RESUMEN
OBJECTIVE: Retroperitoneal fibrosis is a rare disease characterized by chronic inflammation and fibrosis in the retroperitoneal space that may wrap around the ureter and cause an obstruction. Here we present the cases of three patients diagnosed and treated between April and August 2022. CASE PRESENTATION: Here we present three cases of retroperitoneal fibrosis. Imaging revealed hydronephrosis and/or ureteral dilation, whereas laboratory findings such as erythrocyte sedimentation rate, C-reactive protein, and immunoglobulin G4 were abnormal. Serum creatinine and blood urea nitrogen levels suggested renal injury. Additionally, two patients had unclear diagnoses from other hospitals. Later, all patients underwent ureteral stenting and laparoscopic ureterolysis at our hospital and simultaneous diagnosis by biopsy. The two patients with high immunoglobulin G4 levels exhibited extremely severe fibrosis. After discharge, each received maintenance prednisone to prevent recurrence as well as methotrexate, followed by follow-up every 3 months. Fortunately, serum creatinine, blood urea nitrogen, and intravenous urography findings remained normal with an average follow-up of 8.5 months. CONCLUSION: Here we discovered interesting findings in the diagnosis and treatment of retroperitoneal fibrosis, including the stable effect of medical plus surgical treatment, an unclear ureteral obstruction etiology, and the relationship between immunoglobulin G4 level and fibrosis hardness. However, the mechanisms behind these new findings require further study.
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Fibrosis Retroperitoneal , Humanos , Fibrosis Retroperitoneal/diagnóstico , Fibrosis Retroperitoneal/complicaciones , Masculino , Persona de Mediana Edad , Anciano , Femenino , Obstrucción Ureteral/etiologíaRESUMEN
BACKGROUND: Benign uretero-ileal anastomotic stricture (UIAS) is a potentially serious complication that can arise after radical cystectomy (RC) and subsequent urinary diversion. To preserve residual renal function and improve prognosis, it is crucial to derive insights from experience and tailor individualized treatment strategies for different patients. PATIENTS AND METHODS: From October 2014 to June 2021, a total of 47 patients with benign UIAS underwent endoscopic management (n = 19) or reimplantation surgery (n = 28). The basic data, perioperative conditions, and postoperative outcomes of the two groups were compared and analyzed to evaluate efficacy. RESULTS: Comparing preoperative and postoperative clinical efficacy within the same group, the endoscopic group showed no significant differences in creatinine and blood urea nitrogen (BUN) levels before surgery or after extubation (p > 0.05). However, significant differences were observed in glomerular filtration rate (GFR) levels on the affected side before surgery and after extubation (p < 0.05). In contrast, the laparoscopic reimplantation group did not exhibit significant differences in creatinine, BUN, or GFR levels of affected side before surgery and after extubation (p > 0.05). Postoperative clinical efficacy showed no significant difference in creatinine and BUN levels between the two groups (p > 0.05). However, GFR values of affected side in the endoscopic treatment group decreased more than those in the laparoscopic reimplantation group (p < 0.05). Additionally, the laparoscopic reimplantation group was able to remove the single-J tube earlier than the endoscopic treatment group (p < 0.05), had a lower recurrence rate of hydronephrosis after extubation (p < 0.05), and experienced a later onset of hydronephrosis compared to the endoscopic treatment group (p < 0.05). CONCLUSIONS: Based on our experience in treating UIAS following RC combined with urinary diversion, laparoscopic reimplantation effectively addresses the issue of UIAS, allowing for the removal of the ureteral stent relatively soon after surgery. This approach maintains long-term ureteral patency, preserves residual renal function, reduces the risk of ureteral restenosis and hydronephrosis, and has demonstrated superior therapeutic outcomes in this study.
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Anastomosis Quirúrgica , Cistectomía , Complicaciones Posoperatorias , Uréter , Derivación Urinaria , Humanos , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Cistectomía/efectos adversos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Constricción Patológica/etiología , Constricción Patológica/cirugía , Anastomosis Quirúrgica/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Uréter/cirugía , Tasa de Filtración Glomerular , Íleon/cirugía , Estudios Retrospectivos , Neoplasias de la Vejiga Urinaria/cirugía , Resultado del Tratamiento , Creatinina/sangre , Laparoscopía/efectos adversos , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiologíaRESUMEN
OBJECTIVE: To identify the factors influencing postoperative ureteral stenosis following holmium laser lithotripsy. METHODS: A retrospective study was conducted of 106 patients who underwent ureteroscopic holmium laser lithotripsy. The effects of variables including stone location, stone size, the duration of surgery, water intake, disease duration, and stone-associated polyps were investigated. RESULTS: Logistic regression analysis revealed significant associations of ureteral stenosis with stone location, stone size, duration of surgery, water intake, disease duration, and stone-associated polyps. Patients with proximal stones, with large stones, who underwent long surgical procedures, who drank a large amount of water, who had long-term disease, and who had stone-related polyps were more likely to develop postoperative ureteral stenosis. CONCLUSION: Significant perioperative complications of holmium laser lithotripsy are associated with prolonged disease, large ureteral stones, long incarceration periods, and the presence of polyps. Surgeons should consider these risk factors during the preoperative evaluation of patients and surgical planning to minimize the risk of postoperative ureteral stenosis.
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Láseres de Estado Sólido , Litotripsia por Láser , Humanos , Masculino , Femenino , Litotripsia por Láser/efectos adversos , Litotripsia por Láser/métodos , Estudios Retrospectivos , Persona de Mediana Edad , Láseres de Estado Sólido/uso terapéutico , Láseres de Estado Sólido/efectos adversos , Adulto , Anciano , Cálculos Ureterales/cirugía , Cálculos Ureterales/terapia , Factores de Riesgo , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Constricción Patológica/etiología , Constricción Patológica/cirugía , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Ureteroscopía/efectos adversos , Ureteroscopía/métodosRESUMEN
Actinomycosis is a rare chronic granulomatous disease characterized by granuloma formation and tissue fibrosis with sinus tracts, often misdiagnosed due to its similarity to many infectious and non-infectious diseases. This report presents a case of a 60-year-old female with more than 10 years history of rheumatoid arthritis who developed actinomycosis infection after long-term treatment with immunosuppressants and biologics, including methotrexate, leflunomide, and infliximab, leading to recurrent joint pain, poorly controlled rheumatoid arthritis activity, and persistent elevation of white blood cell counts. Abdominal CT revealed a pelvic mass and right ureteral dilation. Pathological examination of cervical tissue showed significant neutrophil infiltration and sulfur granules, indicating actinomycosis. The patient received 18 months of doxycycline treatment for the infection and continued rheumatoid arthritis therapy with leflunomide, hydroxychloroquine sulfate, and tofacitinib, resulting in improved joint symptoms and normalized white blood cell counts. After 2 years of follow-up, the patient remained stable with no recurrence. This case highlights the importance of clinicians being vigilant for infections, particularly chronic, occult infections from rare pathogens, in rheumatoid arthritis patients on potent immunosuppressants and biologics, advocating for early screening and diagnosis.
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Actinomicosis , Artritis Reumatoide , Obstrucción Ureteral , Humanos , Femenino , Artritis Reumatoide/complicaciones , Artritis Reumatoide/tratamiento farmacológico , Persona de Mediana Edad , Actinomicosis/diagnóstico , Actinomicosis/complicaciones , Actinomicosis/tratamiento farmacológico , Obstrucción Ureteral/etiología , Inmunosupresores/uso terapéuticoRESUMEN
PURPOSE OF REVIEW: The purpose of this review article is to provide a contemporary overview of benign uretero-enteric anastomotic stricture (UAS) management and outcomes. RECENT FINDINGS: In this article, we will review the most recent studies investigating UAS and evaluate etiology, potential risk factors, presentation, diagnosis, and management options, along with personal insight gained from our experience with managing this challenging reconstructive complication. Benign UAS is a relatively common long-term complication of intestinal urinary diversion, affecting approximately 1 in 10 patients. It is thought to be caused by ureteral tissue ischemia and fibrosis at the anastomotic site. Risk factors appear to include any that increase the likelihood of leak or ischemia; it is not clear if anastomotic approach impacts risk for stricture as well. Management options are varied and include endourologic, open, and robotic approaches. Endoscopic approaches may be less morbid but are considerably less effective than reconstruction performed after a period of ureteral rest.
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Anastomosis Quirúrgica , Uréter , Derivación Urinaria , Humanos , Constricción Patológica/etiología , Constricción Patológica/cirugía , Anastomosis Quirúrgica/efectos adversos , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Uréter/cirugía , Complicaciones Posoperatorias/etiología , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Factores de RiesgoRESUMEN
PURPOSE: High-pressure balloon dilatation (HPBD) of the ureterovesical junction with double-J stenting is a minimally invasive alternative to ureteral reimplantation or cutaneous ureterostomy for first-line surgical treatment of primary obstructive megaureter (POM). The aim of our study was to identify the risk factors associated with the need for secondary procedures due to HPBD failure. METHODS: Prospective data were collected from patients who underwent HPBD for POM between 2007 and 2021 at a single institution. The collected data included patient demographics, diagnostic modalities, surgical details, results, and follow-up. Multivariate logistic regression analysis was performed. RESULTS: Fifty-five ureters underwent HPBD for POM in 50 children, with a median age of 6.4 months (IQR: 4.5-13.8). Nineteen patients (37.25%) underwent secondary ureteric reimplantation, with a median of 9.8 months after primary HBPD (95% CI 6.2-9.9). The median follow-up was 29.4 months (IQR: 17.4-71). Independent risk factors for redo-surgery in a multivariate logistic regression model were: progressive ureterohydronephrosis (OR = 7.8; 95% CI 0.77-78.6) and early removal of the double-J stent. A risk reduction of 7% (95% CI 2.2%-11.4%) was observed per extra-day of catheter maintenance. The optimal cut-off point is 55 days, ROC curve area: 0.77 (95% CI 0.62-0.92). Gender, distal ureteral diameter, pelvis diameter, dilatation balloon diameter and preoperative differential renal function did not affect the need for reimplantation. CONCLUSIONS: The use of a double-J stent for at least 55 days seems to avoid the need for a secondary procedure. Therefore, we recommend removing the double-J catheter at least 2 months after the HBPD.
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Dilatación , Reoperación , Obstrucción Ureteral , Humanos , Masculino , Femenino , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Factores de Riesgo , Lactante , Dilatación/métodos , Factores Protectores , Estudios Prospectivos , Uréter/cirugía , Ureteroscopía/métodos , Stents , Estudios RetrospectivosRESUMEN
This case report describes a male in his late 40s with a 4 cm pelvic mass compressing the left distal ureter, resulting in left hydroureteronephrosis. Biopsy of the mass was suggestive of a solitary fibrous tumour. The patient underwent a robotic-assisted laparoscopic excision of the left pelvic mass. Intraoperatively, the mass was found to be densely adhered to the ureter, necessitating a left distal ureterectomy and ureteric reimplantation. Subsequent histopathological analysis revealed the mass was a solitary fibrous tumour with no evidence of malignancy.
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Laparoscopía , Procedimientos Quirúrgicos Robotizados , Tumores Fibrosos Solitarios , Uréter , Obstrucción Ureteral , Humanos , Masculino , Procedimientos Quirúrgicos Robotizados/métodos , Tumores Fibrosos Solitarios/cirugía , Tumores Fibrosos Solitarios/complicaciones , Tumores Fibrosos Solitarios/patología , Tumores Fibrosos Solitarios/diagnóstico por imagen , Laparoscopía/métodos , Uréter/cirugía , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Adulto , Neoplasias Pélvicas/cirugía , Neoplasias Pélvicas/complicaciones , Neoplasias Pélvicas/patología , Hidronefrosis/etiología , Hidronefrosis/cirugíaRESUMEN
The involvement of kidney, perirenal fat, and ureter is a rare variant of inguinal hernia. We report a case of a 78-year-old man presenting with typical clinical signs of acute appendicitis. Ultrasonography and CT scan revealed ptosis of the right kidney with a major part of the perirenal capsule involved in a large right sided inguinal hernia with acute obstruction of the ureter and urostasis. Acute surgery was performed, involving resection of perirenal fat, liberation, resection, and neoimplantation of the ureter, and hernioplasty. The postoperative period was uneventful. This case illustrates diagnostic unpredictability of acute appendicitis as well as anatomic variety of inguinal hernias.
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Apendicitis , Hernia Inguinal , Humanos , Masculino , Anciano , Hernia Inguinal/cirugía , Hernia Inguinal/diagnóstico , Hernia Inguinal/diagnóstico por imagen , Hernia Inguinal/complicaciones , Diagnóstico Diferencial , Apendicitis/cirugía , Apendicitis/diagnóstico , Enfermedad Aguda , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/diagnóstico por imagenRESUMEN
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.
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Técnica Delphi , Obstrucción Ureteral , Ureteroscopía , Urolitiasis , Humanos , Urolitiasis/cirugía , Factores de Riesgo , Ureteroscopía/efectos adversos , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Constricción Patológica , Complicaciones Posoperatorias/etiología , Enfermedad Iatrogénica , Internacionalidad , ConsensoRESUMEN
OBJECTIVE: To evaluate the safety and effectiveness of endoscopic treatments with Allium® metal ureteric stent (AMUS) for ureteric strictures after kidney transplantation (KT). PATIENTS AND METHODS: In a prospective manner, we gathered clinical data from 68 patients who underwent endoscopic treatments with AMUS for ureteric strictures after KT between January 2019 and March 2022. The definition of surgical success was the unobstructed drainage of the AMUS, or in cases where there was AMUS migration, occlusion or encrustation and subsequently removed, there is no worsening of renal hydronephrosis in the patient during the follow-up period. RESULTS: Based on the specific circumstances of the ureteric strictures, three distinct types of surgery were selected for treatment. The overall success rate of endoscopic treatments for ureteric strictures following KT was 90% (61/68) during a follow-up period of 1 year. Surgical complications included haematuria (18%), pain (10%), urinary tract infections (7.4%), and lower urinary tract symptoms (7.4%). The incidences of stent migration, occlusion, and encrustation were 10%, 2.9%, and 1.5%, respectively. Postoperatively, significant improvements were observed in various parameters. At 1 month after surgery, there was a notable decrease in blood creatinine levels (105.5 vs 90.4 mol/L), urea nitrogen levels (6.6 vs 5.4 mmol/L), and hydronephrosis volume (64.4 vs 43.9 mL). Additionally, the serum estimated glomerular filtration rate increased from 49.5 to 64.4 mL/min/1.73 m2. The follow-up results of patients at 1 year after surgery were similar to those observed at 1 month after surgery. CONCLUSIONS: Systemic endoscopic treatments with AMUS were found to be safe and effective for ureteric strictures after KT with short-term follow-ups. This technique offers a novel option for the treatment of post-KT strictures.
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Trasplante de Riñón , Stents , Obstrucción Ureteral , Humanos , Trasplante de Riñón/efectos adversos , Femenino , Masculino , Persona de Mediana Edad , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Adulto , Estudios Prospectivos , Complicaciones Posoperatorias/etiología , Ureteroscopía/efectos adversos , Ureteroscopía/métodos , Resultado del Tratamiento , Constricción Patológica/cirugía , Constricción Patológica/etiología , AncianoRESUMEN
Previous reports show increased severity of perinephric fat stranding (PFS) with elevated serum creatinine in obstructing ureterolithiasis. We sought to investigate this association with our institution's patient population.We reviewed charts of patients diagnosed with obstructive ureterolithiasis or nephrolithiasis in our emergency department between January and October 2018. Patient demographics, lab results, and computed tomography (CT) imaging were reviewed. A blinded radiologist reviewed all CTs and graded hydronephrosis and PFS. Subjects were stratified by degree of PFS and compared via paired t-test, chi-squared test, univariate analysis, and multivariate analysis.We identified 141 patients; 114 had no-mild (Group 1) PFS, while 27 had moderate-severe (Group 2) PFS. Group 1 had a mean age of 56 (SD = 16.1) and mean stone size of 7.3 mm (SD = 4.22); 77% of the cohort had symptoms under 24 h. Group 2 was older with a mean age of 65 (SD = 16.2, p = 0.01) and mean stone size of 10.1 mm (SD = 6.07, p < 0.01); 50% had symptoms less than 24 h (p = 0.01). PFS did not correlate with change in serum creatinine. Univariate and multivariate analysis showed increasing age increased the odds of moderate-severe PFS by 3.5% (OR = 1.035, p < 0.05) while increased stone size increased the odds of moderate-severe PFS by 13.7% (OR = 1.137, p = 0.01).Although increased PFS correlated with increased age and stone size, no correlation was found with presenting creatinine or change in creatinine. Degree of PFS is likely a poor predictor of renal disease severity in acute ureterolithiasis.
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Creatinina , Humanos , Persona de Mediana Edad , Femenino , Masculino , Creatinina/sangre , Anciano , Estudios Retrospectivos , Factores de Edad , Adulto , Obstrucción Ureteral/sangre , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/etiología , Ureterolitiasis/complicaciones , Ureterolitiasis/sangre , Tomografía Computarizada por Rayos X , Índice de Severidad de la Enfermedad , Tejido Adiposo/diagnóstico por imagen , Tejido Adiposo/patología , Riñón/diagnóstico por imagen , Riñón/patologíaAsunto(s)
Obstrucción Ureteral , Reflujo Vesicoureteral , Humanos , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Reflujo Vesicoureteral/cirugía , Reflujo Vesicoureteral/etiología , Derivación Urinaria/métodos , Estudios de Seguimiento , Resultado del Tratamiento , Preescolar , Uréter/cirugía , Uréter/anomalías , Lactante , Factores de Tiempo , Masculino , Femenino , NiñoRESUMEN
INTRODUCTION: We aimed to investigate the differences in perioperative outcomes, especially ureteroenteric strictures, between patients who underwent a stented ureteroenteric anastomosis at the time of robot-assisted radical cystectomy (RARC) and ileal conduit vs those who did not. METHODS: A retrospective review of our RARC database was performed (2009-2023). Patients were divided into those who received stented ureteroenteric anastomosis vs those who did not. Propensity score matching was performed in the ratio of 3 (stented ureteroenteric anastomosis) to 1 (stent-free) in terms of age, gender, BMI, race, American Society of Anesthesiologists score, neoadjuvant chemotherapy, Charlson Comorbidity Index, prior radiation therapy, previous abdominal surgery history, clinical T3/clinical T4 stage, preoperative metastasis, and preoperative hydronephrosis. A cumulative incidence curve was used to depict ureteroenteric strictures and a Cox regression model was used to identify variables associated with ureteroenteric strictures. RESULTS: Four hundred eighty-eight patients underwent RARC, 366 individuals underwent a stented ureteroenteric anastomosis, and 122 patients underwent a stent-free approach. There was no significant difference in 90-day overall complications, high-grade complications, readmissions, UTIs, leakage, and ileus (P > .05). Ureteroenteric strictures occurred at a rate of 13% and 18% at 1 and 2 years, respectively in the stented group, vs 7% and 10% in the stent-free group (P = .05). Stent placement was significantly associated with ureteroenteric strictures. CONCLUSIONS: Stent-free ureteroenteric anastomosis was associated with fewer strictures following RARC and ileal conduit.
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Anastomosis Quirúrgica , Cistectomía , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Robotizados , Stents , Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Humanos , Masculino , Femenino , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Estudios Retrospectivos , Cistectomía/efectos adversos , Cistectomía/métodos , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Anciano , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/métodos , Stents/efectos adversos , Constricción Patológica/etiología , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Neoplasias de la Vejiga Urinaria/cirugía , Uréter/cirugía , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Íleon/cirugíaRESUMEN
OBJECTIVES: To evaluate the etiology and diagnostic tools for ureteropelvic obstruction in kidney transplant recipients, we investigated the short-term and long-term outcomes of Foley Y-V pyeloplasty. MATERIALS AND METHODS: We retrospectively reviewed 10 patients who underwent kidney transplant followed by additional interventions to treat obstructive ureteral pathologies between 2016 and 2020. We enrolled 4 patients who had received intervention to treat ureteropelvic obstruction. For these 4 patients, serum creatinine and estimated glomerular filtration rate levels were recorded at baseline, during the symptomatic period, and long-term. In this single center study, we investigated diagnostic tools and management strategies for ureteropelvic obstruction and assessed performance of Foley Y-V nondismembered pyeloplasty in kidney transplant recipients. RESULTS: Among 4 patients, graft function (assessed by serum creatinine and estimated glomerular filtration rate) worsened significantly (P = .03) in the symptomatic period of ureteropelvic obstruction in all patients; however, graft function levels improved rapidly to levels similar to baseline (P = .07) after Y-V pyeloplasty. In addition, no statistically significant difference was detected between baseline and longterm graft functions afterY-V pyeloplasty in follow-up (P = .28). CONCLUSIONS: Diagnosis and management of ureteropelvic obstruction in kidney transplant recipients are challenging due to rarity and lack of an ideal management algorithm.There is no specific diagnostic tool to discriminate this pathology from other ureteral pathologies; therefore, a regimen of conventional imaging modalities and diuretic renogram combined with endoscopic evaluation is more reliable. Moreover, nondismembered Foley Y-V pyeloplasty is effective and safe for graft function in the short-term and long-term.
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Tasa de Filtración Glomerular , Trasplante de Riñón , Obstrucción Ureteral , Humanos , Trasplante de Riñón/efectos adversos , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Obstrucción Ureteral/diagnóstico , Estudios Retrospectivos , Resultado del Tratamiento , Masculino , Femenino , Adulto , Factores de Tiempo , Persona de Mediana Edad , Procedimientos Quirúrgicos Urológicos/efectos adversos , Pelvis Renal/cirugía , Recuperación de la Función , Valor Predictivo de las Pruebas , Factores de RiesgoRESUMEN
PURPOSE: To determine the non-contrast computer tomography imaging features of pyonephrosis and evaluate the predictive value of Hounsfield units (HUs) in different hydronephrotic region slices. MATERIALS AND METHODS: We retrospectively reviewed data from patients with hydronephrosis who had renal-ureteral calculi. All patients were categorized into pyonephrosis and simple hydronephrosis groups. Baseline characteristics, the mean HU values in the maximal hydronephrotic region (uHU) slice, and the range of uHU in different slices (ΔuHU) were compared between the two groups. Univariate and multivariate analyses were performed to identify risk factors for pyonephrosis. RESULTS: Among the 181 patients enrolled in the current study, 71 patients (39.2%) were diagnosed with pyonephrosis. The mean dilated pelvis surface areas were comparable between patients with pyonephrosis and simple hydronephrosis (822.61 mm² vs. 877.23 mm², p=0.722). Collecting system debris (p=0.022), a higher uHU (p=0.038), and a higher ΔuHU (p<0.001) were identified as independent risk factors for pyonephrosis based on multivariate analysis. The ΔuHU sensitivity and specificity were 88.7% and 86.4%, respectively, at a cutoff value of 6.56 (p<0.001), whereas the sensitivity and specificity for detecting pyonephrosis at a uHU cutoff value of 7.96 was 50.7% and 70.9%, respectively (p=0.003). CONCLUSIONS: Non-contrast computer tomography was shown to accurately distinguish simple hydronephrosis from pyonephrosis in patients with obstructive uropathy. Evaluation of the ΔuHU in different slices may be more reliable than the uHU acquired from a single slice in predicting pyonephrosis.
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Hidronefrosis , Valor Predictivo de las Pruebas , Pionefrosis , Tomografía Computarizada por Rayos X , Humanos , Pionefrosis/diagnóstico por imagen , Pionefrosis/complicaciones , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Hidronefrosis/diagnóstico por imagen , Hidronefrosis/etiología , Adulto , Anciano , Cálculos Ureterales/complicaciones , Cálculos Ureterales/diagnóstico por imagen , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/etiología , Cálculos Renales/complicaciones , Cálculos Renales/diagnóstico por imagenRESUMEN
INTRODUCTION: Postoperative ureteral strictures and vesicoureteral reflux after ureteroneocystostomy for kidney transplant can be managed by endoscopic procedures like balloon dilation and endoscopic injections. Complicated/recurrent cases, however, are usually managed by reconstructive surgery. We hereby highlight our technique of robotic-assisted native pyeloureterostomy with indocyanine green (ICG). MATERIALS AND SURGICAL TECHNIQUE: A 57-year-old woman, diagnosed with grade 4 vesicoureteral reflux on her transplanted kidney, was considered a candidate for ureteral reimplantation. After an endoscopic part, where the ICG is inserted into the renal pelvis, we proceed with the robotic native pyeloureterostomy. The renal pelvis of the transplanted kidney was identified with the help of the ICG in firefly mode. After the dissection of the graft pelvis, we performed a tension-free pyeloureterostomy using the native ureter. The postoperative course was uneventful and the patient was discharged on the third postoperative day. DISCUSSION: Robotic-assisted pyelo-ureterostomy appears as a safe and efficient technique for management of complicated urological complications postrenal transplantation using the native ureter. Intrapelvic ICG injection, not possible with open surgery, helps identifying the grafted pelvis thus reducing operative time and avoiding unnecessary dissection of the vascular hilum of the graft. Because of minimal dissection and the short operative time, abdominal drainage is unnecessary and the postoperative course is usually uneventful with a fast discharge from the hospital.
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Verde de Indocianina , Trasplante de Riñón , Procedimientos Quirúrgicos Robotizados , Ureterostomía , Humanos , Femenino , Persona de Mediana Edad , Ureterostomía/métodos , Reflujo Vesicoureteral/cirugía , Reflujo Vesicoureteral/etiología , Pelvis Renal/cirugía , Colorantes , Complicaciones Posoperatorias/cirugía , Uréter/cirugía , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiologíaAsunto(s)
Verde de Indocianina , Uréter , Humanos , Uréter/cirugía , Uréter/diagnóstico por imagen , Colorantes , Imagen Óptica/métodos , Espectroscopía Infrarroja Corta , Procedimientos de Cirugía Plástica/métodos , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Constricción Patológica/cirugía , Procedimientos Quirúrgicos Urológicos/métodosRESUMEN
OBJECTIVE: To determine the role of near-infrared fluorescence imaging (NIFI) combined with indocyanine green (ICG) to assess ureteral tissue perfusion in a benign genitourinary reconstruction cohort with a high prevalence of prior abdominopelvic radiation and surgery. MATERIALS AND METHODS: A prospective, single-surgeon series, between June 2018 and April 2022, of patients who underwent open genitourinary reconstructive surgeries in which NIFI/ICG was utilized to intraoperatively assess ureteral tissue perfusion prior to ureteral anastomosis. Primary outcome was ureteroanastomotic stricture (UAS). Secondary outcomes included impact of NIFI/ICG on surgical decision-making and ureter resection length. RESULTS: Thirty nine patients, median age 66, underwent 40 multimodality reconstructive surgeries during which NIFI/ICG was utilized in the open setting. Radiation-induced etiology was present in 32 of 40 (80%) patients. UAS occurred in 1 of 57 (1.8%) anastomoses with median follow-up of 23.4 months. Use of NIFI/ICG changed intraoperative decision-making in 63% of cases. Change in intraoperative decision-making was more common in patients with prior abdominopelvic radiation (66%) compared to non-radiated patients (13%), P = .007. Discordance between subjective (white-light) and objective (NIFI/ICG) ureteral perfusion (white-light) occurred in 61% of ureters. Mean length of resected ureter was higher following objective assessment with NIFI/ICG (3.6 cm) versus subjective assessment (white light) conditions (1.8 cm), P = .001. CONCLUSION: Use of NIFI/ICG was associated with low rates of UAS at 2-year follow-up in a cohort with high prevalence of prior radiation. NIFI/ICG was associated with longer lengths of ureter resection and ureteral perfusion assessment discordance compared to subjective surgeon assessment under white-light conditions.