Stentless repair of left urethral defect with appendiceal interposition: A case report

Avci, Emran Kuzey; Atıcı, Semra Demirli; Uylaş, Ufuk; Kamer, Erdinç

doi:10.1016/j.ijscr.2022.106805

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…When a ureteral stricture is radiation-induced, the appendix may have been excluded from the field of radiation, allowing for replacement of the ureter with tissue that is non-irradiated and thus healthier ( 72 ). While many urologic surgeons would place a stent to maintain patency following robotic ureteral reconstruction with the appendix, recent reports of stentless appendiceal ureteroplasty have also yielded promising results ( 66 , 67 , 73 ).…”

Section: Resultsmentioning

confidence: 99%

Narrative review of flaps and grafts in robotic reconstructive urologic surgery

Doersch,

Hines,

Ajay

2024

Ann Laparosc Endosc Surg

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Background and Objective: Flaps and grafts are used for filling dead space, ureteral substitution, and as mesh alternatives. The surgical robot is invaluable in urologic reconstructive surgery due to the ability of the robot to reach the deep pelvis, its minimally invasive access, the ability to use indocyanine green to identify structures and assess tissue perfusion and viability, and ergonomics for the surgeon. Robotic reconstruction can involve tissue transfer in the form of flaps and grafts to provide form and function to organs that have been damaged by iatrogenic injuries, trauma, infections, cancer, radiation injury, or congenital abnormalities. Common flaps and grafts can be readily adapted to the robotic approach. In this literature review, we examine the robotic use of flaps and grafts in reconstructive urology. Methods: A thorough literature review was conducted via a PubMed search for predefined terms. Key Content and Findings: Flaps and grafts in reconstructive urology are used for interposition, ureteral substitution, and as mesh alternatives. Omental flaps are used for tissue interposition, or to provide structure and nutrients, and are easily employed with the robot. Various robotic applications of peritoneal flaps have been described. Vascular rectus abdominis musculocutaneous flaps are well-vascularized flaps that occupy dead space and provide structural support, which can be harvested readily with the robot. Sigmoid epiploica are an excellent flap for pelvic reconstruction. Gracilis flaps and fascia lata grafts are well-tolerated and provide space occupying tissue. Boari flaps aid in robotic ureteral reconstruction, especially in the setting of long defects. Oral mucosa is excellent for ureteral or bladder neck reconstruction. Rectal mucosa is well-tolerated and easy to harvest robotically for a variety of urinary tract reconstructive applications. The appendix or ileum can be interposed for repair of damaged ureters. Conclusions: Various flaps and grafts have been adapted for robotic reconstructive urology. As the field develops, refinement of techniques and innovation in flaps and employment of the robot will propel this field forward. More studies, especially comparative studies, are needed to elucidate the flaps and grafts that are most likely to be successful with the least morbidity for each use case.

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Section: Resultsmentioning

confidence: 99%

Narrative review of flaps and grafts in robotic reconstructive urologic surgery

Doersch,

Hines,

Ajay

2024

Ann Laparosc Endosc Surg

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“…While ureteral reconstruction can also be performed using small and large intestine, the appendix offers several advantages over other intestinal conduits. Advantages include the match in size, less absorptive surface with less metabolite absorption and a lower risk of electrolyte disorders, and avoidance of intestinal resection and anastomosis [ 2 , 6–7 ]. Limitations to this operation include the finite length of the appendix and the inability to perform the operation if the appendix is absent, inflamed or damaged [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…An appendiceal graft is more suitable for right-sided ureteral reconstruction due to its inherent ipsilateral location. The use of an appendiceal graft for left-sided ureteral reconstruction has been reported but it is less common due to its higher complication rate [ 6 , 8 ]. The long-term success of appendiceal ureteral replacement in terms of satisfactory transport of urine and maintaining good renal function, has been documented [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Ureteral reconstruction with appendiceal interposition graft following resection of retroperitoneal leiomyosarcoma

Williams

Diallo

Issa

et al. 2023

Journal of Surgical Case Reports

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Ureteral defects can be repaired using a variety of different techniques that depend on the length and position of the defect. Here we describe a case where a long, upper-ureteral defect was successfully reconstructed using an appendiceal interposition graft. A 60-year-old female patient underwent resection of a right-sided retroperitoneal leiomyosarcoma that was encasing the entire upper ureter and obstructing the right kidney. The mass was resected en bloc, leaving behind an 11 cm ureteral defect. The defect was successfully reconstructed with an appendiceal interposition graft. Appendiceal interposition grafts are a feasible and effective approach for ureteral reconstruction in adults following oncologic resection. We describe various technical aspects that optimize the success of ureteral reconstruction.

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Appendicular Ureteroplasty for a Firearm Related Rupture of the Right Ureter

Wa Numbe,

Mirindi,

Nnashi

et al. 2024

RRU

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One of the most challenging aspects of urology is restoring patency to ureters with long defects. In certain cases, it may not be feasible to perform plastic surgery on the ureter with its own tissue or bladder. In such instances, alternative solution like appendicular ureteroplasty may be promising solution. Ureteral injuries have several etiologies, some of them are secondary to unintentional ureteral trauma during surgery. More than half of these injuries are unrecognized during the first laparotomy. Extensive ureteral injuries are difficult to repair, even with application of several types of surgical techniques. The advantage of appendicular ureteroplasty is the simplicity of the ureteral replacement technique without compromising other substitution options in case of failure. This is a case report of a young adult with abdominal gunshot injuries, with significant loss of tissues located to distal third of the right ureter. The appendicular urethroplasty was successfully performed. The patient remained stable after one year of out follow-up as an outpatient.

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Stentless repair of left urethral defect with appendiceal interposition: A case report

Cited by 4 publications

References 14 publications

Narrative review of flaps and grafts in robotic reconstructive urologic surgery

Narrative review of flaps and grafts in robotic reconstructive urologic surgery

Ureteral reconstruction with appendiceal interposition graft following resection of retroperitoneal leiomyosarcoma

Appendicular Ureteroplasty for a Firearm Related Rupture of the Right Ureter

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