BACKGROUNDRetrocaval ureter is a rare congenital abnormality. Operative repair is always suggested in cases of significant functional obstruction. Laparoscopic procedures have been employed as the minimally invasive therapeutic option for retrocaval ureter. However, the laparoscopic techniques for retrocaval ureter might be technically challenging to some surgeons. The aim of this article was to present our experience and surgical techniques of pure transperitoneal laparoscopic pyelopyelostomy and ureteroureterostomy in nine patients with retrocaval ureter.

METHODSA total of nine patients of retrocaval ureter underwent pure laparoscopic pyelopyelostomy or ureteroureterostomy. The operation was performed with the patients placed in the 70-degree lateral decubitus position via a three port transperitoneal approach with two 10-mm and one 5-mm ports. The distal part of the dilated renal pelvis was transected at the ureteropelvic junction and the ureter was relocated anterior to the inferior vena cava. The tension-free pyeloureteral or ureteroureteral anastomosis was completed with the intracorporal freehand suturing and in situ knot-tying techniques combined with interrupted and continuous fashion. A double J ureteral stent was inserted in an antegrade manner during laparoscopy. Intravenous urography or computerized tomography and renal ultrasonography were performed after 3 months postoperatively.

RESULTSAll operations were completed laparoscopically, and no open conversion was required. The mean operative time was 135 minutes (range, 70 - 250 minutes), with minimal blood loss (less than 60 ml). No intra-operative complications or significant bleeding occurred. All patients presented mild postoperative pain and quick convalescence. The symptoms disappeared and hydronephrosis decreased substantially after surgery.

CONCLUSIONSPure transperitoneal laparoscopic correction for retrocaval ureter was associated with an excellent outcome, minimal invasiveness and short hospital stay. It is technically feasible and reliable for retrocaval ureter treatment. Laparoscopic surgery could be the standard treatment for retrocaval ureter.

Adult ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Treatment Outcome ; Ureter ; surgery ; Ureteral Obstruction ; surgery ; Young Adult

OBJECTIVE: To discuss the safety and efficacy of laparoscopic ureterovesical reimplantation in the treatment of transplanted ureteral stenosis. METHODS: One case of laparoscopic ureterovesicalre implantation in the treatment of ureteral stenosis after renal transplantation was reported, and related literatures was reviewed. A 54-year-old woman was admitted to our hospital with main complaint of hydronephrosis of transplanted kidney for five years after renal transplantation. Her physical examination showed slightly bulging in the transplanted kidney area without tenderness. The magnetic resonance urography (MRU) showed that the transplanted kidney and ureter were dilated obviously, with significant dilatation of renal pelvis and calyx, about 5 cm at the widest point of renal pelvis expansion, and the end of ureter was narrow, without abnormal filling defect in the ureter. The primary diagnosis was distal transplanted ureteral stenosis. After twice endoscopic ureteral dilatation by multi-endoscopic technique, there was no improvement in the hydronephrosis after the removal of the stent. After thorough preoperative preparation, laparoscopic ureterovesical reimplantation was performed under general anesthesia. Firstly, the median umbilical ligament, the lateral umbilical ligament and the peritoneal fold were cut off, and the anterior bladder space was dissociated distally. The space of left side wall of the bladder and the pubic bone was gradually dissociated, and the space of anterior bladder wall and the pubic bone was dissociated. Secondly, the right side wall of the bladder was dissociated from the head to the tail, and the surrounding structure was carefully identified to avoid injury of the ureter of the transplanted kidney. The transplanted ureter was sought between the right side of the bladder and the lower pole of the transplanted kidney. The distal end of the ureter was cut open, and the narrow section was cut off, confirming that no stenosis in the proximal ureter. The ureterocystic anastomosis was performed by Lich-Gregoir method (extra-bladder). Finally, the bladder tissue around the anastomosis site was fixed to the right pelvic wall to reduce tension. RESULTS: The operation was completed successfully, the operation time was 210 min, the amount of bleeding was about 30 mL, and there was no surgical complication. The creatinine was stable after operation, with serum creatinine declining to 68 μmol/L, and serum creatinine 94 μmol/L before operation. The patient was discharged 5 days after operation. After follow-up of 3 months, KUB indicated that the position of ureteral stent was good and the function of renal transplantation was stable. CONCLUSION Laparoscopic ureterovesical reimplantation is a safe and effective treatment for ureteral ureteral stricture after renal transplantation. Compared with open surgery, laparoscopic surgery has less impact on renal renal allograft, with faster recovery, less bleeding, fewer complications, less postoperative pain and minimally invasive wound. This surgical procedure is difficult and requires an experienced urologist with high laparoscopic skills to perform.
Constriction, Pathologic ; Female ; Humans ; Kidney Transplantation ; Laparoscopy ; Middle Aged ; Replantation ; Ureter/surgery* ; Ureteral Obstruction/surgery*

Aged ; Female ; Humans ; Kidney Pelvis ; pathology ; surgery ; Rupture, Spontaneous ; diagnosis ; etiology ; surgery ; Ureteral Calculi ; complications ; diagnosis ; surgery ; Ureteral Obstruction ; complications ; diagnosis ; surgery

Ureteral injury can be classified as iatrogenic or traumatic, which represents a rare but challenging field of reconstructive urology. Due to their close proximity to vital abdominal and pelvic organs, the ureters are highly susceptible to iatrogenic injury, while ureteral injury caused by external trauma is relatively rare. The signs of ureteric injury are difficult to identify initially and often present after a delay. The treatment of ureteral injury, which is depended on the type, location, and degree of injury, the time of diagnosis and the patient's overall clinical condition, ranges from simple endoscopic management to complex surgical reconstruction. And long defect of the ureter presents much greater challenges to urologists. Ureterotomy under endoscopy using laser or cold-knife is available for the treatment of 2-3 cm benign ureteral injuries or strictures. Pyeloplasty is an effective treatment for ureteropelvic junction obstruction and some improved methods showed the possibility of repairing long-segment (10-15 cm) stenosis. Proximal and mid-ureteral injuries or strictures of 2-3 cm long can often be managed by primary ureteroureterostomy. When not feasible due to ureteral defects of longer segment, mobilization of the kidney should be considered, and transureteroureterostomy is alternative if the proximal ureter is of sufficient length. And autotransplantation or nephrectomy is regarded as the last resorts. Most of the injuries or strictures are observed in the distal ureter, below the pelvic brim, and are usually treated with ureteroneocystostomy. A non-refluxing technique together with a ureteral nipple or submucosal tunnel method, is preferable as it minimizes vesico-ureteral reflux and the risk of infection. In order to cover a longer distance, ureteroneocystostomy in combination with a psoas hitch (covering 6-10 cm of defect) or a Boari flap (covering 12-15 cm) is often adopted. Among various ureteral replacement procedures, only intestinal ureteral substitution, which includes ileal ureter, appendiceal interposition and reconfigured colon substitution, has gained wide acceptance when urothelial tissue is insufficient. Ileal ureter can be used to replace the ureter of >15 cm defect and even to replace the entire unbilateral ureter or bilateral ureter. Laparoscopic and robotic-assisted techniques are increasingly being employed for ureteral reconstruction and adopted with encouraging results.
Humans ; Reconstructive Surgical Procedures ; Surgical Flaps ; Ureter/surgery* ; Ureteral Obstruction ; Urologic Surgical Procedures

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.
Humans ; Hydronephrosis ; Kidney Pelvis ; Laparoscopy ; Ureter ; Ureteral Obstruction/surgery* ; Urologic Surgical Procedures

No abstract available.
Child ; Humans ; Hydronephrosis/*congenital/diagnosis/etiology ; Male ; Multicystic Dysplastic Kidney/diagnosis/*etiology ; Polyps/*complications/diagnosis/surgery ; Ureteral Diseases/complications/diagnosis/surgery ; Ureteral Obstruction/diagnosis/*etiology

Adolescent ; Adult ; Female ; Humans ; Kidney Pelvis ; surgery ; Laparoscopy ; methods ; Male ; Middle Aged ; Ureteral Obstruction ; surgery ; Urologic Surgical Procedures ; methods

Adolescent ; Adult ; Female ; Humans ; Kidney Pelvis ; surgery ; Laparoscopy ; methods ; Male ; Middle Aged ; Robotics ; Ureteral Obstruction ; surgery ; Urologic Surgical Procedures ; methods

OBJECTIVE: To study the trend of surgical type, surgical procedure and etiological distribution of upper urinary tract repair in recent 10 years. METHODS: The preoperative and perioperative variables and follow-up data of upper urinary tract reconstruction surgery in RECUTTER (Reconstruction of Urinary Tract: Technology, Epidemiology and Result) database from 2010 to 2021 were searched, collected and analyzed. The surgical type, surgical procedure, duration of hospitalization, time of operation, incidence of short-term complications, and proportion of the patients undergoing reoperations were compared between the two groups of 2010-2017 period and 2018-2021 period. RESULTS: A total of 1 072 patients were included in the RECUTTER database. Congenital factors and iatrogenic injuries were the main causes of upper urinary tract repair. Among them, 129 (12.0%) patients had open operation, 403 (37.6%) patients had laparoscopic surgery, 322 (30.0%) patients had robot-assisted laparoscopic surgery and 218 (20.3%) patients had endourological procedure. In the last decade, the total number of surgeries showed a noticeable increasing annual trend and the proportion of robot-assisted laparoscopic surgery in 2018-2021 was significantly higher than that in 2010-2017 (P < 0.001). The 1 072 patients included 124 (11.6%) cases of ileal ureter replacements, 440 (41.1%) cases of pyeloplasty, 229 (21.4%) cases of balloon dilation, 109 (10.2%) cases of ureteral reimplantation, 49 (4.6%) cases of boari flap-Psoas hitch surgery, 60 (5.6%) cases of uretero-ureteral anastomosis, 61 (5.7%) cases of lingual mucosal onlay graft ureteroplasty or appendiceal onlay flap ureteroplasty. Pyeloplasty and balloon dilatation had been the main types of surgery, while the proportion of lingual mucosal onlay graft ureteroplasty plus appendiceal onlay flap ureteroplasty had increased significantly in recent years (P < 0.05). In addition, the time of operation was significantly increased (P < 0.05) after 2018, which was considered to be related to the sharp increase in the proportion of robot-assisted laparoscopic surgery. We found that minimally invasive surgery (endourological procedure and robot-assisted laparoscopic surgery) as an independent risk factor (P=0.050, OR=0.472) could reduce the incidence of short-term post-operative complications. CONCLUSION We have justified the value of the RECUTTER database, created by the Institute of Urology, Peking University in data support for clinical research work, and provided valuable experience for the construction of other multi-center databases at home and abroad. In recent 10 years, we have observed that, in upper urinary tract reconstruction surgery, the surgery type tends to be minimally invasive and the surgery procedure tends to be complicated, suggesting the superiority of robot-assisted laparoscopic surgery.
Humans ; Laparoscopy/methods* ; Retrospective Studies ; Robotic Surgical Procedures ; Treatment Outcome ; Ureter/surgery* ; Ureteral Obstruction/surgery* ; Urologic Surgical Procedures/methods*

BACKGROUNDThe delayed diagnosis of pelvi-ureteric junction (PUJ) disruption in children following blunt abdominal trauma can result in loss of function of the involved kidney. We examined the potential for kidney preservation and the limits of diagnostic delays.

METHODSA retrospective review of 17 cases of PUJ disruption at Beijing Children's Hospital from 1993 to 2009 was done with respect to diagnosis, treatment and follow-up.

RESULTSThe interval from trauma to diagnosis of PUJ disruption was (52 ± 52) days. If one case with nephrectomy was excluded, the interval from trauma to diagnosis was (40 ± 20) days. The average time between injury and first treatment was (49 ± 25) days. Pelvi-ureteric reanastomosis and caliceal ureterostomy were performed separately in 11 and 4 patients, respectively. Ileal replacement for ureter injuries was finally performed in one patient. Hydronephrosis of the injured kidney was reduced and the function improved in 15 out of 17 patients (88%). Only one patient received nephrectomy and the nephrectomy rate was 5.9%.

CONCLUSIONDifferential renal function at the PUJ disruption side can be saved and the rate of nephrectomy reduced by appropriate surgery if the time to diagnosis and first treatment is limited to within two months.

Abdominal Injuries ; complications ; surgery ; Child ; Child, Preschool ; Female ; Humans ; Kidney ; injuries ; surgery ; Kidney Pelvis ; injuries ; surgery ; Male ; Retrospective Studies ; Ureter ; injuries ; surgery ; Ureteral Obstruction ; etiology ; surgery