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Query: UMLS:C0403608 (ureter)
 9,655 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ureteropelvic junction obstruction (UPJO) is characterized by decreased flow of urine down the ureter and increased fluid pressure inside the kidney. Open pyeloplasty had been regarded as the standard management of UPJO for a long time. Laparoscopic pyeloplasty reports high success rates, for both retroperitoneal and transperitoneal approaches, which are comparable to those of open pyeloplasty. However, open and laparoscopic pyeloplasty have yielded disappointing failure rates of 2.5%-10%. The main causes for recurrent UPJO are severe peripelvic and periureteric fibrosis due to urinary extravasation, ureteral ischemia, and inadequate hemostasis. In addition, failing to diagnose lower pole crossing vessels before or during the primary procedure is also responsible for recurrent UPJO. In addition, poor preoperative split renal function, hydronephrosis, presence of renal stones, patient age, diabetes, prior endopyelotomy history, and retrograde pyelography history were considered as predictors of pyeloplasty failure. The failure is usually defined by persistent pain, persistent radiographic obstruction (infection or stones), continued decline in split renal function, or a combination of the above. And the failure of pye-loplasty often occurs in the first 2 years after the surgery. The available options for managing recurrent UPJO with a salvageable renal unit include endopyelotomy, re-do pyeloplasty, stent implantation, percutaneous nephrostomy, ureterocalicostomy, and nephrectomy. Re-do pyeloplasty has such merits as high successful rates and rare complications, compared with endopyelotomy or ureterocalicostomy. And some investigators think that re-do pyeloplasty should be regarded as the gold standard for secondary therapy if feasible. Open pyeloplasty can enlarge the operating field, facilitate the exposure of the ureteropelvic junction, reduce the difficulty of operation, and thus reduce the occurrence of complications. There are no significant differences among the success rates of re-do pyeloplasty under open approach, traditional laparoscopy and robot-assisted laparoscopy, according to previous reports. However, traditional laparoscopic and robot-assisted pyeloplasty give advantages of cosmetology, small trauma, less postoperative pain, speedy recovery and shorter hospitalization, fewer complications and lower recurrent rates. If the primary pyeloplasty is an open operation in retroperitoneal approach, the traditional laparoscopic and robotic operation with retroperitoneal approach should be considered for secondary repair. The cause of recurrent UPJO should be evaluated before surgery and identified intraoperatively to minimize the possibility of recurrence.
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PMID:[Advance in re-do pyeloplasty for the management of recurrent ureteropelvic junction obstruction after surgery]. 3277 19

A 50-year-old female presented to our department of urology with nephrostomy drain in the right kidney been placed because of an acute obstructive pyelonephritis. Nephrostogram revealed an intra-renal pelvis with no passage of contrast into the ureter. Retrograde pyelography identified the extended ureteric stricture and need for a substitution. Laparoscopic ileocalicostomy was performed to achieve a communication between the lower calyx and bladder. Video describing surgical technique is available on https://youtu.be/bIW_m3lwXWY. Due to thick and full-blooded renal parenchyma, a partial nephrectomy of the lower pole had to perform to get an access to the renal calyx. It took 25 min of warm ischemia. At that, sutures of renorrhaphy should have provided reliable hemostasis on the one hand, and free outflow of urine via an isolated calyx on the other. To reduce the length of ileoureter a bladder psoas hitch maneuver was used. A 25-cm-long segment of ileum was isolated and rotated in isoperistaltic manner. Double J stent was held through it. Ileocalicostomy by interrupted and ileovesicostomy by continuous sutures were performed one after another. There were no intraop complications. OR time - 300min. EBL - 200ml. Postoperative course was uneventful. Ten days after surgery, nephrostogram and cystography confirmed the patency of the neoureter and the tightness of both anastomoses. Nephrostomy drain was removed first, ureteral - one day after. "JJ" stood for 3 weeks. The patient is doing well at more than 12 months of follow-up with a stable renal and ileoureteral function. In comparison with open procedure our surgery is significantly less invasive, per contra robotic - not so expensive. As far as we known, this is the first case report of conventional laparoscopic intracorporeal ileocalicostomy with long-term good functional results demonstration.
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PMID:[Laparoscopic ureteral substitution: ileocalicostomy combined with psoas hitch]. 3318 52


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