Management of full-length complete ureteral avulsion

Tang, Kaifa; Sun, Fa; Tian, Yuan; Zhao, Yili

doi:10.1590/s1677-5538.ibju.2015.0372

Cited by 10 publications

(11 citation statements)

References 13 publications

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“…In the literature, 55% [17] of 31 cases had avulsion of the right ureter and 45% [14] had it in left ureter. [3][4][5][6][7][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Two of our cases had right ureter avulsion, and one patient had left ureter avulsion which was in line with the literature.…”

Section: Discussionsupporting

confidence: 88%

“…The literature shows that it is suitable to completely wrap the ureter with omental flap in addition to pyeloureterostomy and ureterovesical anastomosis for all full-length ureteral avulsions and that omental flap feeds the avulsified ureter [5,6]. In line with previous studies and case presentations, we believe that wrapping the avulsified ureter with omental flap and performing pyeloureterostomy and ureterovesical anastomosis would be a good solution for complete ureteral avulsions [27]. We observed that the ureter was relieved on retrograde pyelographies in postoperative patient follow-ups and there was no extravasation in CT urography.…”

Section: Discussionsupporting

confidence: 79%

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Case report series: management of complete ureteral avulsion with review of the relevant literature

Sert¹,

Aydın²

2020

Afr J Urol

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Background Endoscopic operations and ureteroscopy have become the first choice for ureteral calculi and ureter-related operations. The ratios of the complications, which are mostly iatrogenic, range between 9 and 11%. Total ureteral avulsion during URS is quite rare with a prevalence of 0–0.3%. We present three total ureteral avulsions we experienced in our clinic during the last 2 years and their treatment. Case presentation During the last 2 years, we experienced three total ureteral avulsions: one of these occurred in our clinic and the other two occurred in an external center and were referred to us. In two cases, the omental flap was rotated after ureteral reimplantation and the ureter was completely wrapped inside the omental flap. In the third case, boari flap was formed from the bladder. Due to the presence of extrarenal wide renal pelvis, anastomosis was made with boari flap after a y–v flap was rotated on the renal pelvis. D-J stents of the patients were removed at the end of 3 months. Although there was mild hydronephrosis, parenchymal thinning and a significant decrease in functions were not observed. Ureteral avulsion of the patients was successfully managed without the need for nephrectomy. Conclusion Ureteral avulsion management is an extremely difficult condition for both the surgeon and the patient. So, the most important thing is to prevent ureteral avulsion. Ureteroplasty and omental flap treatment are applicable methods with quite successful results for complete ureteral avulsions.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 79%

Case report series: management of complete ureteral avulsion with review of the relevant literature

Sert¹,

Aydın²

2020

Afr J Urol

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“…Various definitive management options have been described based upon the type of injury whether one-point or two-point injury, site of injury, and the extent of ureteral loss as well as the condition of the renal unit and that of the patient. The options are ureteropyelostomy [ 20 ], ureteropyelostomy with omental wrapping [ 21 ], end-to-end ureteral anastomosis [ 3 ], uretero-vesical anastomosis with psoas hitch or Boari flap [ 3 , 10 ], transuretero-ureterostomy [ 22 ], appendix interposition of the ureter [ 23 , 24 ], simple repositioning of the completely avulsed ureter [ 6 ], pyeloureterostomy plus greater omentum investment outside the avulsed ureter and uretero-vesical anastomosis [ 25 , 26 ], extended spiral bladder flap [ 20 ], ileal replacement of ureter [ 27 ], and finally nephrectomy [ 9 , 10 , 28 ] and auto renal transplantation [ 29 ]. .…”

Section: Discussionmentioning

confidence: 99%

“…Despite its high success rate, ileal ureter has its own intrinsic risks in the form of mucus secretion and mucus plug formation, associated bowel complications (ileus, bowel obstruction) and anastomotic narrowing and obstructive uropathy, recurrent pyelonephritis, renal calculi, and dyselectrolytemia. In view of all this, the procedure described by Gao et al and Tang et al for complete ureteral avulsion (repositioning of the avulsed ureter by stented uretero-pyelostomy and uretero-vesical anastomosis, followed by omental wrapping of the ureter) appears very attractive [ 25 , 26 ]. If its efficacy is validated by further studies, it may become the preferred option.…”

Section: Discussionmentioning

confidence: 99%

Ureteral Avulsion during Semirigid Ureteroscopy: A Single-Centre Experience

Bhaskarapprakash

Karri

Velmurugan

et al. 2020

Surgery Research and Practice

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Aims. The aim of the study is to present our experience with the management of ureteral avulsions following semirigid ureteroscopy for ureteral stones. This is one of the largest series reported so far. Methods and Materials. It is a retrospective and observational study done at Sri Ramachandra Institute of Higher Education and Research over the last 18 years. Results. There were seven cases of ureteral avulsion following semirigid ureteroscopy. All patients were males with a mean age of 35.7 years. All had impacted stones, with proximal ureteric location in 6 patients and distal ureteric location in 1 patient. Five cases had two-point avulsions with loss of entire ureter. Two cases had one-point avulsion: one distal ureteric and the other mid-ureteric. Of the five cases with whole length ureteral avulsion, four were managed by classical ileal replacement of ureter and the the fifth case was managed by ileal replacement of ureter by the Yang–Monti technique. Of the two cases with one-point avulsion, one was managed by uretero-neocystostomy and the other by uretero-ureterostomy. All the patients had successful outcome. Conclusions. Even though rare, ureteral avulsion can potentially happen especially when dealing with impacted ureteric stones. Being conscious of the possible occurrence of this serious complication during any difficult ureteroscopy and exercising utmost care during the procedure are important preventive measures. However, this catastrophe can be successfully managed by either immediate definitive repair or in a staged manner.

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“…In some patients, the affected kidney can be mobilized and lowered, which can reduce the anastomosis length by about 3 to 5 cm 11 . In addition, studies have shown a reduction in the incidence of ischemic necrosis by using a pedicled greater omentum graft to cover the bladder flap 12,13 .…”

Section: Surgical Techniquementioning

confidence: 99%

Treatment of Complex Ureteral Strictures or Defects with Autologous Urinary Tract Muscle Flaps

Pang

et al. 2019

Preprint

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Background The surgical alternatives are complicated for complex ureteral strictures or long defects such as nearly full-length ureteral avulsion and recurrent ureteral strictures after pyeloplasty or ureteroplasty with severe local adhesion. This study was performed to summarize our clinical experience in the treatment of complex ureteral strictures or defects with autologous urinary tract muscle flaps. Methods We retrospectively analyzed seven patients with complex ureteral strictures or defects. The seven patients comprised three men and four women ranging in age from 37 to 61 years (average age, 46 years). The causes of ureteral lesions were nearly full-length ureteral avulsion (n = 2), postoperative ureteral stricture after sigmoid augmentation cystoplasty (n = 1), and postoperative recurrent ureteral stricture due to local inflammation and local adhesion (n = 4). The lengths of the defects in the patients with ureteral avulsion were 22 and 24 cm, and the average length of the recurrent ureteral strictures was 5.2 cm (range, 4–8 cm). The patients underwent ureteroplasty using spiral bladder muscle flaps (n = 4), muscle flaps from the dilated ureter or pelvis segment proximal to the strictures (n = 2), or a bowel segment (sigmoid) (n = 1). Six-French double-J stents were placed in the repaired ureters. Results All operations were successful, and the ureteral double-J stents were safely removed under cystoscopy 8 weeks postoperatively. All of the patients had improvement of hydronephrosis, and none had ureteral strictures on intravenous urography or contrast CT. The patient with failed pyeloplasty was found to have enlarged kidney and dilated calyx postoperatively, but the degree was less severe than preoperatively and three-dimensional CT reconstruction showed renal pelvis reduction and a patent ureter with no stenosis at the reconstruction site. Renal function was normal in all patients. Conclusions Treatment of ureteral strictures or defects with autologous urinary tract muscle flaps can be performed in some complicated cases with good results.

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Management of full-length complete ureteral avulsion

Cited by 10 publications

References 13 publications

Case report series: management of complete ureteral avulsion with review of the relevant literature

Case report series: management of complete ureteral avulsion with review of the relevant literature

Ureteral Avulsion during Semirigid Ureteroscopy: A Single-Centre Experience

Treatment of Complex Ureteral Strictures or Defects with Autologous Urinary Tract Muscle Flaps

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