Robot-assisted pyeloplasty with buccal mucosa graft for the management of an extended recurrent ureteropelvic junction stricture

A clinical case of robot-assisted pyeloplasty with buccal mucosa graft of an extended recurrent stricture of the left ureteropelvic junction is presented. The patient had previously undergone left-sided laparoscopic antevasal pyeloplasty and retrograde endopyelotomies with ureteral stenting. However, after these interventions, the dilatation of the left pelvicalyceal system persisted, the patient complained of lumbar pain and periodic exacerbations of chronic pyelonephritis. Transperitoneal robotic access isolated the ureteral upper third and the ureteropelvic junction from scar tissue, after dissecting the narrowed ureteral section, its length was about 3.0 cm. In this regard, plastic surgery was performed with a buccal mucosa graft, the ureter was drained with a stent. There were no postoperative complications, and on day 3 the patient was discharged. The stent was removed 4 weeks after. During the control ultrasound examination, the renal pelvicalyceal system was relatively reduced, and the patient did not notice any pain.

Safety and Clinical Value of Prophylactic Ureteral Stenting Before Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy

Background Prophylactic ureteral stents (PUS) are typically placed prior to complex abdominal or pelvic operations at the surgeon’s discretion to help facilitate detection of iatrogenic ureteral injury. However, its usefulness and safety in the setting of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) have not been examined. This study aims to evaluate the potential clinical value and risk profile of prophylactic ureteral stent placement prior to CRS-HIPEC. Methods We performed a single-institutional retrospective analysis of 145 patients who underwent CRS-HIPEC from 2013 to 2021. Demographic and operative characteristics were compared between patients who underwent PUS placement and those that did not. Ureteral stent–related complications were evaluated. Results Of the 145 patients included in the analysis, 124 underwent PUS placement. There were no significant differences in patient demographics, medical comorbidities, or tumor characteristics. Additionally, PUS placement did not significantly increase operative time and was not associated with increased pelvic organ resection. However, patients who underwent prophylactic ureteral stenting had significantly higher peritoneal carcinomatosis index score (15.1 vs 9.1, P =.002) and increased rate of ureteral complications (24.2% vs 14.3%, P =.04), which led to lengthened hospital stay (13.2 days vs 8.1 days, P = .03). Notably, the sole ureteral injury and three cases of hydronephrosis were seen in patients who underwent PUS. Conclusion Prophylactic ureteral stent placement in patients undergoing CRS-HIPEC may be useful, particularly in patients with predetermined extensive pelvic disease. However, PUS placement is not without potential morbidity and should be selectively considered in patients for whom benefits outweigh the risks.

Is JJ Ureteral Stenting Inferior to Percutaneous Nephrostomy as a Drainage Method in Emphysematous Pyelonephritis?

<b><i>Introduction:</i></b> The aim of the study was to examine the efficacy of JJ stenting in comparison with percutaneous nephrostomy (PCN) as a drainage method in patients with emphysematous pyelonephritis (EPN). <b><i>Methods:</i></b> We retrospectively identified patients with EPN between January 2000 and January 2021. Platelet-to-leukocytic ratio (PLR) at the time of hospital admission and discharge, time taken to clear air locules and to normalize leukocytic count, and air locule volume in mm³ were identified. Renal drainage by either PCN or JJ stent was required if symptoms persist for ≥3 days or in obstructed renal units. Failure of drainage method was defined as conversion to another method of drainage, need for intensive care unit admission, salvage nephrectomy, and mortality. <b><i>Results:</i></b> Twenty-nine patients were managed by JJ stent. Treatment success was identified in 20 patients and 19 patients who were managed by PCN and JJ stent, respectively. Higher air locule volume ≥16.7 mm³ and lower PLR ≤18.4 increased the risk of drainage failure (<i>p</i> = 0.009 and 0.001, respectively). <b><i>Conclusion:</i></b> Ureteral JJ stenting is an effective method for EPN drainage with a comparable overall success to the PCN use. Higher air locule volume and lower PLR increased the risk of drainage failure.

Urosepsis secondary to ureterosciatic hernia corrected with ureteral stent placement: a case report and literature review

Background Ureterosciatic hernia is a rare type of pelvic floor herniation that occurs through the sciatic foramen. The resulting ureteral obstruction may lead to hydronephrosis and to further complications including urinary tract infection and urosepsis. There have been 30 reported cases of ureterosciatic hernia. Ureteral stenting and surgical repair have been used as treatment options. Case presentation We report the case of an 86-year-old woman who was transferred to Tokyo Metropolitan Bokutoh Hospital with symptoms of fever and septic shock. Her computed tomography scan revealed left hydronephrosis and deviation of the left ureter into the sciatic foramen; she was therefore diagnosed with a left ureteral sciatic hernia and admitted in our intensive care unit for further treatment with resuscitative fluids, vasopressors, and antibiotics. Following a retrograde insertion ureteral catheter insertion, ureteral incarceration was relieved, and a double-J ureteral stent was placed in situ. Antibiotic treatment was initiated, and the patient’s hemodynamic status gradually improved. Conclusions Although ureterosciatic hernia is a rare disorder, it is associated with serious complications including urinary tract infection with sepsis, which may warrant urgent corrective procedure to relieve the structural obstruction. Treatment may be conservative or surgical, though treatment with ureteral stent placement may be a favorable approach in elderly patients with multiple comorbidities presenting with urosepsis.

Xanthogranulomatous pyelonephritis infected with the Providencia stuartii: a case report and literature review

Background Xanthogranulomatous pyelonephritis (XGP) is a rare and severe chronic inflammatory disease of the renal parenchyma, which is most commonly associated with super-infections by bacteria such as E. coli, Proteus mirabilis, and occasionally Pseudomonas species. Case presentation Herein, we present a rare case of a patient with XGP infected with Providencia stuartii. Initially, the patient refused nephrectomy and underwent holmium laser lithotripsy and right ureteral stenting, followed by meropenem treatment of 7 days. Relapse occurred in the third month after discharge from the hospital, due to which she underwent a radical nephrectomy. Discussion The diagnosis of XGP is confirmed by histopathology. The standard treatment for XGP is antibiotic therapy and radical nephrectomy, but partial nephrectomy may be appropriate in select cases.

Analysis of Use of Percutaneous Nephrostomy and Ureteral Stenting in Management of Ureteral Obstruction

Introduction and objectives: The basic aim of the study is to analyze the use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction. Methodology of the study: This cross sectional study was conducted at Department of Urology, UCM, University of Lahore during January 2019 to October 2019. This study was done with the permission of ethical committee of hospital. There were 110 patients who selected for this study analysis. Enrollment criteria consisted of the need for unilateral or bilateral upper urinary tract diversion for at least 6 months. Either a PCN tube or an internal ureteral stent (e.g., double-J stent) was used for ureteral obstructions of various etiologies. Results: There were 110 patients with mean age 60 years in this study. There were 66 patients with ureteral stents and 44 (40%) with PCN tubes. A smaller elevation in serum creatinine was noted in the PCN group (0.21 vs. 0.78 mg/dL, p = 0.03). Nine of 86 (10.4%) double-J stents were converted to PCN tubes during the study period. Residual hydronephrosis after decompression was more common in the stent group than in the PCN group (65.2% vs. 27.2%, p = 0.01). Conclusion: It is concluded that Urinary diversion or decompression using PCN produced better preservation of renal function and lower incidences of complications in our study. Key words: PCN, Hydronephrosis, Urinary, Renal, Function

Optimization of laparoscopic ureteral repair with a buccal graft in case of its extended strictures and obliterations

Purpose of the study. Currently, laparoscopic technique has become widely used in the treatment of extended strictures and obliterations of the ureter. The use of minimally invasive approaches will also be relevant for such a relatively new operation as buccal ureteroplasty. In the literature, there are isolated publications devoted to this technique. The aim of this study was to study the results of our own experience of laparoscopic ureteral reconstruction using a buccal graft.Patients and methods. We observed 5 patients – 2 men and 3 women, at the age of 30–62 years. All patients have already been operated on the urinary tract, of these, in four patients, the urinary tract was drained with a nephrostomy or internal ureteral stent. Two patients underwent replacement ureteroplasty with tubularized buccal graft, and three patients underwent augmentation ureteroplasty with buccal graft using the onlay method.Results. All operations in this group were carried out without conversions. The average length of the ureteral defect was 4.9 cm (4.0–6.0 cm). The patients did not have severe complications in the postoperative period according to the ClavienDindo classification. One patient underwent treatment for exacerbation of chronic pancreatitis; one man experienced ureteral stent migration, which required restentation. The follow-up period was 1–15 months; one woman developed unextended ureteral restenosis, which was eliminated by endoureterotomy and ureteral stenting. At the moment, all patients are spared from permanent urinary drains, they do not have upper urinary tract obstruction. Conclusion. All operations in this group were carried out without conversions. The average length of the ureteral defect was 4.9 cm (4.0–6.0 cm). The patients did not have severe complications in the postoperative period according to the Clavien-Dindo classification. One patient underwent treatment for exacerbation of chronic pancreatitis; one man experienced ureteral stent migration, which required restentation. The observation period for the patients was 1–15 months, one woman developed short ureteral restenosis, which was eliminated by endoureterotomy and ureteral stenting. At the moment, all patients do not have permanent urinary drains, violations of the urodynamics of the upper urinary tract were not revealed in them.