MyMedR

Fulltext Renal autotransplantation after an iatrogenic left ureteric injury

Neo EN, Zulkifli Z, Sritharan S, Lee BC, Nazri J

Med J Malaysia, 2007 Jun;62(2):164-5.

We report a case of renal autotransplantation performed successfully for an iatrogenic ureteric injury with loss of 9 cm of ureteric length. The surgical options available for management of ureteric injuries are discussed, varying from a simple re-anastomosis to the more complex renal autotransplantation.

Matched MeSH terms: Ureter/surgery

Fulltext Bifid blind-ending ureter--a case report

Lam HS

Singapore Med J, 1991 Feb;32(1):84-6.

PMID: 2017715

An interesting case of bifid blind-ending ureter occurring in a young Indian girl is reported. She presented with severe recurrent right iliac fossa pain for which she underwent appendicectomy which did not resolve her symptoms. Subsequent urological investigation--IVU and retrograde pyeleogram--revealed the genuine diagnosis. Surgical excision of the blind-ending branch was successful in relieving the intractable pain. A review of the literature on this uncommon congenital urological problem is outlined stating its clinical significance and treatment options.

Matched MeSH terms: Ureter/surgery

Avulsed ureter

Dublin N, Razack AH

ANZ J Surg, 2003 Apr;73(4):254-5.

PMID: 12662241

Matched MeSH terms: Ureter/surgery*

Fulltext Peritoneal implantation of ureter in a cadaveric kidney transplant recipient

Tan SY, Lim CS, Teo SM, Lee SH, Razack A, Loh CS

Med J Malaysia, 2003 Dec;58(5):769-70.

PMID: 15190667

We report here a case of a kidney transplant recipient in whom the ureter was initially implanted into the peritoneum. Excessive ultrafiltration volume and reversal of serum vs dialysate creatinine ratio when the patient was recommenced on continuous ambulatory peritoneal dialysis first suggested the diagnosis which was subsequently confirmed by a plain abdominal x-ray demonstrating placement of ureteric stent in the peritoneum. This rare complication was successfully corrected with surgical re-implantation of ureter into the bladder and 5 years later, the patient remains well with good graft function.

Matched MeSH terms: Ureter/surgery*

Fulltext Iatrogenic ureter injuries: eleven years experience in a tertiary hospital

Mahendran HA, Singam P, Ho C, Goh EH, Tan GH, Zuklifli MZ

Med J Malaysia, 2012 Apr;67(2):169-72.

PMID: 22822637 MyJurnal

Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity from infection and possible loss of renal function. A successful repair is related to the timing of diagnosis, site of injury and method of repair. This study was a retrospective review of outcomes of iatrogenic ureteric injury and factors contributing to successful operative repair. Twenty consecutive cases referred to the Urology Unit of the UKM Medical Center during an 11-year period from 1998 to 2009 were reviewed. Thirteen patients were diagnosed intraoperatively and underwent immediate repair. Seven patients had delayed diagnosis but also underwent immediate repair. In our series, there was no significant difference in outcome between injuries diagnosed intraoperatively versus injuries with delayed diagnosis. There was significant difference in the outcomes between methods of ureteric repair where ureter reimplantation via psoas hitch or Boari flap yielded better results than primary end-to-end anastomosis Three patients suffered loss of renal function from unsuccessful ureter repair. We conclude that all iatrogenic ureteric injury should be repaired immediately in the absence of overt sepsis. Ureter reimplantation using a Boari flap or psoas hitch is preferred to the end-to-end anastomosis especially when there is delayed diagnosis

Matched MeSH terms: Ureter/surgery*

Fulltext Hand-assisted laparoscopic nephrectomy and nephroureterectomy: our experience in Hospital Universiti Kebangsaan Malaysia

Ho CC, Zulkifli MZ, Nazri J, Sundram M

Med J Malaysia, 2008 Mar;63(1):41-3.

PMID: 18935731

Hand-assisted laparoscopic nephrectomy (HAL-N) and nephroureterectomy (HAL-NU) were introduced to bridge the gap between open and laparoscopic surgery. This newer technique has the benefits of both laparoscopic and open surgical approaches but has a shorter learning curve and decreased operative time compared to laparoscopic surgery. A review of our 2-year experience showed that for the seventeen cases of HAL-N that was performed, the mean operative time was 187.8 minutes while the mean length of hospital stay was 4.1 days. For the two HAL-NU cases, the mean operative time was 415 minutes while the mean length of hospital stay was 5.5 days. Only one complication occurred and it was an incisional hernia at the hand-port site. There was no recurrence for the carcinoma cases. Our experience shows that this technique is feasible and safe.

Matched MeSH terms: Ureter/surgery*

Intravesical stent position as a predictor of quality of life in patients with indwelling ureteral stent

Inn FX, Ahmed N, Hou LG, Abidin ZAZ, Yi LL, Zainuddin ZM

Int Urol Nephrol, 2019 Nov;51(11):1949-1953.

PMID: 31441009 DOI: 10.1007/s11255-019-02262-7

PURPOSE: The internal drainage provided by a ureteral stent helps with the relief and prevention of ureteral obstruction. By definition, correct stent placement is one with a complete loop in both the renal pelvis and bladder. This prevents stent migration proximally or distally despite urinary flow, patient movement, and ureteral peristalsis.

METHODS: We performed a comparative prospective cross-sectional study assessing the impact of intravesical stent position on the quality of life in 46 patients with a ureteral stent. This is done using the Ureteral Stent Symptom Questionnaire (USSQ).

RESULTS: 52.5% of patients had an ipsilateral positioned intravesical stent, while the remaining had their stent positioned contralaterally. Intravesical stent position significantly influenced the quality of life. The USSQ score was worse for the contralateral group. Subscore analysis found that urinary symptoms and body pain index contribute significantly to the morbidity. Majority of patients in the ipsilateral group reported no discomfort as compared to the contralateral group.

CONCLUSIONS: To the best of our knowledge, this is the first study assessing the impact of intravesical stent position on the quality of life in the Asian population. Intravesical stent position has a significant influence on patient's morbidity and quality of life in particular towards their urinary irritative symptoms and body pain. It is imperative to ensure correct distal placement of ureteric stent that does not cross the midline to the contralateral site. We believe that the USSQ should be used in daily clinical practice in assessing the symptoms related to indwelling ureteric stents.

Matched MeSH terms: Ureter/surgery*

Multicenter outcome analysis of different sheath sizes for Flexible and Navigable Suction ureteral access sheath (FANS) ureteroscopy: an EAU Endourology collaboration with the global FANS study group

Kwok JL, Somani B, Sarica K, Yuen SKK, Zawadzki M, Castellani D, et al.

Urolithiasis, 2024 Nov 15;52(1):162.

PMID: 39545972 DOI: 10.1007/s00240-024-01662-4

Flexible and navigable suction ureteral access sheath (FANS) is a potential game changer in flexible ureteroscopy (FURS). The influence of sheath size on outcomes needs research. The primary aim was to analyze 30-day single stage stone free status (SFS), zero fragment rate (ZFR) and complications when using 10/12Fr sheaths vis a vis other sheath sizes. The global FANS research group published the 30-day outcomes in patients who underwent FANS and reasoned this can be a potential game changer. We included 295 patients from this anonymized dataset with division into two groups: Group 1 (Smaller sheath) - 10/12Fr FANS, and Group 2 (Larger sheath) - 11/13Fr or 12/14Fr sheaths. Stone volume was similar between both groups (median 1320 mm3, p = 0.88). Ureteroscopy and total operative time was longer in the smaller sheath group (35 vs. 32 min, p = 0.02 and 50 vs. 45 min, p = 0.001, respectively). While 30-day computed tomography SFS (100% stone free or single residual fragment ≤ 2 mm) were not significantly different (96% vs. 95%, p > 0.99), ZFR (100% stone-free) was better with smaller sheaths (68% vs. 53%, p = 0.02). There was no difference in postoperative complication rates, and no sepsis in both groups. Urologists should consider individualizing appropriate sheath size in normal adult kidneys. Sheath size did not affect complication rates, risk of perioperative injury to the pelvicalyceal system or ureteric injury, but smaller FANS sheaths had similar high SFS. The ZFR with smaller sheaths was better, but this needs to be validated. These smaller sheath outcomes need to be balanced with longer ureteroscopy time, operative time, reach to the lower pole, ease of suction and visibility during lithotripsy. Large volume studies in different types of pelvicalyceal anatomy can determine if indeed smaller FANS is the best choice in FURS.

Matched MeSH terms: Ureter/surgery

Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: a multi-institutional, multinational evaluation

Patil NN, Mottrie A, Sundaram B, Patel VR

Urology, 2008 Jul;72(1):47-50; discussion 50.

PMID: 18384858 DOI: 10.1016/j.urology.2007.12.097

To report the collective experience of three multinational institutions with the use of robotics to evaluate and treat complex distal ureteral obstruction.

Matched MeSH terms: Ureter/surgery*

Fulltext Ureterovaginal fistula: A complication of a vaginal foreign body

Lo TS, Jaili SB, Ibrahim R, Kao CC, Uy-Patrimonio MC

Taiwan J Obstet Gynecol, 2018 Feb;57(1):150-152.

PMID: 29458888 DOI: 10.1016/j.tjog.2017.12.026

OBJECTIVE: To know the diagnostic tools and proper management of ureterovaginal fistula following neglected vaginal foreign body in order to achieve optimal outcome.

CASE REPORT: A case of ureterovaginal fistula associated with a neglected vaginal foreign body. The patient was complaining of a foul-smelling vaginal discharge and lower abdominal pain. On vaginal examination, a hard and large foreign body was found. Examination under anesthesia was performed, and an aerosol cap was removed from her vagina. The patient developed urinary incontinence after removal of the foreign body. Subsequent work-up demonstrated the presence of a right ureterovaginal fistula. The patient underwent an abdominal ureteroneocystostomy. At one year follow up, the patient had fully recovered.

CONCLUSION: Ureterovaginal fistula following neglected vaginal foreign body is a serious condition. Early diagnosis, treatment of infection and proper surgical management can improve the outcome and decrease complications.

Matched MeSH terms: Ureter/surgery

Fulltext Effect of single-dose dexmedetomidine on postoperative recovery after ambulatory ureteroscopy and ureteric stenting: a double blind randomized controlled study

Shariffuddin II, Teoh WH, Wahab S, Wang CY

BMC Anesthesiol, 2018 01 05;18(1):3.

PMID: 29304735 DOI: 10.1186/s12871-017-0464-6

BACKGROUND: Ambulatory surgery has recently gain popularity, as it is a good method of optimizinghospital resources utilization. To support ambulatory surgery, anaesthetic goals nowrevolve around patients' early recovery with minimal pain and nausea, expedientdischarge home and prompt resumption of activities of daily living. In this study, weevaluated the effect of a single pre-induction dose of dexmedetomidine on anaestheticrequirements, postoperative pain and clinical recovery after ambulatory ureteroscopy andureteric stenting under general anaesthesia.

METHODS: Sixty patients were randomised to receive IV dexmedetomidine 0.5 μg.kg-1 (Group DEX, n = 30) or IV saline (Group P, n = 30). General anaesthesia was maintained with Sevoflurane: oxygen: air, titrated to BIS 40-60. Pain intensity, sedation, rescue analgesics, nausea/vomiting and resumption of daily activities were recorded at 1 h, and postoperative day (POD) 1-5.

RESULTS: Group DEX patients had significant reduction in sevoflurane minimum alveolar concentration (MAC), mean (SD) DEX vs. Placebo 0.6 (0.2) vs. 0.9 (0.1), p = 0.037; reduced postoperative resting pain at 1 h (VAS 0-10) (mean (SD) 1.00 (1.84) vs. 2.63 (2.78), p = 0.004), POD 1 (mean (SD) 1.50 (1.48) vs. 2.87 (2.72), p = 0.002), POD 2 (0.53 (0.97) vs. 1.73 (1.96), p = 0.001) and POD 3 (0.30 (0.75) vs. 0.89 (1.49), p = 0.001). DEX patients also had less pain on movement POD 1 (3.00 (2.12) vs. 4.30 (3.10), p = 0.043) and POD 2 (2.10 (1.98) vs. 3.10 (2.46), p = 0.040), with higher resumption of daily activities by 48 h compared to placebo, 87% vs. 63%, p = 0.04.

CONCLUSIONS: We conclude that a single dose of dexmedetomidine was a useful adjuvant in reducing MAC and postoperative pain (at 1 h and POD 1-3), facilitating faster return to daily activities by 48 h.

TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617001120369 , 31st July 2017, retrospectively registered.

Matched MeSH terms: Ureter/surgery*

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