Efficacy of laparoscopic bladder muscle flap ureteroplasty in the treatment of longsegment injury in the middle and lower ureter: a report of 6 cases
10.3969/j.issn.1009-8291.2023.10.011
- VernacularTitle:腹腔镜膀胱肌瓣输尿管成形术治疗输尿管中下段长段损伤6例疗效分析
- Author:
Jiyi DENG
1
;
Liangwen LIN
1
;
Sicheng WU
1
;
Weimin CHEN
1
;
Zhengbang HU
2
Author Information
1. Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
2. Department of Emergency, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
- Publication Type:Journal Article
- Keywords:
ureteral injury;
laparoscope;
repair;
ureteral avulsion;
bladder muscle flap
- From:
Journal of Modern Urology
2023;28(10):874-878
- CountryChina
- Language:Chinese
-
Abstract:
【Objective】 To explore the feasibility and efficacy of laparoscopic bladder muscle flap ureteroplasty in the treatment of long-segment injury in the middle and lower ureter and to summarize the clinical experience. 【Methods】 The clinical data of 6 patients treated in our hospital during Oct.2018 and Aug.2021 were retrospectively analyzed. Four of them had long-segment ureteral mucosal cuff-like avulsion during ureteroscopic lithotripsy and could not undergo end-to-end ureteral anastomosis or reimplantation, and then laparoscopic bladder muscle flap ureteroplasty plus lumbaris major fixation of the bladder was performed immediately. The other 2 patients had to undergo this procedure due to stricture. 【Results】 All operations were successful. The median ureteral avulsion or ureteral stricture length was 14.5(6, 16) cm, muscle flap length 16.5(8,18) cm, operation time 190 (160, 240) min, blood loss 175 (100, 250) mL, postoperative hospital stay 8 (7, 12) days, and postoperative creatinine (89.38±21.74) μmoI/L. No major complications occurred. One patient developed urinary leakage, which returned to normal after active glycemic control and nutritional therapy; one patient developed postoperative absorption fever, which recovered after physical cooling. During the follow-up of 6 to 45 months, CT showed mild hydronephrosis in some patients, but no ureteral stenosis, impaired renal function or other complications, and patients complained no subjective discomfort. 【Conclusion】 Laparoscopic bladder muscle flap ureteroplasty is safe and effective for patients with long-segment injury in the middle and lower ureter. It has the advantages of small trauma, few long-term complications, and rapid recovery and improvement of renal function. If necessary, it can be combined with lumbaris major fixation of the bladder to shorten the distance from the muscle flap to the broken end of the ureter and to reduce the tension of the anastomosis.
