Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cysts: What we learned and a review of the literature

PURPOSE: To avoid Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cyst (diameter > 70 mm), we present two cases of iatrogenic ureteral injury and discuss their clinical courses and final outcomes. PATIENTS AND METHODS: Two male patients (47 years old and 74 years old) with large left simple renal cysts underwent a retroperitoneal laparoscopic operation to treat the cysts. In the first patient, the left proximal ureter was partially transected (Grade 3) during the operation. The injury was identified intraoperatively. The transection was managed with a primary ureteroureterostomy (end to end) along with a double J ureteral stent. In the second patient, the left proximalureter was partially transected (Grade 4). However, the injury was unrecognized postoperatively for two days. After recognition of the complication, the injury was managed with an early primary ureteroureterostomy, which followed a failed attempt to place ureteral stent endoscopically. RESULTS: In the first patient, a postoperative urinary leakage developed and lasted for 13 days. During long term follow-up of the first patient after the urine leak resolved, there were no reports of pain in the lumbar region or other discomfort. No recurrence of the renal cyst occurred, which was confirmed with an ultrasound at one year postoperatively. In the second patient a ureteral fistula and severe perirenal infection occurred and lasted for 86 days. The patient ultimately underwent a left nephrectomy after conservative management for this surgical complication failed. This patient developed a chronic wound infection that lasted for 3.14 months following the nephrectomy. During follow-up post nephrectomy, the patient developed stage 3B moderate chronic kidney disease (CKD) (GFR = 30 –44 ml/min). CONCLUSIONS: For single large (diameter > 70 mm) renal cysts located at the lower pole of the kidney, it is recommended to not completely dissect out and mobilize the entire renal cyst for cyst decortication in order to avoid injuring the ureter. Iatrogenic ureteral injury increases the risk of readmission and serious life-threatening complications. The immediate diagnosis and proper management ureteric injury can reduce complications and long term sequalae.

A Clinical Control Study on the Retroperitoneal Laparoscopy for Unilateral Simple Renal Cyst Decortication in Day Surgery Mode

Background: Under the constraints of the increasingly tight medical environment and cost, day surgery mode has become a favorable trend and attracts attention from clinicians. Currently, there are no standards or procedures on the retroperitoneal laparoscopy for unilateral simple renal cyst decortication in day surgery mode. We attempted to investigate the feasibility and safety criteria of unilateral simple renal cyst decortication by retroperitoneal laparoscopy in the day surgery ward and to compare the advantages and the disadvantages with conventional inpatient ward mode.Methods: A total of 41 patients with unilateral simple renal cysts meeting surgical indications were enrolled in this study. To see whether patients in the day group could successfully complete the procedure and be admitted and discharged within 24 hours and to summarize the advantages and the advantages. The indexes of the operation time, time of hospitalization, postoperative complication rate, total costs of hospitalization and other indicators were compared between the two groups.Results: 41 cases of unilateral simple renal cyst decortication were completed successfully. Patients were followed up 10-12 months after surgery. The results of time of hospitalization, total costs of hospitalization and time of postoperative removal of drainage tube were statistically significant between the two groups of the day ward group and the inpatient ward group (P <0.05). Conclusions: We concluded the retroperitoneal laparoscopy for unilateral simple renal cyst decortication in patients with unilateral renal cysts was safe and feasible in day surgery mode under certain indicative criteria. The criteria included patients’ age between 40 and 80 years, no previous history of abdominal surgery, CT showing a unilateral renal cyst (Bosniak I or II), preoperative ASA assessment was I or II, no contraindications to surgery or anesthesia, postoperative team management and discharge assessment. Advantage of reducing time of hospitalization and total medical cost may relieve the situation of the shortage of medical resources.

Results of laparoscopic retroperitoneal nephrectomy for benign nonfunction kidneys at Ninh Binh General Hospital

Introduction: Evaluating the result of laparoscopic retroperitoneal nephrectomy for benign nonfunctioning pathology at Ninh Binh General Hospital. Materials and Methods: 20 patients underwent laparoscopic nephrectomy surgery from 08/2016 - 03/2020 at Ninh Binh General Hospital, research with descriptive and prospective method. Results: The average operating time is 100,25 ± 22 minutes (80 - 180 minutes), the average amount of blood loss is 61,5 ± 26,6ml (30 - 100ml), the average amount of drain removal time is 2,5 ± 0,5 day (2 - 3 days), the time of taking analgesic is 3 days, the average amount of time for treatment in the hospital is 4,25 ± 1,1 days (3 - 6 days). During the operations, there is 1 case in which renal abscess and kidney inflammation occur. Therefore, it's difficult to carry out the umbilicus dissection and have to switch to kidney – removal open surgery. There are no adverse medical events or complications after the surgery. Conclusions: Laparoscopic retroperitoneal surgery in kidney removal due to nonfunctioning benign pathology is a safe and effective treatment method. Keywords: Laparoscopic nephrectomy, retroperitoneal laparoscopy.

Percutaneous nephrolithotomy and retroperitoneal laparoscopy in treatment of retrocaval ureter with right renal and ureteral calculi: a case report

Retrocaval ureter is a rare disease associated with abnormal embryonic development. Here, we describe a patient who exhibited retrocaval ureter complicated by renal and ureteral calculi, which were treated by percutaneous nephrolithotomy combined with retroperitoneal laparoscopy. A 64-year-old man was admitted to our hospital because of intermittent back pain that had been present for more than 10 years. During hospitalization, he was diagnosed with retrocaval ureter, right renal calculi, and right ureteral calculi with right hydronephrosis; he underwent percutaneous nephrolithotomy combined with retroperitoneal laparoscopic surgery. After the operation, his condition was stable and he exhibited good recovery. Our findings in this case suggest that percutaneous nephrolithotomy combined with retroperitoneal laparoscopy is a suitable option for the treatment of retrocaval ureter with renal and ureteral calculi.

A Clinical Control Study on the Retroperitoneal Laparoscopy for Unilateral Simple Renal Cyst Decortication in the Day Ward

BackgroundUnder the constraints of the increasingly tight medical environment and market economy, day surgery has a good development trend and attracts more and more attention from clinicians. To investigate the feasibility and safety of unilateral simple renal cyst decortication by retroperitoneal laparoscopy in the day ward and to compare the advantages and disadvantages of conventional inpatient ward.MethodsA total of 41 patients with unilateral simple renal cysts meeting surgical indications were included in this study. The patients were divided into the day ward group and inpatient ward group by the patients' wishes. The indexes of operation time, time of hospitalization, intraoperative blood loss, time of postoperative extubation, postoperative complication rate, patients’ satisfaction rate, quality of life scores and total costs of hospitalization were compared between the two groups.Results41 cases of unilateral simple renal cyst decortication were completed successfully. Patients were followed up 10–12 months after surgery. CT or b-ultrasound examination indicated that the original renal cyst had been decorticated surgically and no recurrence of the cyst was observed after 10 months of postoperative follow-up. Time of postoperative extubation were (9.7 ± 1.8) hours and (20.8 ± 5.5) hours, total hospitalization costs were (5790 ± 99.8) RMB and (7496 ± 120.6) RMB, time of hospitalization were (22.7 ± 1.4) hours and (46.4 ± 11.3) hours in the day ward group and the inpatient ward group, respectively. In the above three aspects, the differences between the two groups were statistically significant (P < 0.05).ConclusionIn this study, we concluded that the retroperitoneal laparoscopy for unilateral simple renal cyst decortication in patients aged between 48 and 80 years, with no previous history of abdominal surgery, unilateral renal cysts (Bosniak grades I or II) on CT, ASA grades I or II, and no surgical or anesthetic contraindications, was safe and feasible in the day ward. Its obvious advantages of reducing time of hospitalization and total costs of hospitalization were worthy of clinical promotion.