The genitofemoral nerve (GFN) has its unique anatomic characteristics of location, run and function in the male urinary system and its relationship with the ureter, deferens and inguinal region is apt to be ignored in clinical anatomic application. Clinical studies show that GFN is closely correlated with postoperative ureteral complications and pain in the inguinal region after spermatic cord or hernia repair. GFN transplantation can be used in the management of erectile dysfunction caused by cavernous nerve injury. Therefore, GFN played an important role in the clinical application of uroandrology. This review summarizes the advances in the studies of GFN in relation to different diseases in uroandrology.
Erectile Dysfunction ; etiology ; surgery ; Hernia, Inguinal ; surgery ; Humans ; Inguinal Canal ; innervation ; Lumbosacral Plexus ; injuries ; Male ; Pain, Postoperative ; etiology ; Peripheral Nerves ; transplantation ; Postoperative Complications ; etiology ; surgery ; Ureter ; innervation ; surgery ; Urogenital System ; innervation ; Vas Deferens ; innervation

Spinal cord injury (SCI) may lead to urinary system disturbances. Patients with SCI usually have neurogenic bladder, and treatment optionss for this condition include clean intermittent catheterization and a permanent indwelling urethral or suprapubic catheter. Complications of catheterization include urinary tract infection, calculi, urinary tract injury, bladder contraction, bladder spasm, renal dysfunction, bladder cancer, and so forth. To the best of our knowledge, ureteral rupture is an unusual complication of catheterization, and ureteral rupture has been rarely reported in SCI patients. Therefore, here we report a case of ureteral rupture caused by a suprapubic catheter used for the treatment of neurogenic bladder with vesicoureteral reflux in a male patient with SCI. Due to SCI with neurogenic bladder, ureteral size can be reduced and the suprapubic catheter tip can easily migrate to the distal ureteral orifice. Thus, careful attention is required when a catheter is inserted into the bladder in patients with SCI.
Catheterization ; Catheters* ; Humans ; Intermittent Urethral Catheterization ; Male* ; Rupture* ; Spasm ; Spinal Cord Injuries* ; Spinal Cord* ; Ureter* ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Bladder, Neurogenic ; Urinary Calculi ; Urinary Catheterization ; Urinary Tract Infections ; Vesico-Ureteral Reflux

OBJECTIVE: The term 'total laparoscopic hysterectomy (TLH) with classical suture method' refers to a surgical procedure performed using only sutures and ligations with intracorporeal or extracorporeal ties, without using any laser or electronic cauterization devices during laparoscopic surgery as in total abdominal hysterectomy. However, the method is not as widely used as electric coagulation equipment for TLH because further advances in technology and surgical technique are required and operative time can take longer. In the current study, we evaluated the benefits of the classical suture method for TLH. METHODS: This study retrospectively reviewed patients who received TLH using the classical suture method from August 2005 to April 2014. The patients' baseline characteristics were analyzed, including age, parity, cause of operation, medical and surgical history. Surgical outcomes analyzed included the weight of the uterus, operative time, complications, changes in hemoglobin level, blood transfusion requirements, and postoperative hospital stay. RESULTS: Of 746 patients who underwent TLH with the classical suture method, mean operation time was 96.9 minutes. Mean average decline in hemoglobin was 1.6 g/dL and transfusion rate was 6.2%. Urinary tract injuries were reported in 8 patients. Urinary tract injuries comprised 6 cases of bladder injury and 3 cases of ureter injury. There were no cases of vaginal stump infection, hematoma, bowel injury or abdominal wound complication. All cases involving complications occurred before 2010. CONCLUSION: The classical suture method for TLH presents tolerable levels of complications and blood loss. Advanced surgical skill is expected to decrease operation time and complications.
Blood Transfusion ; Cautery ; Female ; Hematoma ; Humans ; Hysterectomy* ; Laparoscopy ; Length of Stay ; Ligation* ; Operative Time ; Parity ; Retrospective Studies ; Sutures* ; Ureter ; Urinary Bladder ; Urinary Tract ; Uterus ; Wounds and Injuries

Spontaneous rupture of the ureter is a very rare condition and usually results from ureteral obstruction by a calculus. Only theoretical mechanisms have been proposed and no possible explanation has yet been reported in the literature. Intravenous contrast-enhanced computed tomography is the most informative study with high sensitivity. Treatment should be individualised, and depends on the state of the patient. Minimally invasive endourological procedures with double-J catheter placement and percutaneous drainage offer excellent results. Conservative management with analgesics and antibiotic coverage may be an alternative to surgery. Herein, we present a case of spontaneous rupture of the proximal ureter with no evidence of an underlying pathological condition.
Adult ; Contrast Media ; chemistry ; Humans ; Male ; Rupture, Spontaneous ; Stents ; Tomography, X-Ray Computed ; Ureter ; injuries ; Ureteral Obstruction ; Urinary Catheterization ; Urinary Catheters

Crossed renal ectopia is a condition in which a kidney is located on the side opposite of its ureteral insertion. Ninety percent of crossed ectopic kidneys are fused to their ipsilateral uncrossed renal unit. Crossed renal ectopia without fusion is rare, with only 62 patients reported in the literature to date. These kidneys may suffer iatrogenic injury during an unrelated surgical intervention. The injury, unless self-limiting, may necessitate the removal of the ectopic kidney. We present a unique case of a dual injury, renal as well as ureteric, in a crossed ectopic kidney without fusion that was successfully managed without surgical excision.
Adult ; Choristoma/radiography/*therapy ; Humans ; *Iatrogenic Disease ; Kidney/*abnormalities/injuries/radiography ; Male ; Stents ; Tomography, X-Ray Computed ; Ureter/abnormalities/injuries/radiography

Urinary catheterization is a common procedure, particularly among patients with neurogenic bladder secondary to spinal cord injury. Urethral catheterization is associated with the well-recognized complications of catheter-associated urinary tract infections and limited genitourinary trauma. Unintentional ureteral cannulation represents a rare complication of urethral catheterization and has been previously described in only eight cases within the literature. We describe two cases of aberrant ureteral cannulation involving two patients with quadriplegia. These cases along with prior reports identify the spastic, insensate bladder and altered pelvic sensorium found in upper motor neuron syndromes as major risk factors for ureteral cannulation with a urinary catheter.
Aged ; Female ; Humans ; Male ; Middle Aged ; Spinal Cord Injuries/*complications ; Ureter/*injuries ; Urinary Bladder, Neurogenic/etiology/*therapy ; Urinary Catheterization/*adverse effects

The majority of ureteric injury is iatrogenic during surgical procedures especially pelvic and retroperitoneal operations. Approximately 10% of ureteric injury is associated with colorectal procedures. The major cause is anatomical anomaly. The types of injuries mainly include contusion, clamp injury, ligation injury, cautery, cut injury and distorted traction to an acute angle. The injuries are mainly located in the lower segment of the ureter. An accurate evaluation of the risk of ureteric injury before rectal cancer operation, a better understanding of anatomy in both normal and abnormal conditions, and ureteral stent placement, are important methods to prevent ureteric injury. Primary repair is the best treatment option.
Humans ; Intraoperative Complications ; prevention & control ; Rectal Neoplasms ; surgery ; Ureter ; injuries

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

PURPOSE: We evaluated the feasibility of a laparoendoscopic single-site (LESS) nephroureterectomy for an upper urinary tract tumor. MATERIALS AND METHODS: Between March 2009 and September 2009, 4 patients with upper urinary tract tumors underwent LESS nephroureterectomy. The mean age of the 2 female and 2 male patients was 69 years old, and their mean body mass index was 23.0. We used a homemade single-port device made with a surgical glove and a wound retractor, which were put into a 4 cm periumbilical incision. Operations with articulating and rigid laparoscopic instruments were performed transperitoneally. An open technique with a 4 cm additional midline incision and laparoscopic technique with an endoscopic stapler were used for the treatment of the distal ureter and bladder cuff. RESULTS: All cases were completed successfully, without conversion to conventional laparoscopy or open surgery. The mean operative time was 169.5 minutes. The mean estimated blood loss was 361.4 ml. One patient had transfusion and wound infection. The mean hospital stay was 7.8 days. The mean specimen weight and tumor size were 271.8 g and 2.9 cm. Pathologic results of all cases showed urothelial carcinoma with a negative surgical margin. Three patients were in stage T3N0M0 and 1 was in stage T2N0M0. CONCLUSIONS: Our initial experience shows that LESS nephroureterectomy with a homemade single-port device is technically feasible. However, long term follow-up for the effect on cancer control and technical development for comfortable surgery are needed.
Body Mass Index ; Female ; Gloves, Surgical ; Humans ; Kidney Neoplasms ; Laparoscopy ; Length of Stay ; Male ; Nephrectomy ; Operative Time ; Ureter ; Ureteral Neoplasms ; Urinary Bladder ; Urinary Tract* ; Wound Infection ; Wounds and Injuries

PURPOSE: We evaluated the feasibility of a laparoendoscopic single-site (LESS) nephroureterectomy for an upper urinary tract tumor. MATERIALS AND METHODS: Between March 2009 and September 2009, 4 patients with upper urinary tract tumors underwent LESS nephroureterectomy. The mean age of the 2 female and 2 male patients was 69 years old, and their mean body mass index was 23.0. We used a homemade single-port device made with a surgical glove and a wound retractor, which were put into a 4 cm periumbilical incision. Operations with articulating and rigid laparoscopic instruments were performed transperitoneally. An open technique with a 4 cm additional midline incision and laparoscopic technique with an endoscopic stapler were used for the treatment of the distal ureter and bladder cuff. RESULTS: All cases were completed successfully, without conversion to conventional laparoscopy or open surgery. The mean operative time was 169.5 minutes. The mean estimated blood loss was 361.4 ml. One patient had transfusion and wound infection. The mean hospital stay was 7.8 days. The mean specimen weight and tumor size were 271.8 g and 2.9 cm. Pathologic results of all cases showed urothelial carcinoma with a negative surgical margin. Three patients were in stage T3N0M0 and 1 was in stage T2N0M0. CONCLUSIONS: Our initial experience shows that LESS nephroureterectomy with a homemade single-port device is technically feasible. However, long term follow-up for the effect on cancer control and technical development for comfortable surgery are needed.
Body Mass Index ; Female ; Gloves, Surgical ; Humans ; Kidney Neoplasms ; Laparoscopy ; Length of Stay ; Male ; Nephrectomy ; Operative Time ; Ureter ; Ureteral Neoplasms ; Urinary Bladder ; Urinary Tract* ; Wound Infection ; Wounds and Injuries