The outcomes of isolated ureteral resection and reconstruction in non-urologic cancer patients who underwent cytoreductive surgery (CRC) and hyperthermic intraperitoneal chemotherapy (HIPEC)

Background Urinary system resections are performed during the cytoreductive surgery with hypertermic intraperitoneal chemotherapy (CRS-HIPEC). However, isolated ureter resection and reconstruction results are uncertain. The aim of this study was to evaluate the postoperative outcomes of isolated ureteral resection and reconstructions in patients who underwent CRC and HIPEC procedure. Methods A total of 257 patients that underwent CRC and HIPEC between 2015 and 2017 in the Department of Surgical Oncology, Faculty of Medicine, Ankara University, were retrospectively analyzed. Twenty patients that had undergone isolated ureteral resection and reconstruction were included in the study. Predisposing factors were investigated in patients who developed postoperative complications. Results The mean age of the patients was 55.1 years. The mean follow-up time of all the patients was 11.6 months. Postoperative mortality occurred in two patients. The mean PCI score was 13.9. Postoperative urologic complications were observed in eight patients after ureter reconstruction. There was no statistically significant difference between the groups in terms of reconstruction techniques and postoperative complications (P = 302). There was no correlation between age (P = 0.571) and gender (P = 0.161) with complications. CRS-HIPEC was performed mostly due to gynecologic malignancy. However, there was no correlation between the primary cancer diagnosis and the development of complications (P = 0.514). The hospital stay duration was higher in the group with complications (16.3 vs 8.8 days, P = 0.208). Conclusions Ureteral resections and reconstructions can be performed for R0/1 resections in CRS-HIPEC operations. It leads to an increase in hospital stay. But there is no significant difference in the development of complications. In the management of complications, conservative approach was sufficient.

Kidney auto-transplantation due to upper and middle ureter defect after ureteroscopy injury

Introduction. Surgery complications during and after ureteroscopic procedures are rare, mostly temporary and require no special additional procedures. However, major complications, nevertheless their small incidence (less than 1?2%), can be very serious and they include ureter perforation and avulsion. Case report. We represented a patient with complicated ureter iatrogenic stenosis developed after ureteroscopic procedure of stone removal. After several hospitalizations, septic condition with retroperitoneal abscess and an attempt of endoscopic and open surgical solution, the kidney auto-transplantation was successfully done. Conclusion. There are a small number of complications with ureteroscopic procedures, but when ureter avulsion or perforation occurs, and when the mission is to preserve pair organs, kidney auto-transplantation has the advantage over other methods of ureter reconstruction.