals for 2 - 3 years and yearly thereafter. At the time of follow-up serum creatinine, urine culture, ultrasound, intravenous urography, voiding cystoureterography, nuclear renal scintigraphy and cystometric evaluations were performed. The functions of 11 and 15 renal units were evaluated scintigraphically and stereologically, respectively, in the both preoperative and postoperative first year follow-up. The Wilcoxon Signed Ranks test was used for statistical evaluation and p < 0.05 was considered statistically significant. Results: Mean follow-up was 49 months. Three renal units had Grade III reflux (two of them during voiding) and one unit had Grade IV reflux. At follow-up this patient developed in the ureteral stricture. No patients had urinary tract infection, pyelonephritis or ureteral stricture follow-up period. Between the preoperative and postoperative first year, there was an increase in postoperative split renal function based on renal scintigraphy but this difference was not statistically significant. The stereologically calculated decrease in pelvicaliceal dilatation was statistically significant. Conclusion: Ease of application and no need to taper or plicate the ureter or prepare a submucosal tunnel may be the reasons to consider the direct nipple ureteroneocystostomy technique for megaureters of different etiologies.
文摘To investigate the best treatment option for large upper ureteral stone,percutaneous nephrolithotomy or laparoscopic ureterolithotomy.We searched three key word of upper ureteral stone,laparoscopic ureterolithotomy,percutaneous nephrolithotomy in PubM ed,Scopus and Ebsco.We found approximately twenty suitable articles about this subject since January 1980 until January2014.All articles studies and reviewed meticulously and brief review of these articles was written and some Ideas of experts was added.In many studies,it is suggested that success rate and complications of laparoscopic ureterolithotomy and percutaneous nephrolithotomy are the same,but percutaneous nephrolithotomy has less hospital stay time,duration of surgery and it is more cost effective.Overall it seems that percutaneous nephrolithotomy for treatment of upper ureteral stones is preferable rather than laparoscopic
文摘Purpose: Partial resection of the distal ureter is commonly performed during reconstructive surgery in pediatric urology;particularly for correction of vesicoureteral reflux (VUR) and ureterovesical junction obstruction (UVJO). Many hospitals require pathologic examination of all excised tissues. We examined the pathologic findings in such specimens to evaluate the utility of this practice. Methods: We reviewed the findings on pathologic examination of distal ureteral segments excised during surgical correction of VUR and UVJO in children by a single surgeon over a 13-year period. Results: One hundred and ninety-one specimens from 126 patients were reviewed. None were found to have any significant pathologic findings that impacted therapy. Conclusion: Routine pathological examination of distal ureteral segments excised during surgical correction of VUR and UVJO is not warranted. This presents potential for cost and resource reduction in care of these patients.
