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Journal of Veterinary Internal Medicine 2023Limited information is available regarding the outcome of medical management (MM) of benign ureteral obstruction in cats (BUO).
BACKGROUND
Limited information is available regarding the outcome of medical management (MM) of benign ureteral obstruction in cats (BUO).
HYPOTHESIS
Describe clinical characteristics and outcome of MM of BUO.
ANIMALS
Seventy-two client-owned cats with 103 obstructed kidneys.
METHODS
Medical records of cats diagnosed with BUO between 2010 and 2021 that received >72 hours of MM were retrospectively reviewed. Clinical data, treatment, and outcome were reviewed. Outcome was classified as success, partial success, or failure based on ultrasound findings. Factors associated with outcome were assessed.
RESULTS
Seventy-two cats with 103 obstructed kidneys were enrolled. The causes of obstruction were uroliths in 73% (75/103), strictures in 13.5% (14/103), and pyonephrosis in 13.5% (14/103) of affected kidneys. Median serum creatinine concentration at presentation was 4.01 mg/dL (range, 1.30-21.3 mg/dL). Outcome after MM was considered a success in 30% (31/103), partial success in 13% (13/103), and failure in 57% (59/103) of kidneys. Success was reported in 23% (17/75) of kidneys with uroliths, 50% (7/14) with pyonephrosis, and 50% (7/14) with strictures. Median time to a successful outcome was 16 days (range, 3-115 days). Distal and smaller uroliths (median length, 1.85 mm) were significantly associated with success (P = .05 and P = .01, respectively). Median survival times were 1188 days (range, 60-1700 days), 518 days (range, 7-1812 days), and 234 days (range, 4-3494 days) for success, partial success, and failure, respectively.
CONCLUSIONS AND CLINICAL IMPORTANCE
We found a higher success rate for MM of BUO than previously reported. Smaller distal uroliths (<1-2 mm) were more likely to pass.
Topics: Cats; Animals; Ureteral Obstruction; Pyonephrosis; Retrospective Studies; Constriction, Pathologic; Kidney; Creatinine; Urinary Calculi; Cat Diseases
PubMed: 37073892
DOI: 10.1111/jvim.16709 -
Ugeskrift For Laeger Apr 2023This review summarises the current reconstructive urological procedures seeking to optimise urinary tract function. This includes nephrectomy to avoid complications in... (Review)
Review
This review summarises the current reconstructive urological procedures seeking to optimise urinary tract function. This includes nephrectomy to avoid complications in non-functioning kidneys and reconstruction of uretero-pelvic junction stenosis. Re-implantation of the ureters is indicated in case of reflux or stenosis. The technique depends on the defect and ranges from re-implantation to transplantation of the kidney into the pelvis. Intestine is used for bladder augmentation or to create a new reservoir. Urethral reconstruction is used for complicated strictures, while penile reconstruction includes insertion of implants and straightening procedures.
Topics: Humans; Urology; Constriction, Pathologic; Ureter; Kidney; Plastic Surgery Procedures
PubMed: 37057698
DOI: No ID Found -
Acta Cirurgica Brasileira 2023Ureteral access sheaths (UAS) are widely used in ureteroscopy. UAS are believed to pose a significant risk for ureteral stenosis due to ureteral mucosal compression, but...
PURPOSE
Ureteral access sheaths (UAS) are widely used in ureteroscopy. UAS are believed to pose a significant risk for ureteral stenosis due to ureteral mucosal compression, but little evidence supports this claim. Our systematic review aimed to investigate the relationship between different UAS diameters and stenosis risk.
METHODS
A systematic search was conducted in PubMed, Embase, Web of Science, Scopus, and Cochrane, from its inception to May 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane guidelines were followed. χ2 test was performed to compare the prevalence within the groups.
RESULTS
Six nonrandomized trials and one randomized, with a total of 962 patients, were included. The overall incidence of ureteral stenosis of 0.9%. UAS sizes were: 9.5/11.5Fr, 10/12Fr, 11/13Fr, 12/14Fr, and 14/16Fr. Within each subgroup, the incidence of ureteral stenosis was: 0.4, 8, 0, 1, and 1% (p = 0.099). No trend for stenosis was observed among larger UAS.
CONCLUSIONS
In this systematic review, no relationship between UAS diameter and incidence of ureteral stenosis was observed. Nonetheless, additional randomized controlled trials are required to support this finding.
Topics: Humans; Constriction, Pathologic; Ureter; Ureteroscopy
PubMed: 37909598
DOI: 10.1590/acb387423 -
Urologia Internationalis 2022Ureteral strictures could be a chronic illness that leads to severe side effects and poor quality of life. A treatment with an Allium ureteral stent (URS), a...
INTRODUCTION
Ureteral strictures could be a chronic illness that leads to severe side effects and poor quality of life. A treatment with an Allium ureteral stent (URS), a self-expanding, large-caliber URS, was implemented in our department for ureteral stricture. Our study aim was to report the long-term results, including success rate, complications, and adverse effects.
METHODS
We retrospectively collected data on all patients who were treated with an Allium URS in our department between January 2017 and January 2021. Demographic, clinical, radiological, and perioperative parameters were retrieved and analyzed. The primary outcome was stricture resolution rates following stent removal.
RESULTS
Our cohort included 17 patients, 9 men and 8 women. The etiology of ureteral strictures was urolithiasis in 76.5% and pelvic procedure injury in 17.6%. The overall success rate was 35.29% in an average follow-up of 10.42 ± 2.39 months after stent removal. A higher failure rate was observed in the urolithiasis etiology group (90% vs. 66.7%, p = 0.38). The mean indwelling time of the Allium stent was 14.29 ± 1.29 months.
CONCLUSIONS
Although an Allium URS could be considered as a feasible and attractive treatment of ureteral strictures, due to its minimal invasiveness, the success rate of this treatment is relatively low. Therefore, this option should be carefully considered and should be discouraged in young and fit patients and reserved for older unfit patients who are unwilling to undergo surgical repair of ureteral strictures.
Topics: Allium; Constriction, Pathologic; Female; Humans; Male; Quality of Life; Retrospective Studies; Stents; Treatment Outcome; Ureteral Obstruction; Urolithiasis
PubMed: 35231922
DOI: 10.1159/000522174 -
In Vivo (Athens, Greece) 2020The aim of this review was to provide an update on the status of minimal invasive treatment of ureteral stricture either with a laparoscopic or robotic surgery. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIM
The aim of this review was to provide an update on the status of minimal invasive treatment of ureteral stricture either with a laparoscopic or robotic surgery.
MATERIALS AND METHODS
Eligible studies, published until November 2019 were retrieved through Medline, Cochrane and Pubmed databases. Predetermined inclusion and exclusion criteria were used as selection method for data synthesis and acquisition. The study was performed in accordance with the PRISMA statement.
RESULTS
A total of 19 retrospective studies met the inclusion criteria. All of them demonstrated the safety, feasibility and success of both laparoscopic and robotic ureteral reconstruction. Individual case series or cumulative comparison analysis of the available studies showed at least equivalent success rates and a trend favoring laparoscopic and robotic groups in terms of estimated blood loss and length of hospital stay to the detriment of longer operative times and possibly higher cost.
CONCLUSION
Current evidence suggests the effectiveness, safety and increasing incorporation of minimally invasive techniques for complex stricture repair and reconstruction.
Topics: Constriction, Pathologic; Humans; Laparoscopy; Robotic Surgical Procedures; Treatment Outcome; Ureteral Obstruction
PubMed: 32354881
DOI: 10.21873/invivo.11864 -
Translational Andrology and Urology Jul 2021Traditional ureteral stricture balloon dilation was performed with fluoroscopic assistance. The use of a C-arm X-ray machine delivered hazardous radiation to both...
BACKGROUND
Traditional ureteral stricture balloon dilation was performed with fluoroscopic assistance. The use of a C-arm X-ray machine delivered hazardous radiation to both surgeons and patients. In attempt to eliminate the radiation hazard, we developed a F4.5/6.5 ureteroscope assisted intraoperative X-ray free balloon dilation surgical approach to treat ureteral stricture and to verify its safety and efficacy. Specifically, this method had not been previously reported in the literature.
METHODS
We demonstrated an intraoperative X-ray free balloon dilation with detailed step-by-step procedures description and video illustration. Clinical data of patients undergoing minimally invasive endourological treatment for ureteral stricture between February 2015 and November 2019 were retrospectively analyzed. All steps of X-ray free balloon dilation were carried out under direct vision of a ureteroscope, and two indwelling F7 ureteral stents were used for 3 months postoperatively. Preoperative, intraoperative, and postoperative clinical data were evaluated, and follow-up results were reported. Successful outcome was defined as disappearance of preoperative symptoms, relief of hydronephrosis and stable of renal function. Univariate and multivariate prognostic analyses were performed.
RESULTS
We identified 109 patients who received endourological treatment for ureteral stricture in our hospital's medical database. After excluding patients undergone simple catheter dilation, endoureterotomy and other treatment method, 76 patients received balloon dilation without intraoperative fluoroscopic guidance were included in our study. 4/76 patients report a grade II complication (urinary tract infections, UTIs) according to Clavien Dindo classification. In the 22.5 months median follow-up time, the one-year cumulative success rate and two-year cumulative success rate were 85.9% and 80.2% (61/76), respectively, and the majority (13/15, 86.7%) recurrence of ureteral stricture or hydronephrosis deterioration were found within two years after surgery. The longer stenotic lesion length (>5 mm) or multiple ureter stenosis and compromised blood supply of ureter were significantly associated with postoperative stenosis recurrence.
CONCLUSIONS
X-ray free endoscopic balloon dilation is a safe and effective procedure that could be performed on patients with ureteral stenosis.
PubMed: 34430399
DOI: 10.21037/tau-21-203 -
Translational Andrology and Urology Apr 2020The use of small bowel for ureteral substitution in patients with ureteral stenosis can, nowadays, be safely performed with a laparoscopic or robotic mini-invasive...
The use of small bowel for ureteral substitution in patients with ureteral stenosis can, nowadays, be safely performed with a laparoscopic or robotic mini-invasive approach. To date, this technique required a complete substitution of the ureter with ileum. In this work we present our robotic intracorporeal sub-total ureteral substitution preserving the distal part of the ureter with the aim to reduce the risk of vescico-ureteral reflux. We report the case of a 65-years old male with a "functional" right single kidney and multiple recurrent stenosis. Our technique seems to be feasible and safe, no intra or postoperative complication were recorded. At 3 months of follow-up the trans-nephrostomic enhanced CT showed a completely opacification of ileal ureter, thus the nephrostomic tube was removed. At 6 and 12 months the patient was asymptomatic and with a level of serum creatinine 1.9 and 1.6 mg/dL, respectively. In conclusion the sub-total ureteral substitution with ileum can be a safety and effective procedure for patients who require a mandatory preservation of homolateral renal function.
PubMed: 32420213
DOI: 10.21037/tau.2019.12.32 -
Hinyokika Kiyo. Acta Urologica Japonica Jul 2022We retrospectively reviewed the surgical outcome of ureteral reconstruction that was performed in Asahikawa Medical University Hospital between 2005 and 2021. A total of...
We retrospectively reviewed the surgical outcome of ureteral reconstruction that was performed in Asahikawa Medical University Hospital between 2005 and 2021. A total of 14 patients (3 males, 11 females; 15 ureters) were included in this analysis. The median age was 57 years old. The reason for ureteral reconstruction was ureteral injury or stenosis due to pelvic surgery in 9 patients, transurethral lithotripsy for ureteral stone in 3, ureteral invasion of sigmoid colon cancer in one and ovarian cancer in one. The site of ureteral reconstruction was proximal ureter in 2, middle in 3 and distal in 10. The surgical procedure was ureteroneocystostomy with Boari flap in 8 patients (57%), ureteroureterostomy in 4 (21%), transureteroureterostomy in one (7%), and transureteroureterostomy combined with Boari flap for bilateral ureteral stenosis in the remaining patient (7%). Postoperatively, vesicoureteral reflux, ileus and surgical site infection were observed in 3, 2 and 1 patient, respectively. No patient required nephrostomy or ureteral catheter, or any additional procedure after the surgery. There was no episode of febrile urinary tract infection after the surgery. The mean estimated glomerular filtration rate was, respectivery 75.8 and 78.5 ml/min/1.73 m2 before surgery and at 1-101 months (median of 18) after the surgery. In conclusion, satisfactory outcome was achieved after ureteral reconstruction surgery. We emphasize the importance of selecting the most appropriate procedure for ureteral reconstruction in each patient to prevent renal function deterioration and urinary tract infection.
Topics: Constriction, Pathologic; Female; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Ureter; Urinary Tract Infections
PubMed: 35924705
DOI: 10.14989/ActaUrolJap_68_7_227 -
Percutaneous management of ureteral stenosis of transplanted kidney: technical and clinical aspects.Urologia Internationalis 2011In the field of renal transplantation, advances in the management of graft rejection have led to improved graft and patient survival rates, however other types of... (Review)
Review
In the field of renal transplantation, advances in the management of graft rejection have led to improved graft and patient survival rates, however other types of complications have now become more apparent, e.g. vascular or urological. The most common urological complications following renal transplantation are ureteral stenosis or obstruction, constituting a significant problem of the renal graft's survival. The most important aspects concerning these complications are early diagnosis and prompt treatment since any delay in their management may lead to renal graft dysfunction or even graft loss. Developments in interventional radiology have provided minimally invasive means to treat urological complications with low complication rates. Herein we review the literature in order to evaluate the efficacy of percutaneous management of ureteral stenosis regarding its safety, immediate and long-term results, complications as well as rate of recurrence.
Topics: Catheterization; Constriction, Pathologic; Graft Survival; Humans; Kidney Transplantation; Nephrostomy, Percutaneous; Radiography, Interventional; Recurrence; Stents; Treatment Outcome; Ureteral Obstruction
PubMed: 21952619
DOI: 10.1159/000331897