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Purpose: Evaluation of split renal function (SRF) is critical for guiding surgical treatment decisions for patients with ureteral stricture disease (USD). We aimed to determine whether computed tomography (CT)-based renal parenchymal volumes may be used to predict SRF in patients with USD. Methods: We retrospectively reviewed all patients undergoing surgical management for USD at a single institution from October 2021 to January 2024. Patients who had preoperative nuclear medicine scan (NMS) and CT scan with intravenous contrast that were obtained within six weeks of each other were included. Interval between NMS and CT could be longer if the affected renal unit was drained with ureteral stent and/or percutaneous nephrostomy. Volume measurements were obtained using the 3D Region of Interest (ROI) Tool on Visage®7 Enterprise Imaging Platform (Visage Inc., San Diego, USA) by two investigators that were blinded to NMS derived SRF. Intraclass correlation coefficient (ICC) was used to assess consistency between investigators. Predictive accuracy was assessed using Pearson correlation coefficient (r) and linear regression. Results: 40 of 160 patients met inclusion criteria. There was excellent reliability in calculating renal parenchymal volume between raters (ICC = 0.990). There was a strong linear correlation between estimated CT SRF and NMS SRF (r = 0.912, p < 0.00001). A linear regression model found RObservedSRF = -0.013 + 1.015(REstimatedSRF), with r2 = 0.832. Conclusion: CT-derived parenchymal volume analysis may be used to estimate SRF in patients with USD. This may obviate the need to obtain preoperative renal scans for SRF measurement in selected patients when assessing surgical management options. [ABSTRACT FROM AUTHOR]

The objective is to demonstrate that omitting ureteral stent placement in robotic intracorporeal urinary diversion does not lead to increased risk of perioperative complications, namely ureteral strictures or anastomotic leaks. We retrospectively reviewed the records of 68 consecutive patients who underwent robotic radical cystectomy with ileal conduit creation or orthotopic neobladder by a single surgeon between January 2020 and September 2023. Chronologically, the first cohort of patients had ureteral stents placed to bridge the ureteroenteric anastomosis, and in the second cohort, stenting was omitted. Cohort 1 consisted of 28 patients with surgeries performed between January 2020 and April 2021, while cohort 2 had 40 patients who underwent surgery from April 2021 to September 2023. The cohorts were well matched with regard to patient age, gender, ASA score and rate of neoadjuvant chemotherapy. The choice of urinary diversion was left to surgeon and patient preference, and there was no significant difference in the proportion of ileal conduits versus orthotopic neobladders within each cohort. Estimated blood loss, total operative time, inpatient length of stay and pathologic T and N staging did not statistically differ between the cohorts. Overall, there was no difference in the rates of postoperative ileus, ureteral stricture, anastomotic leak, infectious complications, and 30-day readmission rates between the groups. Tubeless ureteroenteric anastomosis in patients undergoing robotic radical cystectomy with intracorporeal diversion does not appear to increase the risk of anastomotic strictures or postoperative complications. Further prospective evaluation is warranted. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of metallic stents in treating ureteral strictures following surgery and radiotherapy for gynecological tumors is currently uncertain. We aimed to investigate the efficacy and safety of thermo-expandable metallic stent (Memokath) in the treatment of ureteral stricture after radiotherapy for gynecological tumors. Methods: In this descriptive cross-sectional study, 27 patients with ureteral stricture were treated with Memokath stent after gynecological tumor radiotherapy with or without chemotherapy that was admitted to our hospital from August 2021 to August 2023. Clinical data on efficacy, safety, and complications during stent insertion and indwelling were analyzed. Results: The successful insertion of thirty-three stents in twenty-seven patients studied. The stenosis length was 10.14 ± 6.76 cm, and the hospitalization was 4.43 ± 1.83 days. One patient has died from the primary disease carrying a patency stent. The Kaplan-Meier graph showed that the cumilative patency rate of patients with thermo-expandable metallic stent were 92.4% (SD = 5.2%) in eight months, 77.4% (9.1%) in 12 months and 67.7% (SD = 12%) in 29 months, while the cumilative survival rate was 87.5% (SD = 11.5%) in 29 months. The stent patency was 81.48% and later complications of stent indwelling were 5/27, including refractory urinary tract infection (UTI) in three cases, stent migration, and stent intolerance respectively. The creatinine levels, hydronephrosis degree, and glomerular filtration rate improved after the operation, and the first two indicators were statistically significant. Conclusion: Memokath stent is a safe and effective treatment for ureteral stricture after surgery and radiotherapy with or without chemotherapy for gynecological tumors. [ABSTRACT FROM AUTHOR]

As robot-assisted laparoscopic techniques continue to advance, becoming increasingly complex and refined, there has been significant progress in the minimally invasive treatment of ureteral strictures. This abstract aims to provide an overview and description of various surgical techniques that utilize robots for repairing ureteral strictures. We have summarized the progression of these surgical methods and highlighted the latest advancements in the procedures. When compared to open surgery, robot-assisted reconstruction techniques demonstrate superior functional outcomes, fewer postoperative complications, and a faster recovery in the treatment of ureteral strictures. This abstract aims to provide an overview and description of various surgical techniques utilizing robots to repair ureteral strictures. Robotic ureteral stricture correction has emerged as a valuable therapeutic option, particularly when endoscopic procedures are not feasible. Compared to traditional open surgery, robotic methods exhibit superior therapeutic effectiveness, fewer postoperative complications, and accelerated recovery. Reconstructive procedures such as reimplantation, psoas hitch, Boari flap, ureter-to-ureter anastomosis, appendix graft, buccal mucosa graft (BMG), ileal transplantation, or kidney autotransplantation can be performed depending on the extent and location of the stricture. Robotic surgical techniques also offer advantages, such as an expanded field of vision and the incorporation of supplementary technologies such as FireflyTM, indocyanine green (ICG), and near-infrared fluorescence (NIRF) imaging. However, further long-term, multicenter investigations are necessary to validate the positive findings reported in existing case series. Compared with open surgery, robot-assisted reconstruction techniques yield superior functional outcomes, fewer postoperative complications, and accelerated recovery for the treatment of ureteral strictures. [ABSTRACT FROM AUTHOR]

Objective: The management of long-segment ureteral stenosis has posed a significant challenge for urologists. Ureteroplasty with oral mucosal graft has emerged as an effective approach for treating long-segment ureteral stenosis and defects. A key step in replacement repair surgery involves suturing the surrounding tissue with an adequate blood supply around the reconstructed ureter. The current study aims to evaluate the potential practical application of the "perinephric fat wrapping" technique in laparoscopic ureteroplasty with oral mucosal graft. Methods: Between July 2018 and February 2023, 26 patients with ureteral stenosis underwent laparoscopic ureteroplasty with oral mucosal graft at the Second Affiliated Hospital of Anhui Medical University. We used traditional omental wrapping technique (OW group) or perinephric fat wrapping technique (PFW group) to enhance ureter repair. Perioperative and follow-up data for both groups were collected retrospectively and compared. Results: There were 10 patients in OW group, including 4 males and 6 females, with BMI of 23.5±2.8 kg/m2 and stenosis length of 3.6±1.6 cm. There were 16 patients in the PFW group, including 10 males and 6 females, with a BMI of 26.1±3.3 kg/m2 and a median stenosis length of 2.3 cm (range, 1.2~6.0 cm). The operation of both groups was successfully completed, and no serious complications occurred during the operation. The mean operating time (OT) in the OW group was 200.6±41.9 min, the estimated amount of blood loss (EBL) was 25 ml (range, 10~30ml), and the median length of postoperative hospital stay (LHS) was 7.5 days (range 4.0~14.0 days). In the PFW group, the mean operating time (OT) was 211.9±38.3 min, the estimated blood loss (EBL) was 25 ml (range, 5~150ml), and the postoperative hospital stay (LHS) was 6.8±2.0 d. There was no significant difference between the two groups in the above indexes. Postoperative anal exhaust time was 1.0 d (range, 1.0~2.5d) in the PFW group and 1.9±0.5 d in the OW group, with significant difference between the two groups (P=0.009). The mean follow-up time was 36.8±15.9 months, and there was no significant difference between OW group and PFW group in the curative effect of operation. Conclusion: Perinephric fat wrapping technique not only avoids the potential effects of using omentum on abdominal organs, it is also as safe and effective as omentum wrapping technique in repairing and reconstructing the ureter using oral mucosal grafts. Highlights: Perinephric fat wrapping technique not only avoids the potential effects of using omentum on abdominal organs, it is also as safe and effective as omentum wrapping technique in repairing and reconstructing the ureter using oral mucosal grafts. [ABSTRACT FROM AUTHOR]

Abstract Background The effectiveness of metallic stents in treating ureteral strictures following surgery and radiotherapy for gynecological tumors is currently uncertain. We aimed to investigate the efficacy and safety of thermo-expandable metallic stent (Memokath) in the treatment of ureteral stricture after radiotherapy for gynecological tumors. Methods In this descriptive cross-sectional study, 27 patients with ureteral stricture were treated with Memokath stent after gynecological tumor radiotherapy with or without chemotherapy that was admitted to our hospital from August 2021 to August 2023. Clinical data on efficacy, safety, and complications during stent insertion and indwelling were analyzed. Results The successful insertion of thirty-three stents in twenty-seven patients studied. The stenosis length was 10.14 ± 6.76 cm, and the hospitalization was 4.43 ± 1.83 days. One patient has died from the primary disease carrying a patency stent. The Kaplan-Meier graph showed that the cumilative patency rate of patients with thermo-expandable metallic stent were 92.4% (SD = 5.2%) in eight months, 77.4% (9.1%) in 12 months and 67.7% (SD = 12%) in 29 months, while the cumilative survival rate was 87.5% (SD = 11.5%) in 29 months. The stent patency was 81.48% and later complications of stent indwelling were 5/27, including refractory urinary tract infection (UTI) in three cases, stent migration, and stent intolerance respectively. The creatinine levels, hydronephrosis degree, and glomerular filtration rate improved after the operation, and the first two indicators were statistically significant. Conclusion Memokath stent is a safe and effective treatment for ureteral stricture after surgery and radiotherapy with or without chemotherapy for gynecological tumors.

Introduction. The first description of ureteral appendicoplasty was provided by the Italian surgeon Giannettasio in 1901, followed by two German surgeons, Franke and Rydygier. Their work was later included in a review by Melnikoff in 1912. However, it is Melnikoff who is often erroneously credited with performing the first appendicoplasty in the literature. The first ureteral appendicoplasty operation on a 1.5-year-old child in Russia was performed by Soloviev in 1976.Objective. To report the results of performing operations on replacement of ureteral defects by ureteral appendicoplasty in children.Materials & Methods. Between 2009 and 2023, a total of 11 surgeries were conducted to replace extended ureteral defects using the appendix technique in four clinics in Russia and the Republic of Belarus. The follow-up included six boys and five girls with an average age of 79 months (ranging from 18 months to 16 years). Six operations were performed by laparoscopic access (mean operative time 356 minutes). Five operations were performed by open access (mean operative time 257 minutes).Results. Long-term results were assessed between 18 and 192 months in all patients. Urinary tract patency was evaluated based on the results of micturition cystography (in one case, vesicoureteral reflux was recorded) and intravenous urography (one case of stenosis of the distal anastomosis, which was corrected by endoscopic dissection of the stricture site using a fiberoureteroscope). In patients who underwent renoscintigraphy, no progression of renal function decline was observed. In all patients, long-term follow-up showed satisfactory urine passage.Conclusion. The results of the surgical interventions performed by us are assessed as good. In all 11 cases, the replacement of the extended ureteral stricture using an appendix allowed for the restoration of urinary flow. Furthermore, any complications that arose did not necessitate repeated reconstruction of the urinary tract. Nevertheless, it is important to note that, in our opinion, this technique cannot be considered the method of choice. Rather, it represents a last resort for patients who have undergone multiple previous operations due to severe trauma or oncological diseases. In cases involving ureteral strictures, priority should always be given to an operation involving anastomosis with sufficient ureteral length and minimal tissue tension. We firmly believe that this approach offers the best chance for a successful outcome.

Introduction. Ureteral strictures are a common urological complication of kidney transplantation. For short narrowings of the ureter, endoscopic operations are used; for extended defects the Boari operation is often performed. An alternative method may be to use a native ureter.Purpose of the study. To study the results of such operations in four patients.Materials & methods. We observed four patients with extended ureteral strictures of a transplanted kidney. Among them were three women and one man. Previously, all patients had undergone a cadaveric kidney transplant; the time from the operation itself to the development of stricture ranged from 3 months to 13 years. Initially, all patients underwent percutaneous drainage of the pyelocaliceal system of the transplanted kidney. After stabilization of creatinine values, the pelvis or pyeloureteral segment of the transplanted kidney was isolated using a transperitoneal approach. Further, the lower third of the ipsilateral native ureter was crossed at the level of the iliac vessels. Its upper end was clipped and anastomosis with the pelvis or ureteropelvic junction of the graft was performed.Results. The procedures were successful in all patients. In three patients the operation was completed using a laparoscopic approach. In one patient in whom extensive ureteral obliteration developed 3 months after transplantation against the background of incompetent ureterocystoneoastomosis and urinary leakage, when the pelvis was isolated, which was covered by the external iliac vein, the latter was injured with bleeding. This required conversion to open access, suturing of the iliac vein defect, further excision of the pelvis and anastomosis with the native ureter. In the post-operative period, the patient developed thrombosis of the iliac and femoral veins below the suturing area, and successful thrombolytic therapy was performed. Nephrostomy drain was removed before discharge and the stent was removed on an outpatient visit 4 to 6 weeks after surgery. Currently the condition of all patients is stable, the graft is functioning, and their diuresis is unchanged, serum creatinine ranges from 106 to 180 μmol/l.Conclusion. The use of a healthy native ureter is an adequate method of replacement of extended ureteral strictures of the transplanted kidney.

Objective: To assess the augmented anastomotic ureteral reconstruction using buccal mucosal graft based on omental flap for managing ureteral stricture. Subjects and methods: This prospective cohort study was conducted on 13 patients with ureteric strictures of different lengths secondary to Bilhalziasis, iatrogenic (post endoscopy) and post inflammatory etiology in upper and mid ureteral segments were treated with buccal mucosal patch grafts and The graft is fixed to the undersurface or the posterior surface of the omentum before doing graft anastomosis to the ureteral walls as to ensure the process of graft take sticky to the principles of tissue transfer. All patients were subjected to full history taking, clinical examination for assessment of pain, lower or upper urinary track symptoms and laboratory investigation (complete blood count, CRP, liver function test and kidney function test (serum urea and creatinine). Results: The mean operative time was 148.85 min and mean hospital stay was 3 days. Mean blood loss was ranged from 20 to 210 ml and Stent was removed after 8–12 weeks. The mean follow up was 13 months, all patients had a non-obstructive RI value <0.7 with a non-obstructed drainage pattern on the diuretic renogram except one patient who had severe postoperative UTI necessitating nephrostomy tube insertion his drainage curve was plateau. Conclusion: BMG ureteroplasty is a valuable option for a carefully selected patient. The fixation of the graft on the back surface of the omentum allows for better anatomical reconstruction without any twisting to the omental pedicle. [ABSTRACT FROM AUTHOR]

Purpose: Iatrogenic ureteral strictures (US) after endoscopic treatment for urolithiasis represent a significant healthcare concern. However, high-quality evidence on the risk factors associated with US is currently lacking. We aimed to develop a consensus statement addressing the definition, risk factors, and follow-up management of iatrogenic US after endoscopic treatment for urolithiasis. Methods: Utilizing a modified Delphi method, a steering committee developed survey statements based on a systematic literature review. Then, a two-round online survey was submitted to 25 experts, offering voting options to assess agreement levels. A consensus panel meeting was held for unresolved statements. The predetermined consensus threshold was set at 70%. Results: The steering committee formulated 73 statements. In the initial survey, consensus was reached on 56 (77%) statements. Following in-depth discussions and refinement of 17 (23%) statements in a consensus meeting, the second survey achieved consensus on 63 (86%) statements. This process underscored agreement on pivotal factors influencing US in endoscopic urolithiasis treatments. Conclusions: This study provides a comprehensive list of categorized risk factors for US following endoscopic urolithiasis treatments. The objectives include enhancing uniformity in research, minimizing redundancy in outcome assessments, and effectively addressing risk factors associated with US. These findings are crucial for designing future clinical trials and guiding endoscopic surgeons in mitigating the risk of US. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate perioperative complications and the details of postoperative ureteral stricture after ureteroscopy with laser lithotripsy (URS‐L) for upper urinary tract stones in Japan. Methods: Patient data on intra‐ and postoperative complications after ureteroscopy using URS‐L were retrospectively collected from multiple centers in Japan between April 2017 and March 2020 with the cooperation of the Japanese Society of Endourology and Robotics. Data included the number of patients undergoing URS‐L, number and type of intra‐ and postoperative complications, and detailed characteristics of postoperative ureteral stricture. Results: In total, 14 125 patients underwent URS‐L over 3 years at 82 institutions. Annual URS‐L numbers gradually increased from 4419 in 2017, to 4760 in 2018, and 4946 in 2019. The total complication rate was 10.5%, which was divided into intra‐operative complications in 1.40% and postoperative complications in 9.18%. The annual incidences of intra‐ and postoperative complications were not significantly different from year to year (p = 0.314 and p = 0.112). Ureteral perforation, ureteral avulsion, and the intra‐operative conversion rate were 1.35%, 0.03%, and 0.02%, respectively. Fever >38°C, septic shock, blood transfusion, and postoperative mortality were 7.44%, 0.81%, 0.07%, and 0.04%, respectively. Ureteral stricture occurred in 0.8% of cases. The median length of stricture site was 10.0 mm and the success rate of stricture treatment was 54.6%. Conclusion: Although URS‐L utilization has increased in Japan, the annual complication rate has remained steady. Although URS‐L is a useful and less invasive procedure, devastating complications can still occur. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the role of certain radiological parameters and patient characteristics in predicting the success of endoscopic treatment in ureteral stricture disease. Methods: Fifty one adult patients with ureteral stricture disease (< 1 cm) after developing due to upper ureteral stones with ureteroscopic laser disintegration were included and in addition to stone and patient parameters, radiological parameters including ureteral wall thickness (UWT) at the impacted stone site were also measured on computed tomography (CT) images. Patients were divided into two groups: Group 1: Patients with endoscopic treatment success and Group 2: Patients with endoscopic treatment failure. The possible relationship between the UWT values and other radiological parameter was comparatively evaluated. Results: Mean UWT value assessed at the treated stone site was significantly higher in cases unresponsive to endoscopic treatment with values of 2.77 ± 1.03 mm and 4.25 ± 1.32 mm in Group 1 and 2 respectively. A cut off value 3.55 mm for UWT was found to be highly predictive for endoscopic treatment failure. Conclusions: Our current results indicated that assessment of UWT value at the obstructing stone could be helpful enough to predict the likelihood of failure following endoscopic management of strictures with high sensitivity and specificity. Evaluation of this particular parameter could let the endourologists to look for more rational treatment alternatives with necessary measures taken on time. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the utility and outcomes of available endourologic options to treat ureteral stricture after kidney transplantation (KT). Methods: A systematic review was carried out for all English language articles from 2000 to 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standards using EMBASE, MEDLINE, SCOPUS, Google scholar, and Cochrane library. The search term combination for the string was follows: [(Ureteral stricture) OR (ureter stenosis) OR (ureteral stenosis) OR (Stricture ureter) OR (Narrowing ureter) OR (Ureter restriction) OR (ureteral restriction) OR (ureteral narrowing) OR (ureteral obstruction) OR (ureter obstruction) OR (obstructing ureter) OR (obstructive ureter) OR (narrow ureter) OR (ureteral narrow)] AND [(kidney transplant) OR (transplanted kidney) OR (transplant) OR (transplantation)] AND [(management) OR (Robotic) OR (laser) OR (stent) OR (dilatation) OR (dilation) OR (endoscopic) OR (endourological) OR (Urologic) OR (laparoscopic) OR (surgery) OR (treatment)]. Case reports, review articles, animal and laboratory studies were excluded. Risk of bias assessment was conducted using the RoB 2 and ROBINS-I tools. Results: A total of 1102 relevant articles published from 2000 to 2023 were found. After screening of titles and abstracts, a total of 19 articles were included in our systematic review. Ureteral stent/nephrostomy placement, balloon dilatation (ureteroplasty) with or without laser was used as initial approaches whereas follow-up and success rate were analyzed among other parameters. Conclusions: The management of ureteral strictures after KT is challenging and selecting the most appropriate treatment is crucial for successful outcomes. Our review suggests that, an endourologic management is a safe option with good long-term outcomes, especially in short and early strictures. [ABSTRACT FROM AUTHOR]

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]

Objective: This study evaluated ureteral injury and long-term stricture progression after the smallest ureteral access sheath (UAS) application during retrograde intrarenal surgery. Materials and Methods: A total of 154 patients who had undergone retrograde intrarenal surgery procedures and applied a 9.5/11.5-F UAS for kidney stones between September 2016 and March 2019 were prospectively included, and intraoperative, postoperative, and late complications were evaluated. Ureteral injuries were visualized using flexible and semi-rigid ureterorenoscopy, and ureteral stricture was assessed by computed tomographic urography at one-year controls. Results: 56% (n=86) of the patients were males, and %45 (n=68) the mean age was 47±15 years, stone size was 17.1±8 mm, operative time was 56±23 minutes, 80% had ureter wall injury, and 39% and 41% had grade 0 and grade 1 lesions, respectively. Minor complications were developed in 3%, and major complications were seen in 2% of cases. The ureteral stricture was not observed in 1st-year controls. Conclusion: The routine application of 9.5/11.5-F UAS is safe to use in flexible ureteroscopy without any long-term adverse effects.

The possible role of well-assessed radiological parameters in the prediction of ureteral stricture formation in cases with impacted obstructive ureteral calculi has been evaluated. 46 adult patients with or without ureteral stricture formation after ureteroscopic stone management were included. In addition to stone size and some certain radiological parameters including ureteral wall thickness (UWT) of the involved ureter at the impacted stone site was also measured and noted on computed tomography (CT) images. Parameters were evaluated in two subgroups of cases, namely: Group 1: patients in whom a ureteral stricture formed after endoscopic stone removal and Group 2: patients normal ureteral anatomy without any stricture formation. The possible relationship between the UWT values and degree of hydronephrosis (HN) with subsequent stricture formation was comparatively evaluated. All of the stones were proximal ureteral calculi in both groups. Both the degree of HN and proximal ureteral diameter (PUD) parenchymal was higher in cases with stricture formation. In addition, mean parenchymal thickness was lower and mean values of UWT measurements at the stone site were 3.70 ± 0.97 mm and 2.17 ± 0.26 mm in Groups 1 and 2, respectively. A cutoff value 2.49 mm for UWT was found to be highly predictive for stricture formation. UWT value calculated at the obstructing stone site was found to be predictive enough for the likelihood of ureteral stricture formation with high sensitivity and specificity. This evaluation along with some other radiological parameters may enable the urologists to follow such cases on this aspect with necessary measures taken. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). Results: A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years’ studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. Conclusions: The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment. [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]

Background and Objectives: Urethral strictures are the most common complications after surgical treatments of benign prostatic hyperplasia (BPH). Despite various preventive measures, the search for medications with antiproliferative activity and the development of surgical procedures to prevent the development of urethral strictures are still relevant. We evaluated the preventive efficacy of 5-fluorouracil against urethral strictures in patients undergoing surgery for BPH. Materials and Methods: A non-randomized clinical trial including 246 male patients with an average age of 70.0 ± 8.0 years was conducted. The main study group included 124 patients who, in addition to the standard treatment, received lavage with a 5-fluorouracil solution (1000 mg/20 mL per 500 mL of 0.9% isotonic saline) using a modified three-way urethral catheter. The monitoring of clinical, laboratory, and instrumental parameters was carried out 10 days, 3 months, and 6 months after surgery. Results: The evaluation of severity for dysuria symptoms in patients using the IPSS scale throughout the entire follow-up period showed a statistically significant decrease in ischuria and stranguria, prolongation of the interval between urinations, a decrease in intermittent urination, urinary incontinence, and straining before urination in the main group in comparison with the control patients. The patients of both study groups noted an improvement in the quality of life. It was found statistically significant decrease in the maximum urinary flow rate in the main group (p < 0.001). In the control group, after three months, four cases of urethral strictures and stenosis were recorded; after six months, this rate reached nine cases (7.3%), while in the main group, only one patient with infravesical obstruction was found (0.8%) (χ2 = 3.855, p < 0.05). Conclusions: The results of our study could indicate the effectiveness of the antiproliferative drug 5-fluorouracil in combination with use of a modified catheter in relation to the development of postoperative urethral strictures. [ABSTRACT FROM AUTHOR]

Background: Ureteral stricture (US) postureteroscopic lithotripsy (URSL) has emerged as a severe complication with the widespread use of laser technology. Furthermore, managing a complex US is challenging. Therefore, this study evaluated the efficacy of robot-assisted ureteroureterostomy (RAUU) in addressing US post-URSL and analyzed the pathology of transected ureteral tissues to identify the risk factors for US. Methods: we conducted a prospective cohort study on patients who underwent RAUU for URSL-induced US from April 2021 to May 2023. Results: A total of 14 patients with a mean age of 49.8 years were included in this study. The mean stricture length on radiography was 22.66 ± 7.38 mm. Nine (64.2%) patients had experienced failure with previous interventions. The overall success rate was 92.9%, both clinically and radiographically, without major complications, at a mean follow-up of 12.8 months. The pathological findings revealed microcalcifications and a loss of ureteral mucosa in 57.1% and 28.6% of patients, respectively. Conclusions: The RAUU technique shows promise as a viable option for US post-URSL in appropriately selected patients despite severe pathological changes in the ureter. Therefore, the migration of microcalcifications to the site of ureteral perforation may be a significant factor contributing to US development. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated ureteral injury and long-term stricture progression after the smallest ureteral access sheath (UAS) application during retrograde intrarenal surgery. Materials and Methods: A total of 154 patients who had undergone retrograde intrarenal surgery procedures and applied a 9.5/11.5-F UAS for kidney stones between September 2016 and March 2019 were prospectively included, and intraoperative, postoperative, and late complications were evaluated. Ureteral injuries were visualized using flexible and semi-rigid ureterorenoscopy, and ureteral stricture was assessed by computed tomographic urography at one-year controls. Results: 56% (n=86) of the patients were males, and %45 (n=68) the mean age was 47±15 years, stone size was 17.1±8 mm, operative time was 56±23 minutes, 80% had ureter wall injury, and 39% and 41% had grade 0 and grade 1 lesions, respectively. Minor complications were developed in 3%, and major complications were seen in 2% of cases. The ureteral stricture was not observed in 1st-year controls. Conclusion: The routine application of 9.5/11.5-F UAS is safe to use in flexible ureteroscopy without any long-term adverse effects. [ABSTRACT FROM AUTHOR]

Totally intracorporeal robot-assisted unilateral or bilateral ileal ureter replacement (even with ileocystoplasty) can be performed safely and efficiently with acceptable minor complications and high success rate for the treatment of ureteral strictures. Few studies on totally intracorporeal robot-assisted ileal ureter replacement (RA-IUR) have been reported. To report our technique and the outcomes of totally intracorporeal RA-IUR for unilateral or bilateral ureteral reconstruction, involving performing cystoplasty simultaneously. Fifteen patients underwent totally intracorporeal RA-IUR from April 2021 to July 2022 at a single center. The perioperative variables were prospectively collected, and the outcomes were assessed. The surgical procedure included dissection of the proximal end of the ureteral stricture or renal pelvis, harvesting of the ileal ureter, rebuilding of intestinal continuity, upper anastomosis of the ileum to the renal pelvis or the ureteral end, and lower anastomosis of the ileum to the bladder. All operations were performed intracorporeally. Patient demographics and perioperative results were prospectively collected and analyzed for perioperative complications and success rates. A descriptive statistical analysis was performed. All patients successfully underwent totally intracorporeal RA-IUR without open conversion. Seven patients received unilateral RA-IUR and eight received bilateral RA-IUR. The mean (range) length of the harvested ileal segment was 28.3 (15–40) cm, the operative duration was 261.8 (183–381) min, the estimated blood loss was 64.7 (30–100) ml, and the duration of postoperative hospitalization was 10.5 (7–17) d. At a median (range) follow-up of 14 (8–22) mo, the subjective and functional success rates were 100% and 86.7%, respectively. Our results demonstrate that totally intracorporeal unilateral or bilateral RA-IUR (even with ileocystoplasty) can be performed safely and efficiently with acceptable minor complications and a high success rate. Our study indicates that totally intracorporeal robotic ileal ureter replacement surgery is safe and feasible for ureteral reconstruction, even with ileocystoplasty. The postoperative complications are acceptable. At a median follow-up of 14 (8–22) mo, the subjective and functional success rates were 100% and 86.7%, respectively. [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: To determine whether dynamic renal scans – DTPA or MAG3 – routinely performed after flexible ureteroscopies (f-URS) could detect the development of an obstruction and thus promote prompt early intervention for kidney preservation. Patients and methods: In this retrospective study, with all the data recorded prospectively between April 2010 and October 2023, 250 renal units in 242 patients with upper urinary tract stones (UUTS) who underwent ureterorenoscopy by one surgeon in the same medical center were evaluated. Stone-free rate (SFR) was defined as no residual fragments at all using an intraoperative “triple test”. The following characteristics were examined: gender, BMI, age, Hounsfield unit, stone diameter, laterality, renal/ureteral stones, stone-free rate, and auxiliary procedures per renal unit. The Clavien-Dindo classification was used to report complications. Renal units with residual stones were scheduled for a 2nd f-URS. Post- flexible ureteroscopy ureteral obstruction and renal function were detected using renal scan DTPA or MAG-3. The primary outcome was renal/ ureteral obstruction. Results: The mean patient age was 53 years. The mean stone size was 12.3 mm. Stones in renal pelvis, upper, middle and lower calyces were treated in 9.2% (23), 27.6% (69), and 30.8% (77) of cases, respectively; 44% (110) ureteral stones were also treated. The single- and second-session SFRs were 94.8% and 99.7%, respectively. A third auxiliary procedure was needed in one renal unit (0.4%). The mean number of procedures per renal unit was 1.06 (264/250). Ureteral double-J stents were inserted in 53.6% (134) of the cases. In 37 (14.8%) cases, a stent was placed before surgery. Post-operative complications were minor, with readmission and pain control needed in only two patients (0.8%). No avulsion or perforation of the ureters was observed. In six patients with t1/2 between 10-20 minutes, a second renal scan revealed spontaneous improvement and no obstruction in five patients. One patient with large stones and a history of prior ureteroscopy developed a ureteral stricture (0.4%) and needed treatment with laser endoureterotomy. Conclusions: Post-flexible ureteroscopy obstruction due to ureteral stricture is very rare. A routine renal scan post-operatively may be used in potentially high-risk patients.

Objective: Ureteral lesions caused by impacted ureteral stones are likely to result in postoperative ureteral stricture. On this basis, the study aimed to investigate if dual-energy spectral computed tomography can predict ureteral hardening caused by impacted stones and to explore the relationship between different types of ureteral lesions and the risk of ureteral stricture. Methods: This prospective study collected data of 93 patients with impacted stones from hospital automation system during January 2018 to October 2019. They underwent an abdominal scan on a dual-energy spectral computed tomography. During surgery, the operator used ureteroscopy to identify ureteral lesions, which were classified into four categories: edema, polyps, pallor, and hardening. Seven months later, 90 patients were reviewed for the degree of hydronephrosis. Results: Endoscopic observations revealed 38 (41%) cases of ureteral edema, 20 (22%) cases of polyps, 13 (14%) cases of pallor, and 22 (24%) cases of hardening. There were significant differences in hydronephrosis, the period of impaction, the calcium concentration of the ureter, and the slope of the spectral Hounsfield unit curve between the four groups. After that, we evaluated the factors associated with ureteral hardening and found that the calcium concentration of the ureter and hydronephrosis remained independent predictors of ureteral hardening. Receiver operating characteristic curve analysis showed that 5.3 mg/cm³ calcium concentration of the ureter is an optimal cut-off value to predict ureteral hardening. The result of follow-up showed that 80 patients had complete remission of hydronephrosis, with a complete remission rate of 61.9% (13/21) in the hardening group and 97.1% (67/69) in the non-hardening group (p

Abstract Background Currently, strictures of the ureters often develop after endourology of the upper urinary tract, gynecological, and surgical interventions. For long proximal ureteral strictures, ureteroplasty with an on-lay appendix flap may be an option for treatment. Case presentation Five patients had laparoscopic onlay appendicoureteroplastic for long right ureter strictures. The average age of the patients was 42.5 years old. Four patients developed a stricture after transurethral contact ureterolithotripsy; one patient had it after laparoscopic ureterolysis. The average stricture length was 3.5 (2.8–5.2) cm. The length of the stricture was controlled, including using near-infrared fluorescence imaging. With an average observation time of 14.6 (6.2–28.4) months, the operation was effective in all patients. The urodynamics of the upper urinary tract recovered completely in three patients and comparatively improved in two patients. All of the patients stopped feeling any pain. The observed patients were saved from external and internal drainage. Conclusions Laparoscopic onlay ureteroplasty with an appendix in a selected group of patients may be the method of choice for long strictures of the middle and upper parts of the right ureter.

Abstract Introduction Robotic ureteral reconstruction (RUR) has been widely used to treat ureteral diseases. To summarize the surgical techniques, complications, and outcomes following RUR, as well as to compare data on RUR with open and laparoscopic ureteral reconstruction. Methods Our systematic review was registered on the PROSPERO (CRD42022309364) database. The PubMed, Cochrane and Embase databases were searched for publications in English on 06-Feb-2022. Randomised-controlled trials (RCTs) or non-randomised cohort studies with sample size ≥ 10 cases were included. Results A total of 23 studies were included involving 996 patients and 1004 ureters from 13 non-comparative, and 10 retrospective comparative studies. No RCT study of RUR was reported. The success rate was reported ≥ 90% in 15 studies. Four studies reported 85–90% success rate. Meta-analyses for comparative studies showed that RUR had significantly lower estimated blood loss (EBL) (P = 0.006) and shorter length of stay (LOS) (P

Introduction: Robotic ureteral reconstruction (RUR) has been widely used to treat ureteral diseases. To summarize the surgical techniques, complications, and outcomes following RUR, as well as to compare data on RUR with open and laparoscopic ureteral reconstruction. Methods: Our systematic review was registered on the PROSPERO (CRD42022309364) database. The PubMed, Cochrane and Embase databases were searched for publications in English on 06-Feb-2022. Randomised-controlled trials (RCTs) or non-randomised cohort studies with sample size ≥ 10 cases were included. Results: A total of 23 studies were included involving 996 patients and 1004 ureters from 13 non-comparative, and 10 retrospective comparative studies. No RCT study of RUR was reported. The success rate was reported ≥ 90% in 15 studies. Four studies reported 85–90% success rate. Meta-analyses for comparative studies showed that RUR had significantly lower estimated blood loss (EBL) (P = 0.006) and shorter length of stay (LOS) (P < 0.001) than the open approach. RUR had shorter operative time than laparoscopic surgery (P < 0.001). Conclusions: RUR is associated with lower EBL and shorter LOS than the open approach, and shorter operative time than the laparoscopic approach for the treatment of benign ureteral strictures. However, further studies and more evidence are needed to determine whether RUR is more superior. [ABSTRACT FROM AUTHOR]

Purpose: We sought to determine whether preoperative stricture length measurement affected the choice of procedure performed, its correlation to intraoperative stricture length, and postoperative outcomes. Methods: The Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database was queried for patients undergoing robotic ureteral reconstructive surgery from 2013 to 2021 who had surgical stricture length measurement. From this cohort, we identified patients with and without preoperative stricture length measurement via retrograde pyelogram or antegrade nephrostogram. Outcomes evaluated included intraoperative complications, 30-day complications greater than Clavien-Dindo grade II, hardware-free status, and need for additional procedures. Results: Of 153 patients with surgical stricture length measurements, 102 (66.7%) had preoperative radiographic measurement. No repair type was more likely to have preoperative measurement. The Pearson correlation coefficient between surgical and radiographic stricture length measurements was + 0.79. The average surgical measurement was 0.71 cm (± 1.52) longer than radiographic assessment. Those with preoperative imaging waited on average 5.0 months longer for surgery, but this finding was not statistically significant (p = 0.18). There was no statistically significant difference in intraoperative complications, 30-day complication rates, hardware-free status at last follow-up, or need for additional procedures between patients with and without preoperative measurement. The only significant predictive factor was preoperative stricture length on 30-day postoperative complications. Conclusions: Despite relatively high prevalence of preoperative radiographic stricture length measurement, there are few measures where it offers clinically meaningful diagnostic information towards the definitive surgical management of ureteral stricture disease. [ABSTRACT FROM AUTHOR]

Ureteral stricture in renal allografts is one of the common postoperative complications in kidney transplant recipients. Due to short ureter in renal allografts, endovascular treatment should be adopted before reconstruction surgery to avoid irreversible injury. Alleviating renal allograft injury, easing obstruction or establishing drainage channel are the key measures to treat ureteral stricture. In endovascular treatment, balloon dilatation and internal incision yield high recurrence rate, and long-term indwelling of self-expanding metallic ureteral stents may be a better option. Compared with traditional stents, metallic stents may maintain urinary tract patency for a long time and mitigate the irritation of lower urinary tract symptoms,with different indications and efficacy. Although all metallic stents may be displaced and occluded, it still plays a positive role in the treatment of ureteral stricture in renal allografts. In this article, the application of self-expanding metallic ureteral stent in ureteral stricture of renal allografts was mainly illustrated, aiming to provide reference for optimizing the treatment of ureteral stricture in renal allografts. [ABSTRACT FROM AUTHOR]

Objective: To describe the technique of open ureteral repair for multiple strictures, and its surgical outcome, in a patient who previously underwent laparoscopic total hysterectomy and bilateral salpingectomy (THBS). Patient and surgical procedure: We report a 46-year-old female who developed multiple ureteral strictures in her right ureter, four months after undergoing laparoscopic hysterectomy, bilateral salpingectomy. The proximal stricture was measured to be 3 cm while the distal stricture was 2 cm in length. The surgical technique consisted of open laparotomy, enterolysis, non-transecting side-to-side vesicoureteroanastomosis for the distal ureteral stricture. The proximal stricture was repaired using buccal mucosal graft to augment its lumen. There was no note of stricture recurrence on cystoscopy and retrograde pyelogram on short term follow-up. Results: Total operative time was three hours. Blood loss was approximately 300 ml. There were no complications intraoperatively and in the immediate perioperative period. At 6 months follow-up, cystoscopy and retrograde pyelography were performed which showed a healthy ureteral orifice with good peristaltic movements, and a non-dilated ureter. Conclusion: Repair of synchronous ureteral strictures can be performed using a combination of a non-transecting ureteroneocystostomy and buccal mucosal graft ureteroplasty. The technique is easily reproducible with good results and low morbidity, on short term follow-up.

Background: Malignant ureteral obstruction (MUO) is a sequela of advanced malignant disease that requires renal drainage, with tandem ureteral stents (TUSs) being a viable option. This study aimed to evaluate the TUS failure rate, associated risk factors, and the feasibility of replacing failed TUSs with a new pair of stents. Methods: A retrospective analysis of MUO patients treated with TUS insertion from 2014 to 2022 was conducted. TUS failure was defined as urosepsis, recurrent urinary tract infections, acute kidney failure, or new hydronephrosis on imaging. Cox proportional hazard regression analysis identified the independent predictors of TUS failure. Results: A total of 240 procedures were performed on 186 patients, with TUS drainage failing in 67 patients (36%). The median time to failure was 7 months. Multivariate analysis revealed female gender (OR = 3.46, p = 0.002), pelvic mass (OR = 1.75, p = 0.001), and distal ureteral obstruction (OR = 2.27, p = 0.04) as significant risk factors for TUS failure. Of the failure group, 42 patients (22.6%) underwent TUS replacement for a new pair. Yet, 24 (57.2%) experienced a second failure, with a median time of 4.5 months. The risk factors for TUS second failure included a stricture longer than 30 mm (OR = 11.8, p = 0.04), replacement with TUSs of the same diameter (OR = 43, p = 0.003), and initial TUS failure within 6 months (OR = 19.2, p = 0.006). Conclusions: TUS insertion for the treatment of MUO is feasible and has good outcomes with a relatively low failure rate. Primary pelvic mass and distal ureteral obstruction pose higher risks for TUS failure. Replacing failed TUSs with a new pair has a success rate of 42.8%. Consideration should be given to placing larger diameter stents when replacing failed TUS. [ABSTRACT FROM AUTHOR]

Purpose: Robot-assisted laparoscopy (RALP), conventional laparoscopy (LP), and balloon dilation (BD) have all been identified as common treatments for benign ureteral stricture (BUS). The purpose of the research would be to compare the safety and efficacy differences in the three groups. Patients and Methods: Patients who received RALP, LP, or BD for BUS were studied retrospectively from January 2016 through December 2020. Professional and experienced surgeons performed all operations. We collect and analyze baseline characteristics, stricture details, and perioperative and follow-up information. Results: The results showed no statistically significant difference between the three groups for baseline characteristics and stricture details. No statistical difference was also found between RALP and LP in specific surgical techniques. The average operative time was longer in the LP group than RALP and BD groups (178 minutes vs 150 minutes vs 67 minutes, respectively, p < 0.001). BD had lower estimated blood loss than RALP and LP (14 mL vs 40 mL vs 32 mL, p < 0.001) and similar between the RALP and LP groups (p = 0.238). The BD group had the shortest postoperative hospital stay compared with the RALP and LP groups (2.95 days vs 5.25 days vs 6.52 days, p < 0.001), and no statistically significant difference existed between the RALP and LP groups (p = 0.098). RALP had considerably greater hospitalization expenses than both LP (p < 0.001) and BD (p < 0.001). Complications and short-term success rates (6 months) were similar. The BD group had poorer long-term success (12 and 24 months) than the RALP and LP groups, whereas there was no statistically significant difference between the RALP and LP groups. Conclusions: For the management of BUS, RALP, LP, and BD are all safe and effective, with equivalent complication rates and short-term success. In long-term success rates, BD is low than RALP and LP. [ABSTRACT FROM AUTHOR]

Summary: Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

The use of cryoablation in the management of small renal masses is widely acceptable. Although rare but ureteral injury during the procedure with subsequent stricture formation can result in devastating effects on renal function. On the other hand, the management of such strictures requires reconstructive surgery as gold standard. Unfortunately, in some cases the reconstructive surgery might not be feasible, and the treatment usually is ureteral stent insertion that need to be changed regularly. Here we present a case of a 53-year-old gentleman who developed an upper ureteric iatrogenic stricture post cryoablation in which the reconstructive surgery was not feasible due to high procedural risk. We used metallic ureteral stent (Memokath) instead of regular ureteral double J stent. We found that if the reconstructive surgery is not possible the usage of Memokath in treating iatrogenic ureteral strictures is associated with better quality of life, lower costs and a similar functional outcome when compared to ureteral double J stent that needs regular frequent changes.

Zhaosheng Jiang,1,&ast; Jiahao Wang,2,&ast; Wei Meng,1,&ast; Youlang Zhou,3 Limin Ma,1 Yangbo Guan1 1Department of Urology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, People’s Republic of China; 2Department of Urology, Wuxi Hospital Affiliated to the Nanjing University of Chinese Medicine, Wuxi, People’s Republic of China; 3Research Central of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yangbo Guan; Limin Ma, Tel +86 18912888908 ; Tel +86 13404292020, Email guanyangbo123@ntu.edu.cn; ntmalimin@163.comIntroduction: Ureteral stricture caused by iatrogenic ureteral injury induced ureteral injury is more common and challenging to recover quickly. The effective prevention of ureteral stricture due to iatrogenic ureteral injury-induced ureteral damage is a current challenge for urologists. The purpose of this study was to evaluate the effectiveness of nanoparticle/pirfenidone complex-coated ureteral stents with slow-release pirfenidone for the prevention of ureteral stricture in rabbits. In this study, we developed a nanoparticle/pirfenidone complex-coated ureteral stent to deliver pirfenidone into the injured ureter to inhibit ureteral stricture.Methods: Twelve New Zealand rabbits were divided into four groups: Sham, US, US+ Unmodified ureteral stent, and US+NP/PFD ureteral stent; we constructed an irreversible electroporation model of ureteral injury in rabbits and placed unmodified ureteral stents and nanoparticle/pirfenidone complex-coated ureteral stents into the ureter. Two weeks later, we euthanized the rabbits and removed their bilateral kidneys and ureters. We evaluated the effect of ureteral stent prophylaxis by gross specimen observation, section staining, and Western Blot.Results: We found that the nanoparticle/pirfenidone complexes could adhere uniformly to the surface of the ureteral stent. After placement into the ureter, the nanoparticle/pirfenidone complexes were able to remain on the surface of the ureteral stent. We found nanoparticle/pirfenidone complexes could diffuse in the ureteral epithelial tissue two weeks after the order. The study showed that nanoparticle/pirfenidone complex-coated ureteral stents placed into the ureter showed significantly less stenosis due to fibrosis than in US control rabbits and rabbits treated with unmodified ureteral stents.Conclusion: We used a novel platform based on nanoparticle/pirfenidone complex-coated ureteral stents for local and sustained delivery of pirfenidone, which can effectively deliver pirfenidone to the tissue and can slowly control the release of pirfenidone. Therefore, combining ureteral stents with nanoparticle/pirfenidone complexes was an effective measure to prevent ureteral stricture.Keywords: nanoparticles, ureteral stricture, fibrosis, ureteral stents, pirfenidone

Introduction. The review is aimed at analyzing the worldwide experience in the use of the oral mucosa in ureteroplasty due to benign ureteral strictures.Objective. To study the features of the use of the oral mucosa in ureteral reconstruction based on a review of the worldwide literature.Materials and methods. The review was conducted using the PubMed, EMBASE, and the Russian Science Citation Index database. In the first stage, 1013 sources were found, of which 38 articles were selected for inclusion in the review. Of these, 13 studies used an open approach, 15 — robotic, 6 — laparoscopic, 3 — laparoscopic and robotic, 1 — open and laparoscopic. A buccal graft was used in 29 studies and a lingual graft was used in 9 studies.Results. In total, oral mucosal ureteroplasty was performed 308 times in 306 patients: open technique — 64 times, robotic — 145 times, laparoscopic — 99 times. A buccal graft was used in 67.9% (209/308) of the cases, a lingual graft was used in 32.1% (99/308). Postoperative complications were observed in 15.9% (49/308) of the cases: 12.2% after the open technique, 10.4% after the robotic technique and 20.2% after the laparoscopic technique. With a postoperative follow-up period of 1 to 85 months (average 15.3 months), treatment success was achieved in 92.5% (285/308) of the cases: 93.8% for open technique, 88.2% for robotic, 98.0% for laparoscopic.Conclusion. The use of the oral mucosa for ureteroplasty due to benign ureteral stricture allows high rates of efficiency and safety. The results of ureteroplasty do not depend on the choice of surgical approach, type of graft and graft transplantation technique.

Ureteral stricture, urine leakage and other urinary complications are likely to occur after kidney transplantation, which severely affect the function of renal allograft and even lead to renal allograft loss. Ureteral stent plays a critical role in kidney transplantation, which could promote the urine flow from kidney to bladder after kidney transplantation, lower the pressure within the ureter and reduce the risk of early urinary complications. However, it may also cause urinary tract infection, stent-related complications and BK virus infection, etc. Therefore, clinicians should flexibly grasp the indications for ureteral stent removal. In this article, the application, potential adverse reactions and the timing of removal of ureteral stent in the field of kidney transplantation were reviewed, aiming to provide reference for clinical decision-making related to ureteral stent after kidney transplantation. [ABSTRACT FROM AUTHOR]

Radiation is a common treatment modality for pelvic malignancies. While it can be effective at cancer control, downstream effects can manifest months to years after treatment, leaving patients with significant morbidity. Within urology, a particularly difficult post-radiation consequence is urinary tract stricture, either of the urethra, bladder neck, or ureter. In this review, we will discuss the mechanism of radiation damage and treatment options for these potentially devastating urinary sequelae. [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]

Purpose: To identify preoperative predictors of endo-urological treatment (EUT) failure while promoting a new diagnostic and therapeutic pathway for benign uretero-enteric anastomosis stricture (UES) management after radical cystectomy (RC). Materials and methods: We relied on a prospectively maintained database including 96 individuals (122 renal units) who developed a benign UES at our institution between 1990 and 2018. UES was classified into two different types according to morphology: FP1 (i.e., sharp or duckbill) and FP2 (i.e., flat or concave). EUT feasibility, success rate, as well as intra and postoperative complications were recorded. Uni- and multivariable logistic regression analysis (MVA) assessed for predictors of EUT failure. Results: Overall, 78 (63.9%) and 32 (26.3%) cases were defined as FP1 and FP2, respectively. EUT was not feasible in 33 (27.1%) cases. After a median follow-up of 50 (IQR 5–240) months, successful treatment was reached only in 15/122 (12.3%) cases. EUT success rates raised when considering short (< 1 cm) (16.8%), FP1 morphology (16.7%) strictures, or the combination of these characteristics (22.4%). Overall, 5 (5.2%) cases had CD ≥ III complications. FP2 (OR: 1.91, 95%CI 1.21–5.31, p = 0.03) and stricture length ≥ 1 cm (OR: 9.08, 95%CI 2.09–65.71, p = 0.009) were associated with treatment failure at MVA. Conclusions: Endoscopic treatment for benign UES after RC is feasible but harbors a low success rate. Stricture length and radiological morphology of the stricture are related to endoscopic treatment failure. Surgeons should be aware of the stricture features during the preoperative decision-making process to choose the optimal candidate for endoscopic treatment. [ABSTRACT FROM AUTHOR]

Background and Objectives: Urethral strictures are the most common complications after surgical treatments of benign prostatic hyperplasia (BPH). Despite various preventive measures, the search for medications with antiproliferative activity and the development of surgical procedures to prevent the development of urethral strictures are still relevant. We evaluated the preventive efficacy of 5-fluorouracil against urethral strictures in patients undergoing surgery for BPH. Materials and Methods: A non-randomized clinical trial including 246 male patients with an average age of 70.0 ± 8.0 years was conducted. The main study group included 124 patients who, in addition to the standard treatment, received lavage with a 5-fluorouracil solution (1000 mg/20 mL per 500 mL of 0.9% isotonic saline) using a modified three-way urethral catheter. The monitoring of clinical, laboratory, and instrumental parameters was carried out 10 days, 3 months, and 6 months after surgery. Results: The evaluation of severity for dysuria symptoms in patients using the IPSS scale throughout the entire follow-up period showed a statistically significant decrease in ischuria and stranguria, prolongation of the interval between urinations, a decrease in intermittent urination, urinary incontinence, and straining before urination in the main group in comparison with the control patients. The patients of both study groups noted an improvement in the quality of life. It was found statistically significant decrease in the maximum urinary flow rate in the main group (p < 0.001). In the control group, after three months, four cases of urethral strictures and stenosis were recorded; after six months, this rate reached nine cases (7.3%), while in the main group, only one patient with infravesical obstruction was found (0.8%) (χ2 = 3.855, p < 0.05). Conclusions: The results of our study could indicate the effectiveness of the antiproliferative drug 5-fluorouracil in combination with use of a modified catheter in relation to the development of postoperative urethral strictures.