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Archivos Espanoles de Urologia May 2017Although the laparoscopic ureteral reimplantation (LUR) has a history of over 20 years, its presence in the literature is relatively sparse, almost always in the form of... (Review)
Review
Although the laparoscopic ureteral reimplantation (LUR) has a history of over 20 years, its presence in the literature is relatively sparse, almost always in the form of small case series with low statistical power, which has prevented consistent results. It has proven to be a safe and effective technique, improving the safety profile and perioperative complications compared to open ureteral reimplantation (OUR). The few long-term results suggest a similar success rate between the open and laparoscopic approaches. Although we do not found in the literature a strong evidence of the benefits of anti-reflux reimplantation techniques in adults, most of the published series include these procedures. Ureteral reimplantation is considered the treatment of choice in ureteral injuries below the iliac vessels. This is its main indication now. Intraoperative recognition of the injury and immediate LUR avoid other complications, but most of ureteral injuries are diagnosed in the early postoperative period. Although the classical recommendations advise urinary diversion and delayed treatment, the immediate approach is feasible, and indeed seems to improve results in complications, stay and long-term renal function. In situations of postoperative peritonitis secondary to a ureteral fistula, immediate LUR offers specific advantages, at least theoretically, for the protective effect of pneumoperitoneum in abdominal sepsis.
Topics: Humans; Iatrogenic Disease; Intraoperative Complications; Laparoscopy; Time Factors; Treatment Outcome; Ureter; Ureteral Diseases; Urologic Surgical Procedures
PubMed: 28530620
DOI: No ID Found -
Rheumatic Diseases Clinics of North... May 2013Retroperitoneal fibrosis (RPF) is a condition characterized by the presence of inflammation and fibrosis in the retroperitoneal space, for which no standard diagnostic... (Review)
Review
Retroperitoneal fibrosis (RPF) is a condition characterized by the presence of inflammation and fibrosis in the retroperitoneal space, for which no standard diagnostic criteria exist. Historically, treatment has focused on relieving the obstruction with percutaneous or cystoscopic assisted placement of ureteral stents followed by more definitive resolution of ureteric obstruction with open or laparoscopic ureterolysis. However, over the past several years management has shifted from primarily a surgical approach to an immunosuppressive-based therapy aimed at modulation of the immune system. This review focuses on the recent advances in the classification, epidemiology, pathophysiology, pathology, imaging, and treatment of RPF.
Topics: Aortic Diseases; Comorbidity; Disease Management; Humans; Immunosuppressive Agents; Retroperitoneal Fibrosis; Stents; Ureter
PubMed: 23597969
DOI: 10.1016/j.rdc.2013.02.004 -
Basic & Clinical Pharmacology &... Jan 2022The primary goals of medical expulsive therapy are to increase the rate of stone expulsion along the ureter to avoid ureteral obstruction and reduce ureteral colic and... (Review)
Review
The primary goals of medical expulsive therapy are to increase the rate of stone expulsion along the ureter to avoid ureteral obstruction and reduce ureteral colic and thus avoid the need for surgical and more invasive interventions. This review focussed on the findings from in vivo and in vitro animal and human studies that have investigated the pharmacological mechanisms controlling ureteral motility and their translation to current and potentially new clinically used drugs for increasing the rate of stone expulsion along the ureter. The complicated contractility profile of the ureter, which alters with age, tissue segment region, orientation and species contributes to the difficulty of interpreting studies on ureteral pharmacology, which translates to the complexity of discovering ideal drug targets for medical expulsive therapy. Nevertheless, the current drug classes clinically used for patients with stone lodgement include α -adrenoceptor antagonists, calcium channel blockers and NSAIDS, whilst there are promising targets for drug development that require further clinical investigations including the phosphodiesterase type 5 enzyme, β-adrenoceptors and 5-HT receptors.
Topics: Age Factors; Animals; Drug Development; Drug Discovery; Humans; Species Specificity; Treatment Outcome; Ureter; Ureteral Calculi
PubMed: 33991399
DOI: 10.1111/bcpt.13613 -
Archivio Italiano Di Urologia,... Sep 2022We present our experience of the endourological management of encrusted ureteral stents (EUS) and a literature review on forgotten encrusted ureteral stents. (Review)
Review
INTRODUCTION
We present our experience of the endourological management of encrusted ureteral stents (EUS) and a literature review on forgotten encrusted ureteral stents.
METHODS
A total of 13 encrusted ureteral stents from 12 patients were removed in two hospitals. The medical records were retrospectively analyzed for stent indication, indwelling time, clinical presentation, investigations, type and the number of surgical procedures, operative time, complications, duration of hospital stay, and the follow-up.
RESULTS
Five ureteral stents (US) inserted before ESWL (extracorporeal shockwave lithotripsy) for renal stones, seven US for ureteric stones with ureteric colic, and one ureteral stent for post ureteroscopy procedure. The mean indwelling time was 15.07 ± 7.34 months with a range from 6 to 24 months. The mean Kidney,Ureter and Bladder (KUB) score of encrusta-tion grading was 11.84 ± 2.07 with a range from 9 to 15. The encrusted stents were removed by a combination of cystolithotripsy, semi-rigid ureteroscopy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and ESWL. The average total number of procedures to remove one EUS was 3 ± 1.08 with a range of 2 to 5 proce-dures. Six encrusted stents were removed in one, five stents required two, one stent required three and one stent required four hospital admissions. The median operative time was 210 minutes with a range of 60 to 660 minutes per EUS removal and the mean hospital stay was 2.69 ± 1.43 days with a range of 1 to 6 days. All patients had successful removal of encrusted stent and complete stone clearance with no major complica-tions. In the follow-up, one patient had recurrent ureteric stone, one patient on regular stent exchange due to poor renal function and one patient developed significant ureteric stricture referred for reconstruction.
CONCLUSIONS
Removal of forgotten encrusted impacted ureteral stents is challenging and requires a multimodal surgical approach. It adds significant costs to the health care system and in addition it affects patient safety and quality of life. Patient education, avoiding unnecessary ureteral stent place-ment and a computerized stent monitoring system reduces the incidence of forgotten ureteral stents and their complications.
Topics: Humans; Kidney Calculi; Lithotripsy; Quality of Life; Retrospective Studies; Stents; Ureter; Ureteral Calculi; Urinary Calculi
PubMed: 36165475
DOI: 10.4081/aiua.2022.3.305 -
Experimental and Clinical... May 2021Despite advances in surgical techniques and organ preservation, transplant ureteric strictures remain a common complication in kidney transplantation. A variety of...
OBJECTIVES
Despite advances in surgical techniques and organ preservation, transplant ureteric strictures remain a common complication in kidney transplantation. A variety of endourological and surgical techniques have been utilized; however, there is a lack of consensus on the optimal modality in dealing with these complex cases.
MATERIALS AND METHODS
We present challenging ureteral reconstruction cases after failed attempts at ureteral dilatation, failed conventional open repairs, and/or with bladder dysfunction.
RESULTS
All renal allografts were salvaged by successful use of bladder Boari flap and intestinal segment interpositions/diversions.
CONCLUSIONS
Operative repair remains the most durable and successful approach, and minimally invasive options should be reserved for nonsurgical candidates, with consideration of a single attempt in patients with early, distal, short (<2 cm), nonischemic strictures.
Topics: Constriction, Pathologic; Humans; Kidney Transplantation; Ureter; Ureteral Obstruction; Urinary Bladder
PubMed: 33797353
DOI: 10.6002/ect.2020.0566 -
Annals of the Royal College of Surgeons... Jan 1972
Topics: Acute Kidney Injury; Colon; Dilatation; Female; Humans; Ileum; Methods; Postoperative Complications; Radiation Effects; Radiotherapy; Retroperitoneal Fibrosis; Tuberculosis, Urogenital; Ureter; Ureteral Calculi; Ureteral Diseases; Ureteral Neoplasms; Ureteral Obstruction; Ureterocele; Urinary Diversion; Urinary Tract Infections; Urography
PubMed: 5062021
DOI: No ID Found -
BJU International Oct 2022To summarise the causes of ureteric damage and the current standard of care, discussing the risks and benefits of available therapeutic options. We then focus on the... (Review)
Review
OBJECTIVES
To summarise the causes of ureteric damage and the current standard of care, discussing the risks and benefits of available therapeutic options. We then focus on the current and future solutions that can be provided by ureteric bioengineering and provide a description of the ideal characteristics of a bioengineered product.
METHODS
We performed a literature search in February 2021 in: Google Scholar, Medline, and Web of Science. Three searches were conducted, investigating: (a) the epidemiology of ureteric pathology, (b) the current standard of care, and (c) the state of the art in ureteric bioengineering.
RESULTS
The most-common causes of ureteric damage are iatrogenic injury and external trauma. Current approaches to treatment include stent placement or surgical reconstruction. Reconstruction can be done using either urological tissue or segments of the gastrointestinal tract. Limitations include scarring, strictures, and infections. Several bioengineered alternatives have been explored in animal studies, with variations in the choice of scaffold material, cellular seeding populations, and pre-implantation processing. Natural grafts and hybrid material appear to be associated with superior outcomes. Furthermore, seeding of the scaffold material with stem cells or differentiated urothelial cells allows for better function compared to acellular scaffolds. Some studies have attempted to pre-implant the graft in the omentum prior to reconstruction, but this has yet to prove any definitive benefits.
CONCLUSION
There is an unmet clinical need for safer and more effective treatment for ureteric injuries. Urological bioengineering is a promising solution in preclinical studies. However, substantial scientific, logistic, and economic challenges must be addressed to harness its transformative potential in improving outcomes.
Topics: Animals; Bioengineering; Constriction, Pathologic; Treatment Outcome; Ureter; Urologic Diseases
PubMed: 35388587
DOI: 10.1111/bju.15741 -
Urologia Internationalis 2023The aim of the study was to assess the effectiveness of the main classes of drugs used at reducing morbidity related to ureteric stents.
BACKGROUND
The aim of the study was to assess the effectiveness of the main classes of drugs used at reducing morbidity related to ureteric stents.
SUMMARY
After establishing a priori protocol, a systematic electronic literature search was conducted in July 2019. The randomized clinical trials (RCTs) selection proceeded in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and was registered (PROSPERO ID 178130). The risk of bias and the quality assessment of the included RCTs were performed. Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), and quality of life (QoL) were pooled for meta-analysis. Mean difference and risk difference were calculated as appropriate for each outcome to determine the cumulative effect size. Fourteen RCTs were included in the analysis accounting for 2,842 patients. Alpha antagonist, antimuscarinic, and phosphodiesterase (PDE) inhibitors significatively reduced all indexes of the USSQ, the IPSS and QoL scores relative to placebo. Conversely, combination therapy (alpha antagonist plus antimuscarinic) showed in all indexes of the USSQ, IPSS, and QoL over alpha antagonist or antimuscarinic alone. On comparison with alpha blockers, PDE inhibitors were found to be equally effective for urinary symptoms, general health, and body pain parameters, but sexual health parameters improved significantly with PDE inhibitors. Finally, antimuscarinic resulted in higher decrease in all indexes of the USSQ, the IPSS, and QoL relative to alpha antagonist.
KEY MESSAGE
Relative to placebo, alpha antagonist alone, antimuscarinics alone, and PDE inhibitors alone have beneficial effect in reducing stent-related symptoms. Furthermore, there are significant advantages of combination therapy compared with monotherapy. Finally, PDE inhibitors are comparable to alpha antagonist, and antimuscarinic seems to be more effective than alpha antagonist alone.
Topics: Humans; Male; Adrenergic alpha-Antagonists; Muscarinic Antagonists; Pain; Quality of Life; Stents; Ureter
PubMed: 34818261
DOI: 10.1159/000518387 -
Current Urology Reports Jan 2015Reconstruction of long ureteral defects often warrants the use of graft tissue and extensive surgical procedures to maintain the safe transport of urine from the kidneys... (Review)
Review
Reconstruction of long ureteral defects often warrants the use of graft tissue and extensive surgical procedures to maintain the safe transport of urine from the kidneys to the urinary bladder. Complication risks, graft failure-related morbidity, and the lack of suitable tissue are major concerns. Tissue engineering might offer an alternative treatment approach in these cases, but ureteral tissue engineering is still an underreported topic in current literature. In this review, the most recent published data regarding ureteral tissue engineering are presented and evaluated, with a focus on cell sources, implantation strategies, and (bio)materials.
Topics: Animals; Humans; Plastic Surgery Procedures; Tissue Engineering; Ureter
PubMed: 25404179
DOI: 10.1007/s11934-014-0465-7 -
BMC Urology Jun 2022For patients with malignant ureteral obstruction or stricture who require long-term internal drainage, plastic double-J stents (DJ stents) represent the mainstay of...
BACKGROUND
For patients with malignant ureteral obstruction or stricture who require long-term internal drainage, plastic double-J stents (DJ stents) represent the mainstay of therapeutic strategies. DJ stents should be replaced at least once every 6 months to avoid infection or obstruction. Although DJ stents are generally replaced under cystoscopy, successful fluoroscopy-guided retrograde replacement of DJ stents in the interventional suite has been described in the literature.
METHODS
Between April 2004 and May 2020, we exchanged 143 DJ stents in 19 male and 22 female patients under fluoroscopic guidance using Nelaton catheters, snare catheters, and 8F DJ stents. All procedures were performed with patients under sedation and local anesthesia. There were 39 patients with malignant ureteral obstruction and two patients with benign ureteral strictures. This study was approved by the Institutional Review Board. Technical success, clinical success, complications, procedure time, and mean interval between two procedures were retrospectively reviewed, and the factors affecting the success rate of the procedure were analyzed.
RESULTS
Obstruction was detected at the abdominal ureter in 4 patients, pelvic ureter in 29 patients, and intravesical ureter in 8 patients. Twenty-six patients underwent two or more sessions of the procedures, whereas 15 patients underwent single-session procedures. Total 34 outpatient-based procedures and 109 inpatient-based procedures were performed. Technical success and clinical success were achieved in 94.4% (135/143) and 93.3% (126/135) procedures, respectively. Mean procedure time was 21.5 min (range 9-192 min). Mean procedure interval was 101.8 days (range 5-306 days). Technical success was negatively affected by male sex and obstruction at the pelvic ureter and was positively affected by previous successful exchange. Left-sided ureteral stent placement and old age negatively influenced clinical success. Septic shock occurred in one patient and was treated with antibiotics.
CONCLUSION
Fluoroscopy-guided trans-urethral exchange of DJ stents is an effective and less painful procedure.
Topics: Constriction, Pathologic; Female; Fluoroscopy; Humans; Male; Retrospective Studies; Stents; Ureter; Ureteral Obstruction
PubMed: 35706037
DOI: 10.1186/s12894-022-01034-3