Search

Purpose: This study aims to investigate the efficacy and safety of Allium metallic ureteral stents in treating patients with refractory ureteral strictures. Materials and methods: A total of 13 patients with refractory ureteral strictures were prospectively enrolled in the study. After ureteral balloon dilation, an Allium stent was inserted into the ureter through the stricture. Serum blood urea nitrogen and creatinine levels, kidney-ureter-bladder x-ray, and renal ultrasonography reports were evaluated preoperatively, 3 months after the procedure, and at the last outpatient visit. Treatment success was defined as improvement in both renal function and the grade of hydronephrosis. Improvement was defined as the enhancement of renal function without the resolution of hydronephrosis. Adverse events were recorded. Results: The median (interquartile range [IQR]) age of the patients was 63 (46-76) years. The median (IQR) follow-up was 15 (13.5-21) months. Treatment success and improvement were noted in 9 (69.2%) and 3 (23.1%) patients, respectively. Compared with the preoperative levels, the median (IQR) serum creatinine levels were significantly improved at 3 months after the operation (1.6 [1.25-2.85] versus 1.2 [1.05-2.05]; P = 0.02) and at the last visit (1.6 [1.25-2.85] versus 1.2 [1.05-1.8]; P = 0.02). Stent migration and encrustation were noted in 3 (23.1%) and 1 (7.7%) patients, respectively. Conclusion: Allium ureteral stents are safe and effective for patients with refractory ureteral strictures. [ABSTRACT FROM AUTHOR]

Background: Metal ureteral stents (MUS) has gained popularity as an endoscopic treatment alternative for the management of ureteral strictures. The aim of this study was to evaluate the safety, efficacy, and tolerability of MUS for treating ureteral strictures and to identify any factors that could influence the success of this intervention. Methods: This study is a prospective analysis of the efficacy and safety of MUS for treating ureteral strictures in a single-center setting. The study enrolled 246 patients who had been diagnosed with ureteral strictures and had undergone MUS placement between January 2019 and July 2021. The patients were followed-up for a duration of 2 years. Results: The overall success rate of MUS placement was 71.7%. Furthermore, the success rate of ureteral strictures after kidney transplantation (78.2%) was significantly higher than common ureteral strictures (73.0%) or recurrent ureteral strictures (67.6%). Additionally, postsurgery, there was a considerable reduction in hydronephrosis volume (68.9 ± 96.1 vs. 32.1 ± 48.8 cm3), blood creatinine level (103.7 ± 49.8 vs. 94.4 ± 47.5 mol/l) and urea nitrogen level (6.7 ± 7.2 vs. 5.1 ± 2.4 mmol/l). The study also reported that the rate of adverse events associated with MUS was relatively low, included hematuria (7.9%), pain (6.8%), urinary tract infection (6.4%), and lower urinary tract symptoms (5.3%). Conclusions: MUS appear to be a safe and effective treatment option for ureteral strictures, with a high success rate and low complication rate. These results have important implications for the management of ureteral strictures and can help guide clinical decision-making in the selection of treatment options. [ABSTRACT FROM AUTHOR]

Ureteral stricture caused by holmium: YAG laser lithotripsy is one of the most challenging issues for urologists. Currently, evidence for rapamycin application in reducing ureterostenosis is not sufficient. This study aimed to assess the inhibition of ureteral stricture of rapamycin-eluting stents in vitro and in vivo. A bilayered drug-eluting ureteral stent consisted of drug blending with poly (lactic-co-glycolic acid) (PU/drug stent), which was over-layered by polycaprolactone (PCL) by ultrasonic atomizing spraying. Stent morphology was observed by scanning electron microscope. A kidney-ureter-bladder model was established to simulate the stents-releasing condition, and high-performance liquid chromatography was used to measure the drug release rate. The inhibitory proliferation was detected by CCK-8. The bladder of rats was injured through electro tome, and stents were implanted for 7, 14, and 28 days. The effects of drug-eluting stents was investigated by hematoxylin-eosin staining, immunofluorescence staining, real-time quantitative polymerase chain reaction and western blot. The bilayered stents could block the burst loss of the drug and maintained a sustained delivery period because of the 5.3 μm thickness of the PCL layer. The relative growth rates of cells plotted inhibitory effect on the proliferation of human urethral scar fibroblast cells. For in vivo results of 28 days, the bilayered stent maintained structural integrity and induced less deposition of crystals, thinner and less lamina propria connective tissues were formed, and α-SMA and TGF-β1 were downregulated. Bilayered rapamycin-eluting stent is significantly effective in alleviating fibrosis in in vitro and in vivo models. The occurrence of ureteral stricture resulting from holmium: YAG laser lithotripsy presents a significant challenge for urologists. Traditional double J stents have not been proven to offer a shorter indwelling time or improved inhibition of tissue blocking. While drug-eluting stents containing rapamycin, paclitaxel, and other substances have been extensively used in treating artery stenosis, there is insufficient evidence supporting their application in reducing ureterostenosis. Consequently, a biodegradable polymer ureteric scaffold incorporating rapamycin was fabricated in this study, employing ultrasonic atomization spraying technology to optimize the bilayers composed of 75/25 poly (lactic-co-glycolic acid) (PLGA) and polycaprolactone (PCL). The efficacy of the scaffold was subsequently confirmed through in vitro and in vivo experiments. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate perioperative outcomes and complications of a modified technique of ileal conduit diversion. Methods: Forty-seven cases of radical cystectomy with modified ileal conduit diversion were performed at our institution from January 2015 to January 2020. After radical cystectomy, a segment of ileum was used to pack the conduit and was placed below the digestive anastomosis. Then, the mesentery window of the ileo-ileal anastomosis was sutured. The ureters were anastomosed on their native side on single loop ureteral stents. All procedures were performed by a single surgical team. Intra- and postoperative complications were classified and reported according to the Satava and Clavien–Dindo grading systems. Results: The mean age of population was 66.40±10.14 years, and 76.6% were male. Concomitant diabetes was found in 31.9% of patients. About three quarters of patients had T2G3 bladder cancer. Mean blood loss was 449.36±246.50 ml, and hospitalization was 10.32±5 days. With a mean follow-up of 17.36±12.63 months, the recurrence rate was 17%, and 14.9% of patients died of bladder cancer. Out of the 47 patients, three (4.3%) experienced intraoperative complications, while 15 (31.9%) had postoperative complications. Of these, only three patients experienced Clavien–Dindo complications ⩾grade 3. Multivariate logistic regression model showed that diabetes (p =0.023) and higher blood loss (p =0.010) were significantly associated with an increased risk of postoperative complications. We reported one case of ureterointestinal anastomosis stenosis on the left side and none on the right side. Despite our results being promising, larger randomized trials with longer follow-up are needed to explore further the feasibility of this technique on a larger scale. Conclusion: We describe a safe and simple surgical technique with a similar postoperative complications rate and a lower incidence of ureteroileal anastomosis stenosis compared to the standard technique. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

To investigate the feasibility and clinical efficacy of laparoscopic ureteroplasty with oral mucosal graft for ureteral stricture and describe the initial experience of eighteen operations. A retrospective analysis was performed on the clinical data of 18 patients who underwent laparoscopic ureteroplasty with oral mucosal graft for long segment or complex ureteral stricture admitted to the Second Affiliated Hospital of Anhui Medical University from July 2018 to June 2021. After the stricture ureter segment was freed during the operation, the ureteral stenosis segment was longitudinally cut. The required oral mucosa is removed according to the length of the stenosis. Oral mucosal grafts were harvested and placed in the ureter as an anterior onlay with omental wrapping. Ureteral repair was performed laparoscopically in all cases, with no conversion to open surgery and no serious complications. The median length of ureteral stenosis was 3 cm (range, 2–7 cm), the mean operative time was 205.8 ± 33.4 min, indwelling time of the drainage tube was 4.9 ± 1.6 days, and the median length of postoperative stay was 7 days (range, 4–14 days). The double J tube was removed three to six weeks postoperatively. One of the eighteen patients had restenosis after surgery, and the other patients showed no deterioration of the severity of the obstructive uropathy after follow-up imaging examination. Laparosopic ureteroplasty with oral mucosal graft is a simple, safe and efficient option for the treatment of ureteral stricture. Although the results of the initial experience are encouraging, a large cohort study with longer follow-up period is need to be done. • Laparoscopic ureteroplasty with oral mucosa graft is suitable for long-segment and multi-segment ureteral stricture. • Laparoscopic ureteroplasty with oral mucosa graft has the advantages of good effect, less trauma and quick recovery • Oral mucosa is more likely to survive after repair and has a lower probability of contracture and postoperative restenosis. [ABSTRACT FROM AUTHOR]

To analyze the characteristics of ureteral stricture after ureteroscopic holmium laser lithotripsy and summarize our experience with the reconstructive strategies. This study retrospectively reviewed 42 patients with ureteral stricture after ureteroscopic holmium laser lithotripsy between December 2009 and December 2019. Patient demographics, laboratory data, imaging studies, perioperative variables, complications, and follow-up data were recorded. Surgical success was defined as relief of symptoms, improved/stabilized hydronephrosis, and stable renal function. The upper, middle, and lower thirds of the ureter were affected in 27, 6, and 7 cases, respectively. Multiple ureteral strictures were found in 2 patients. The median length of the stricture was 3.5 cm (range 1–30 cm). In the upper ureteral strictures, lingual mucosal ureteroplasty (8/27, 29.6%) is the most commonly used treatment method for stricture longer than 3 cm but shorter than 6 cm, followed by appendiceal onlay ureteroplasty (5/27, 18.5%). Four lower ureteral strictures ranging from 3 to 8 cm were repaired with Boari flap. Reconstructive strategies of the middle ureteral strictures included Boari flap, appendiceal onlay ureteroplasty and ureteroureterostomy. Patients with the length of the stricture longer than 8 cm or multiple strictures underwent ileal ureter replacement. The median follow-up was 27.3 ± 17.2 months. The overall success rate was 97.6%. Upper ureter is more vulnerable in ureteroscopic holmium laser lithotripsy. Sufficient follow-up and appropriate examination are necessary for diagnosis. Different treatment strategies need to be flexibly selected according to the location and length of the injury. [ABSTRACT FROM AUTHOR]

Ureteral stricture is a potential postoperative complication of pelvic surgery. Repair is performed in the intraoperative or postoperative phase for various reasons. Ileal reconstruction of ureter is considered for extensive and bilateral ureteral injuries. A 44-year-old female presented to the hospital where she had undergone hysterectomy two months prior, with acute renal failure due to bilateral hydronephrosis. Radiological examination revealed bilateral distal ureteral stricture measuring 5 cm in length. After failed balloon-dilation, ileal reconstruction was successfully performed without perioperative complications; and she has remained free from hydronephrosis with normal renal function for four years. Ileal interposition can be used for reconstruction of long lengths or bilateral ureteral injuries. High success rates and low rates of complication have been reported, and the long-term outcome was also acceptable. Apparent ureteral injury was not observed in our case; however, narrowing of ureteral lumen due to submucosal and sub-adventitial edema was observed as a possible cause of strictures. Although, some minor occult injuries during hysterectomy, including thermal effect, ischemia or physical damage due to traction on the ureters were suggested, we were unable to conclusively determine the etiology. Ileal ureter replacement is a useful reconstruction, and the inverse seven configuration is suitable for long bilateral strictures of distal ureter. • ureteral stricture is a potential postoperative complication of pelvic surgery. This case focuses on ileal reconstruction of ureter for extensive and bilateral ureteral strictures occurring after gynecologic surgery. • we performed ileal ureter replacement in inverse seven configuration without perioperative complications. • the inverse seven configuration is suitable for long bilateral strictures of distal ureter. [ABSTRACT FROM AUTHOR]

Renal transplantation is the most commonly performed solid-organ allograft surgery; in 2021, 25487 kidneys were transplanted in the United States, and nearly 42,000 adult patients were listed for transplant. As the treatment of choice for patients with end-stage renal disease, transplantation is performed at more than 250 centers. Despite a high rate of success, renal transplantation is not without complication, and the interventional radiologist plays a crucial role in the management of the postoperative patient. Knowledge of postsurgical anatomy, imaging findings, and technical challenges unique to these patients is important for the safe and effective treatment of transplant-related conditions. We offer a guide to the most common interventions in the renal transplant population, including biopsy, vascular interventions, and the management of urinary obstruction. [ABSTRACT FROM AUTHOR]

Ureteral stricture disease is a luminal narrowing of the ureter leading to functional obstruction of the kidney. Treatment of strictures is mandatory to preserve and protect renal function. In recent times, the surgical management of ureteral strictures has evolved from open repair to include laparoscopic, robotic and interventional techniques. Prompt diagnosis and early first line intervention to limit obstructive complications remains the cornerstone of successful treatment. In this article, we discuss minimally invasive, endo-urological and open approaches to the repair of ureteral strictures. Open surgical repair and endoscopic techniques have traditionally been employed with varying degrees of success. The advent of laparoscopic and robotic approaches has reduced morbidity, improved cosmesis and shortened recovery time, with results that are beginning to mirror and in some cases surpass more traditional approaches.Level of evidence: Not applicable for this multicentre audit. [ABSTRACT FROM AUTHOR]

Purpose Renal autotransplantation is an infrequently performed procedure. It has been used to manage complex ureteral disease, vascular anomalies and chronic kidney pain. We reviewed our 27-year experience with this procedure. Materials and Methods This is a retrospective, observational study of 51 consecutive patients who underwent renal autotransplantation, including 29 at Oregon Health and Science University between 1986 and 2013, and 22 at Virginia Mason Medical Center between 2007 and 2012. Demographics, indications, operative details and followup data were collected. Early (30 days or less) and late (greater than 30 days) complications were graded according to the Clavien-Dindo system. Factors associated with complications and pain recurrence were evaluated using a logistic regression model. Results The 51 patients underwent a total of 54 renal autotransplants. Median followup was 21.5 months. The most common indications were loin pain hematuria syndrome/chronic kidney pain in 31.5% of cases, ureteral stricture in 20.4% and vascular anomalies in 18.5%. Autotransplantation of a solitary kidney was performed in 5 patients. Laparoscopic nephrectomy was performed in 23.5% of cases. Median operative time was 402 minutes and median length of stay was 6 days. No significant difference was found between preoperative and postoperative plasma creatinine (p = 0.74). Early, high grade complications (grade IIIa or greater) developed in 14.8% of patients and 12.9% experienced late complications of any grade. Two graft losses occurred. Longer cold ischemia time was associated with complications (p = 0.049). Of patients who underwent autotransplantation for chronic kidney pain 35% experienced recurrence and 2 underwent transplant nephrectomy. No predictors of pain recurrence were identified. Conclusions The most common indications for renal autotransplantation were loin pain hematuria syndrome/chronic kidney pain, ureteral stricture and vascular anomalies in descending order. Kidney function was preserved postoperatively and 2 graft losses occurred. At a median followup of 13 months pain resolved in 65% of patients who underwent the procedure. Complication rates compared favorably with those of other major urological operations and cold ischemia time was the only predictor of postoperative complications. [ABSTRACT FROM AUTHOR]

Objective This study was conducted to investigate the efficacy and safety of ureteral dilation and placement of a long-term ureteral stent for patients with various types of ureteral obstructions. Methods We retrospectively reviewed the records of 39 patients presenting with ureteral obstruction secondary to malignant strictures ( n = 9) or nonmalignant strictures ( n = 30). The mean age of these patients was 55.8 ± 16.1 years (range, 13–87 years). All patients underwent retrograde ureteral balloon dilation and placement of one to three ureteral stents. Stent patency rate and complications including febrile urinary tract infection, stent encrustation, and stent fragmentation were recorded. Results A total of 117 ureteral stents were implanted during the 83 procedures. Three stents were placed in seven patients and two stents in 20 patients. The patency rate was 95.2% with a mean 75-day follow-up. There was no encrustation in 104 stents and Grade 1 in 13 stents. The patency rate was similar between the patients with malignant strictures and those with nonmalignant strictures (100% vs. 94.7%, p = 0.57). However, three episodes of febrile urinary tract infection were noted only in patients with malignant strictures. The improvement of hydronephrosis and complications were also comparable between those patients with ureteral stents indwelling for >90 days and those for <90 days. No stent fragmentation was found in any of the patients. Conclusion We demonstrated that ureteral dilation and placement of a single or multiple ureteral stents was effective and safe for patients with ureteral obstruction. [ABSTRACT FROM AUTHOR]

Purpose Ureteral stricture is a rare cause of hydronephrosis in children and is often misdiagnosed on ultrasound (US) and diuretic renal scintigraphy (DRS), requiring intraoperative diagnosis. We evaluated ureteral strictures diagnosed by magnetic resonance urography (MRU) at our institution. Materials and methods Children with ureteral stricture who underwent MRU were identified. Patient demographics, prior imaging, MRU findings, and management were assessed. The efficacy of MRU in diagnosis of stricture was compared with US and DRS. Patients with ureteropelvic or ureterovesical junction obstruction were excluded. Results Twenty-eight ureteral strictures diagnosed by MRU between 2003 and 2013 were identified; 22% of strictures were diagnosed by DRS ± US. The mean age at MRU diagnosis was 2.4 years (range 4 weeks–15 years). Hydronephrosis was the most common presentation, accounting for 20 (71%) cases. Other etiologies included pain (3), incontinence (2), and urinary tract infection, cystic kidney, and absent kidney, present in one case each. A mean of 2.7 imaging studies was obtained prior to MRU diagnosis. Twenty-one (75%) ureteral strictures required surgical intervention, with the approach dependent upon location. Conclusions MRU provides excellent anatomic and functional detail of the collecting system, leading to accurate diagnosis and management of ureteral stricture in children. [ABSTRACT FROM AUTHOR]

Purpose: We defined the role of the Boari bladder flap procedure with or without downward nephropexy for proximal vs distal ureteral strictures. Materials and Methods: We retrospectively reviewed the records of all patients who underwent open ureteral reconstruction for refractory ureteral strictures, as done by a single surgeon between 2007 and 2010. Patients were grouped by stricture site into group 1—proximal third of the ureter and group 2—distal two-thirds. Operative techniques and outcomes were reviewed. Results: During the 30-month study period a total of 29 ureteral reconstruction procedures were performed on 27 patients. A Boari bladder flap was used in 10 of the 12 patients (83%) in group 1 and 10 of the 17 (59%) in group 2. Concomitant downward nephropexy was done more commonly in group 1 (58% vs 12%, p = 0.014). At a mean followup of 11.4 months there was no difference in the overall failure rate between groups 1 and 2 (17% vs 12%). Complications developed more frequently in group 1 (75% vs 35%, p = 0.060), hospital stay was longer (mean 8.0 vs 4.4 days, p = 0.017) and mean estimated blood loss was greater (447 vs 224 ml, p = 0.008). Conclusions: The Boari bladder flap procedure is a reliable technique to reconstruct ureteral strictures regardless of site. Renal mobilization with downward nephropexy is a useful adjunctive maneuver for proximal strictures. [Copyright &y& Elsevier]

Introduction Laparoscopic ureteroureterostomy (UU) is a preferred and valid minimally invasive procedure for treatment of benign ureteral strictures. In some cases with chronic inflammation or after repeated endoscopic ureteral surgery, it is difficult to identify the location of a ureteral stricture. Presentation of case We report a case of 48-year-old man with an impacted stone after laparoscopic partial nephrectomy. Although transurethral lithotripsy (TUL) was performed, the ureteral stricture did not improve by subsequent endoscopic ureteral Holmium laser incision and balloon dilation. Discussion To simultaneously identify the exact location of the constriction, we performed retroperitoneal laparoscopic ureteroureterostomy with intraoperative observations via super-slim flexible fiberoptic ureteroscopy retrograde. Conclusions Accurate identification of the ureteral stricture via observation by laparoscopy and observation by ureteroscopy was feasible. In contrast to the use of a rigid ureteroscopy, flexible fiberoptic ureteroscopy did not require placing the patient in an unnatural position. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the long-term outcome of laser endoureterotomy for benign ureteral stricture. Materials and Methods: From a database of 69 patients who underwent retrograde laser endoureterotomy from October 2001 to June 2007 we identified 35 with a benign ureteral stricture. Clinical characteristics, operative results and functional outcomes were investigated. Success was defined as symptomatic improvement and radiographic resolution of obstruction. Results: Median followup was 27 months (range 10 to 72). All except 1 patient were followed at least 16 months. All patients completed clinical followup and 33 completed imaging. Of 35 patients 29 (82%) were symptom-free during followup and 26 of 33 (78.7%) were free of radiographic evidence of obstruction. All except 1 failure occurred within less than 9 months postoperatively. The success rate was higher for nonischemic strictures (100% vs 64.7%, p = 0.027) and tended to be higher for strictures 1 cm or less (89.4% vs 64.2%, p = 0.109). Conclusions: Holmium laser endoureterotomy is effective for benign ureteral stricture in well selected patients. Most failures occur within less than 9 months after surgery, which may indicate a need for closer followup during postoperative year 1. Factors that might may outcome are ischemia and stricture length. [Copyright &y& Elsevier]

Purpose: We report long-term outcomes and late complications after laparoscopic nephrectomy with autotransplantation. Materials and Methods: We retrospectively reviewed clinical data on all patients who underwent laparoscopic nephrectomy with autotransplantation between July 2000 and March 2007. Late complications, ie greater than 6 months, that required surgical intervention were analyzed. Clinical outcomes in patients with primary ureteral stricture disease and oncological outcomes in patients with renal tumors were examined. Results: Indications for autotransplantation included complex ureteral stricture disease in 15 patients and renal malignancy in 4. Median age at surgery was 48 years (range 25 to 68). Median followup was 29 months. Of the 17 patients with greater than 6 months of followup late complications requiring surgical intervention occurred in 4. Transplant nephrectomy was required in 2 patients in the stricture group. Indications for nephrectomy were nonfunction complicated by pseudoaneurysm in 1 case and chronic loin pain in 1. Another patient had recurrent nephrolithiasis requiring percutaneous nephrolithotomy and in 1 a pseudoaneurysm was managed successfully by endovascular techniques. Two patients in the tumor group had disease progression, which was managed medically. Conclusions: Given the complexity and severity of disease that necessitates renal autotransplantation, it is not surprising that additional treatments are required. Patients with primary stricture disease may be at increased risk for vascular aneurysm due to infection and/or inflammation. Tumor progression is possible after ex vivo tumor excision and autotransplantation, especially in patients requiring heroic measures to avoid or delay dialysis. Thus, careful patient selection and vigilant followup are mandatory. [Copyright &y& Elsevier]

Purpose: Ureteral obstruction due to benign strictures is a significant complication of radical cystectomy and urinary diversion for bladder cancer that can lead to renal function loss and infection related morbidity. Treatment may be performed surgically or with minimally invasive techniques. We describe the 10-year experience at our department with various treatment modalities for post-cystectomy benign strictures. Materials and Methods: The study group consisted of 28 patients treated for benign ureteral strictures following radical cystectomy for bladder cancer. Their medical records were reviewed for clinical presentation, diagnostic procedures, treatment and long-term outcome. Results: The study group represented 12.7% of all 221 patients treated at our department with radical cystectomy for bladder cancer in 1994 to 2004. Ureteral strictures were asymptomatic in 71.4% of cases. Median time to diagnosis was 7.0 months and 75% of the patients were diagnosed within year 1 after cystectomy. Treatment consisted of stenting, dilation and open surgical revision with removal of the strictured segment and reanastomosis. Median followup was 62.5 months. The stenting procedures served as the long-term definitive treatment in 45% of cases, whereas balloon dilation uniformly failed. Although open surgical revision was technically challenging, it had a long-term success rate of 93%. Conclusions: Benign ureteral strictures commonly occur during postoperative year 1 and they are usually asymptomatic. Early diagnosis and prompt drainage are required to prevent consequent renal parenchymal loss and infectious complications. Although minimally invasive procedures are viable treatment alternatives, open surgical revision is still the preferred long-term definitive treatment. [Copyright &y& Elsevier]

Purpose: We report our long-term experience with the management of benign ureteroileal anastomotic strictures using self-expandable metal stents. Materials and Methods: A total of 16 male and 2 female patients with a mean ± SD age of 72 ± 7 years (range 66 to 78) with benign fibrotic strictures at the site of ureteroileal anastomosis underwent implantation of self-expandable metal stents with a nominal diameter of 6 to 8 mm. A total of 24 ureteroileal conduits were treated. The external nephrostomy tubes were removed after fluoroscopic validation of ureteral patency. Patients were followed with blood biochemistry, ultrasonography, urography and/or virtual endoscopy. Retrograde external-internal catheter insertion through the cutaneous stoma was performed in cases of recalcitrant stricture. Results: The technical success rate of ureteroileal stricture crossing and stenting was 100% (24 of 24 cases). Mean followup was 21 months (range 7 to 50). The clinical success rate during the immediate post-stenting period was 70.8% (17 of 24 cases). The 1 and 4-year primary patency rates were 37.8% and 22.7%, respectively. Secondary interventions included repeat balloon dilation in 15 ureters, of which 8 also underwent subsequent coaxial stent placement. The 1 and 4-year secondary patency rates were 64.8% and 56.7%, respectively. Except in 2 patients who died external-internal Double-J® catheters continued to be inserted retrograde in 6 ureteroileal conduits. They are periodically exchanged to prevent mucous inspissation and stent encrustation. Conclusions: Metal stents served as the definitive treatment for stricture in more than half of the cases, whereas in the remainder the stents allowed the uncomplicated and regular exchange of Double-J catheters in retrograde fashion. This combined, less invasive treatment for ureteroileal anastomotic strictures may help patients avoid surgical revision and preserve quality of life. [Copyright &y& Elsevier]

Purpose: Ileal and intestinal ureteral replacement remains a useful procedure for complex ureteral reconstruction. We examined the long-term safety and efficacy of this procedure, especially in regard to maintaining preoperative renal function and the avoidance of major complications. Materials and Methods: A total of 56 patients underwent intestinal ureteral substitution at our institution between 1979 and 2003, including 52 with an ileal ureteral replacement, 2 with colonic replacement alone and 2 with bilateral ureteral replacement, necessitating ileum and colon for 1 ureter each. The factors reviewed were indications for surgery, type of ureteral replacement, and the presence and type of complications. Followup data included excretory urogram or equivalent imaging results, and measurement of serum chloride, bicarbonate and creatinine before and after the procedure. Results: Overall the complication rate remained low. Mean followup was 6.04 years (median 3.2). Most postoperative complications, which occurred in 10 patients (17.9%), were minor in nature, including pyelonephritis, fever of unknown origin, neuroma, hernia, recurrent urolithiasis and deep venous thrombosis. Major complications occurred in 6 patients (10.5%), including anastomotic stricture, ileal graft obstruction, wound dehiscence and chronic renal failure. Overall patients did not experience worsening renal function after the procedure with equivalent median creatinine before and after the procedure (1.0 mg/dl). Conclusions: During long-term followup major complications are rare and renal function remains preserved. Ileal and intestinal ureteral substitution remains a safe and efficacious procedure in patients with complex and difficult ureteral issues not amenable to more conservative measures. [Copyright &y& Elsevier]

Background: The management of ureteral stricture is still a challenge for urologists. The aim of this prospective study was to assess the safety and effectiveness of self-expanding metal ureteral stents (URS) in ureteral strictures.Methods: We performed URS placement procedures for ureteral stricture from Jan 2019 to July 2020, and prospectively collect various data before and after the operation. A paired T test was used to compare continuous variables before and after surgery, binary logistic regression analysis was used to identify the independent risk predictors of surgical failure.Results: A total of 147 patients with 157 renal units received successful placement of URS. The mean operative time was 70.0 min. After a median follow-up time of 15 months, 73.2% (115/157) of stents were kept in situ. The most common complication was hematuria (13, 8.8%), followed by urinary tract infection (11, 7.5%) and pain (8, 5.4%). The volume of hydronephrosis (67.9 ± 34.9 VS 34.9 ± 51.1 cm3, P = 0.0001), serum creatinine level (103.0 ± 54.5 VS 93.8 ± 45.1 μmol/L, P = 0.034) and blood urea nitrogen level (6.6 ± 6.7 VS 5.4 ± 2.4 mmol/L, P = 0.032) decreased significantly at last follow up when compared with baseline. Stricture of the distal ureter was an independent risk factor for stent failure (HR 1.77, 95% CI 1.15, 2.73, P = 0.009).Conclusions: URS was found to be safe and effective for ureteral strictures with a limited complications and good long-term results. For those who are not suitable for surgical reconstruction, the URS is an alternative management. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: In this study, we compared between the efficacy and complications of percutaneous nephrostomy (PCN) tubes and those of internal ureteral stents (e.g., double-J stents) used for relieving ureteral obstructions. Materials and methods: A retrospective chart review was performed. Between 2003 and 2009, 110 patients (63 females and 47 males, with a mean age of 63.6 years, range 19–89 years) who had an extrinsic ureteral obstruction, and subsequently underwent either PCN tube placement (n = 44) or internal ureteral stent placement (n = 66), were enrolled. Clinical data on patients with duration of diversion/drainage for more than 6 months were collected. Statistical analyses were performed with respect to a patient''s age, etiology of the obstruction, outcome of residual hydronephrosis, and renal function tests. Results: Patient ages and procedure-related complications were comparable between these two groups. The mean duration of diversion was 16.8 ± 8.6 months in the stent group versus 14.1 ± 6.7 months in the PCN group (p = 0.067). A smaller elevation in serum creatinine was noted in the PCN group (0.21 vs. 0.78 mg/dL, p = 0.03). Nine of 86 (10.4%) double-J stents were converted to PCN tubes during the study period. Residual hydronephrosis after decompression was more common in the stent group than in the PCN group (65.2% vs. 27.2%, p = 0.01). These findings suggest better preservation of renal function by a PCN tube. Conclusions: Results of this study suggest that, to better preserve renal function, PCN is the choice of treatment, irrespective of the etiology. While patients who have a PCN tube may have to carry an additional external drainage device, the complications did not seem to differ significantly from those who used internal drainage with a ureteral stent. Because young cancer patients may especially need aggressive chemotherapy to prolong their survival, PCN urinary drainage may become a better choice from the standpoint of cancer control. [Copyright &y& Elsevier]

Abstract: Objective: We report our preliminary experience with thulium-laser endoureterotomy for managing ureteral strictures. Materials and Methods: From October 2008 to September 2009, 12 patients received thulium-laser endoureterotomy for ureteral stricture at our hospital. Clinical characteristics and operative results were retrospectively investigated. Successful treatment was defined as an adequate diameter noted by ureterorenoscopy, being free of associated symptoms, and having no obstructive uropathy on an imaging study at follow-up. Results: Successful treatment was observed in nine patients (75%). The three patients (25%) without obvious improvement received a repeat thulium-laser endoureterotomy, or a double-J stent was reinserted. Conclusion: Our results show that a thulium-laser endoureterotomy is a safe and effective modality for managing ureteral strictures. It was found to have a success rate similar to that of other minimally invasive treatment modalities. [Copyright &y& Elsevier]

Summary In a case of upper ureteral stricture refractory to laser ureterotomy, laparoscopic ureteroureterostomy was performed for resection of the stricture and reanastomosis of the ureter. Precise localization of the stricture segment was achieved by retrograde ureteroscopy performed concurrently with laparoscopy, with minimal change in the patient's position. [ABSTRACT FROM AUTHOR]

Objective Management of late-occurring or long (>3 cm) post-transplant ureteral strictures usually requires open surgery, which includes ureteroureterostomy (UU) as an option. Recently, robotic-assisted laparoscopic UU for ectopic ureters in a duplicated system has been described. We report a case of a robotic-assisted laparoscopic transplant-to-native side-to-side UU in a 14-year-old girl with a stricture of nearly two-thirds of her transplant ureter 5 years after a cadaveric renal transplant. Results Robotic-assisted laparoscopic native-to-transplant UU was performed with resultant durable improvement in the patient's hydronephrosis and kidney function. Conclusion Based on our case and review of the literature, robotic-assisted laparoscopic UU should be part of the armamentarium for long or late-occurring transplant ureteral strictures. [ABSTRACT FROM AUTHOR]