Technical Options in
Complex Ureteral Lesions:
'Ureter-Sparing' Surgery

Passerini-Glazel, Giacomo; Meneghini, Andrea; Aragona, Francesco; Oliva, G; Milani, C.; Pagano, Francesca

doi:10.1159/000475301

Cited by 21 publications

(16 citation statements)

References 10 publications

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“…3,11 Third, our report demonstrates that DN performed during RUU is a useful adjunctive maneuver in facilitating a tensionfree anastomosis in challenging upper and middle RUU. Although concomitant DN during open ureteral reconstruction has been described with good results in a few case series, 17,18 DN has surprisingly received little attention in the urological literature as an adjunctive maneuver during ureteral reconstruction. In our case series, five patients (two patients with proximal and three patients with mid ureteral pathology) received concomitant DN during RUU.…”

Section: Discussionmentioning

confidence: 99%

Single Surgeon Experience with Robot-Assisted Ureteroureterostomy for Pathologies at the Proximal, Middle, and Distal Ureter in Adults

Lee

Llukani

Reilly

et al. 2013

Journal of Endourology

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Section: Discussionmentioning

confidence: 99%

Single Surgeon Experience with Robot-Assisted Ureteroureterostomy for Pathologies at the Proximal, Middle, and Distal Ureter in Adults

Lee

Llukani

Reilly

et al. 2013

Journal of Endourology

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“…In comparison, Simmons et al 14 reported laparoscopic ureteral reconstructions with a nearly 15% complication rate, and Passerini-Glazel et al 11 reported an even lower complication rate using open surgical techniques. A recently published study by Wenske et al 15 shows a 3% rate for Clavien Grade III complications with a 1% death rate, not specifying the percentage for lower-grade complications.…”

Section: Discussionmentioning

confidence: 99%

“…5 The surgical options for treating such defects can be divided into urothelial-and non-urothelial-based reconstructions; the former option is always considered the preferable method, as it obviates the need for gastro-intestinal surgery. [9][10][11] In addition, use of the urothelium is also advatageous, it being a non-absorptive tissue, resistant to the inflammatory and potentially carcinogenic effects of urine. 12 Review of the current literature reveals a paucity of data regarding urothelial-based reconstructions of the upper-and mid-ureter.…”

Section: Discussionmentioning

confidence: 99%

Urothelial-based reconstructive surgery for upper- and mid-ureteral defects: Long-term results

Rosenzweig

Mor

Erlich

et al. 2016

CUAJ

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Introduction: Ureteral strictures can result in obstructive nephropathy and renal function deterioration. Surgical management of ureteral defects, especially in the proximal-and mid-ureter, is particularly challenging. Our purpose was to analyze the long-term outcomes of urothelial-based reconstructive surgery for upper-and mid-ureteral defects. Methods:We conducted a retrospective analysis of a single tertiary centre's database, including 149 patients treated for ureteral defects between 2001 and 2011. Thirty-one patients (21%) underwent complex urothelial-based surgical repairs for upper-and mid-ureter defects. Patients' median age was 61 years. The mean length of the ureteral strictures was 2.5 cm, located in upper-, mid-ureter, or in between in 19 (61%), 10 (32%), and two (6%) patients, respectively. All patients were treated with a primary urothelial-based repair. Median followup time was 26 months. The primary outcome of the study was the long-term preservation of renal function and lack of clinical obstruction. The secondary endpoint of the study was the assessment of the intra-and postoperative complication rates. Results: Most of the lesions were benign (22, 71%), while nine strictures (29%) were malignant. Seven patients (23%) suffered from postoperative complications, five of which were infectious. The median pre-and postoperative calculated glomerular filtration rates were 66 ml/min/1.72m 2 and 64ml/min/1.72m 2 , respectively. Success rate was 84%, defined as lack of need for re-operation or kidney drainage at the last followup. Conclusions: Upper-and mid-ureteral defects present a complex pathology necessitating experienced reconstructive surgical skills. Our data suggest good long-term results for primary urothelialbased reconstructions for these pathologies.

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“…The degree to which renal descensus limits caudal mobilization for ureteral reconstruction is limited primarily by the renal vein. 1,4 Renal vein transection and relocation into the distal inferior vena cava has been described but is rarely used.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Renal Descensus for Upper Tract Reconstruction

Sutherland

Williams

Jarrett

2011

Journal of Endourology

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We describe a modern use of laparoscopic renal descensus during the reconstruction of the upper urinary tract. The patient is a 76-year-old mononephric man with recurrent carcinoma in situ in the distal ureter. Using the described technique, we produced an additional 8 to 10 cm of ureteral length and performed a simple ureteroneocystotomy instead of using a traditional psoas hitch and Boari flap creation, bowel interposition, or autotransplantation. Laparoscopic renal descensus is an uncommonly used but simple procedure that may prevent the need for bladder mobilization or Boari flap creation, particularly in the setting of a hostile pelvis.

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Technical Options in Complex Ureteral Lesions: 'Ureter-Sparing' Surgery

Cited by 21 publications

References 10 publications

Single Surgeon Experience with Robot-Assisted Ureteroureterostomy for Pathologies at the Proximal, Middle, and Distal Ureter in Adults

Single Surgeon Experience with Robot-Assisted Ureteroureterostomy for Pathologies at the Proximal, Middle, and Distal Ureter in Adults

Urothelial-based reconstructive surgery for upper- and mid-ureteral defects: Long-term results

Laparoscopic Renal Descensus for Upper Tract Reconstruction

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