A Contemporary Case Series of Complex Surgical Repair of Surgical/Endoscopic Injuries to the Abdominal Ureter

Ficarra, Vincenzo; Rossanese, Marta; Crestani, Alessandro; Caloggero, Simona; Alario, Giuseppe; Novara, Giacomo; Giannarini, Gianluca; Valotto, Claudio

doi:10.1016/j.euf.2020.07.003

Cited by 13 publications

(13 citation statements)

References 27 publications

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“…From an anatomical standpoint, the ureter was divided into an abdominal tract (from the ureteropelvic junction to the crossing with iliac vessels) and a pelvic tract (from the crossing with iliac vessels to the orifice in the bladder). The abdominal ureter was further divided into three segments based on their different blood supply: immediately distal to the ureteropelvic junction, lumbar and crossing the iliac vessels 3 …”

Section: Methodsmentioning

confidence: 99%

“…The abdominal ureter was further divided into three segments based on their different blood supply: immediately distal to the ureteropelvic junction, lumbar and crossing the iliac vessels. 3 The following preoperative variables were assessed: age at diagnosis, gender, body mass index, Charlson comorbidity index, serum creatinine, estimated glomerular filtration rate (eGFR), cause of injury, timing of reconstruction, involved ureteral side and segment and type of upper tract drainage placed (retrograde ureteral stent or percutaneous nephrostomy tube). Preoperative imaging evaluation was based on abdominal CT, antegrade or retrograde pyelography and renal scan in selected cases only.…”

Section: Wementioning

confidence: 99%

“…2,9,16,17 Whereas several series confirmed the efficacy of ureterocystoneostomy with or without bladder psoas hitch in the management of pelvic ureteral iatrogenic injuries, only few studies analysed the outcomes of reconstructive surgery for mid-or upper-ureter lesions. 3,[8][9][10]18 Moreover, no study has ever compared perioperative outcomes and failure rate of open versus robotic ureteral reconstruction for iatrogenic injuries.…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of iatrogenic ureteral injuries was historically estimated between 0.5% and 1% of all surgical procedures 1 . However, in the last decades, an increasing number of these lesions have been observed in patients undergoing endourological interventions for the management of urinary stones or upper tract tumours 2,3 . More rarely, ureters can be damaged during other surgical or endoscopic urological procedures such as partial nephrectomy, retroperitoneal lymph node dissection, radical and simple prostatectomy and transurethral resection of the prostate or bladder tumours.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes and treatment failure after open or robotic ureteral reconstruction for iatrogenic injuries

et al. 2023

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ObjectivesThe aim of this study is to assess the aetiology, perioperative outcomes and treatment failure of contemporary patients undergoing open or robot‐assisted ureteral reconstruction for iatrogenic injuries.Patients and methodsWe retrospectively analysed consecutive patients who underwent ureteral reconstruction for iatrogenic injuries at two academic centres 07/2013 and 06/2022. A variety of open or robot‐assisted procedures were performed, including uretero‐cystoneostomy, Boari bladder flap, uretero‐ureterostomy, ileal replacement and pyelo‐ureteroplasty. All procedures were performed by a single surgeon with extensive experience in open and robot‐assisted surgery and preference‐based management. Outcome measures were aetiology, estimated blood loss, length of stay, postoperative complications and treatment failure, defined as upper tract obstruction requiring permanent urinary drainage. We also planned a subgroup analysis comparing the outcomes between open and robot‐assisted procedures.ResultsFifty‐nine patients were included. Most injuries were consequent to endourological procedures (44%). The most frequently performed procedures were uretero‐cystoneostomy (49.2%) and Boari bladder flap (32.2%). Forty (67.8%) were open, and 19 (32.2%) were robot‐assisted procedures. Major postoperative complications were recorded in seven (11.9%) patients. After a median follow‐up of 42 months (interquartile range 12–24), treatment failure was observed in seven (11.9%) cases. Robot‐assisted versus open procedures were associated with decreased estimated blood loss (p = 0.01), length of stay (p < 0.001) and treatment failure (0/19 vs. 7/36, p = 0.04).ConclusionIn our series of iatrogenic ureteral lesions requiring reconstructive surgery, endourological procedures were the most frequent cause. Major postoperative complications were infrequent, and treatment failure rate was low. The robot‐assisted approach was associated with improved perioperative outcomes and lower failure rate compared with open.

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Section: Methodsmentioning

confidence: 99%

Section: Wementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes and treatment failure after open or robotic ureteral reconstruction for iatrogenic injuries

et al. 2023

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“…3 Ureteral reconstruction includes uretero-ureteral anastomosis, ureteroneocystostomy (if the length of the ureter is insufficient, the Boari flap or psoas hitch techniques may be added), uretero-ureteral anastomosis, and pyeloplasty. 62,68,74,75 If the ureteral injury is extensive, ileal ureter or autologous renal transplantation may be considered. [76][77][78][79] In cases of renal dysfunction or poor infection control, nephrectomy may be performed.…”

Section: Cq10 Does Renal Trauma-associated Urinary Extravasation Requ...mentioning

confidence: 99%

The Japanese Urological Association's clinical practice guidelines for urotrauma 2023

Horiguchi,

Shinchi,

Ojima

et al. 2023

Int J of Urology

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The Japanese Urological Association's guidelines for the treatment of renal trauma were published in 2016. In conjunction with its revision, herein, we present the new guidelines for overall urotrauma. Its purpose is to provide standard diagnostic and treatment recommendations for urotrauma, including iatrogenic trauma, to preserve organ function and minimize complications and fatality. The guidelines committee comprised urologists with experience in urotrauma care, selected by the Trauma and Emergency Medicine Subcommittee of the Specialty Area Committee of the Japanese Urological Association, and specialists recommended by the Japanese Association for the Surgery of Trauma and the Japanese Society of Interventional Radiology. The guidelines committee established the domains of renal and ureteral, bladder, urethral, and genital trauma, and determined the lead person for each domain. A total of 30 clinical questions (CQs) were established for all domains; 15 for renal and ureteral trauma and five each for the other domains. An extensive literature search was conducted for studies published between January 1, 1983 and July 16, 2020, based on the preset keywords for each CQ. Since only few randomized controlled trials or meta‐analyses were found on urotrauma clinical practice, conducting a systematic review and summarizing the evidence proved challenging; hence, the grade of recommendation was determined according to the 2007 “Minds Handbook for Clinical Practice Guidelines” based on a consensus reached by the guidelines committee. We hope that these guidelines will be useful for clinicians in their daily practice, especially those involved in urotrauma care.

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Robotic Repair of Ureteral Strictures: Techniques and Review

Elbers¹,

Socarrás²,

Rivas³

et al. 2021

Curr Urol Rep

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A Contemporary Case Series of Complex Surgical Repair of Surgical/Endoscopic Injuries to the Abdominal Ureter

Cited by 13 publications

References 27 publications

Outcomes and treatment failure after open or robotic ureteral reconstruction for iatrogenic injuries

Outcomes and treatment failure after open or robotic ureteral reconstruction for iatrogenic injuries

The Japanese Urological Association's clinical practice guidelines for urotrauma 2023

Robotic Repair of Ureteral Strictures: Techniques and Review

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