Upper urinary tract dilation due to conglutination of intraluminal distal ureters after orthotopic neobladder with split-cuff nipple ureteral reimplants: Early results of 8 cases
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The purpose of this article was to evaluate function of lower urinary tract for 5-18 years old children with recurrent urinary tract infections and to compare urodynamic changes in two groups: with recurrent lower urinary tract infections and with recurrent upper urinary tract infections. 35 urodynamic studies in 5-18 years old children (3 boys and 32 girls) with recurrent urinary tract infection were performed at the Clinic of Children's Diseases of Kaunas University of Medicine in 2004. 21 of these children had recurrent lower urinary tract infections and 14 recurrent upper urinary tract infections. Changes in urodynamics were present in 91.4% of children: in all children with recurrent lower urinary tract infections and in 11 children with upper recurrent urinary tract infections (78.6%). Detrusor instability was found in 20 (57.1%) children: in 14 (66,7%) with recurrent lower urinary tract infections and in 6 (42.9%) with recurrent upper urinary tract infections. In 32 (85%) children detrusor instability was accompanied by changes in bladder volume. Changes of bladder volume were present for 26 (74.3%) children with recurrent urinary tract infections. Detrusor after contraction was diagnosed in 57.1% of children with recurrent lower urinary tract infections and in 28.6% with recurrent upper urinary tract infections. For children with recurrent urinary tract infections attention for urinary tract dysfunction must be paid.
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Objectives To compare the oncological outcome between extravesical excision and transurethral excision for bladder cuff management in patients undergoing nephroureterectomy with upper urinary tract urothelial cancer. Methods From J anuary 2005 to D ecember 2010, 396 patients were enrolled in the present retrospective study. Nephroureterectomy was carried out either by endoscopic or extravesical bladder cuff excision. The oncological outcome between these two procedures was analyzed in patients with different tumor locations. Results The average age of the patients was 66.41 ± 10.52 years, and the median follow‐up duration was 40.65 ± 23.84 months. For upper urinary tract urothelial cancer management, extravesical bladder cuff excision was carried out in 240 patients, whereas the endoscopic method was carried out in 156 patients. Previous bladder cancer is still the most independent predictor for bladder recurrence ( P < 0.001). In addition, endoscopic bladder cuff management for low ureteral tumor was also independently associated with more bladder tumor recurrence ( P = 0.017). Non‐organ confined pathological stage still independently predicted metastasis ( P < 0.001) and cancer‐specific death ( P < 0.001). Conclusions There are similar oncological outcomes after nephroureterectomy combined with extravesical or endoscopic bladder cuff management for patients with upper urinary tract urothelial cancer above the low ureter. However, there is a higher incidence of bladder tumor recurrence for the low ureteral tumor after nephroureterectomy with endoscopic bladder cuff excision.
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In 66 urologically normal adults and 73 cases with diseases of upper urinary tract, various examinations were made to clarify the fundamental problems on electro-ureterography-through-cystoscope.The results obtained are as follows:1. Wave pattern of the action potentialA standard wave pattern, which has all of the four deflections, i. e., positive before-potential, negative main potential, negative accessory potential and positive after-potential, was recorded both in the ureter of the normal persons and that of the patients with deseases of the upper urinary tract. In the normal ureter, the action potential was found to travel from the renal pelvis down to the urinary bladder.2. Electro-ureterographic difference between the upper and the lower portions of the ureterNo remarkable difference in discharge interval, amplitude and duration of the action potential was observed between the upper and the lower portions of the ureter. But conduction velocity was found to be faster in the lower portion.Similarity of the discharge interval recorded both in the upper and the lower portions of the ureter showed that all peristalsis was conducted from the upper portion down to the lower portion without fading away on the way.3. Electro-ureterographic difference between the right and the left uretersDischarges of the action potential of the both ureters were not synchronized. However, measured values of the action potential were almost similar in the both ureters.4. Relation between urinary volume and ureteral peristalsisi) Despite of urine volume, the discharge interval was found to be almost the same, when the secretion rate of urine was constant. Alteration of discharge interval was proved to occur, when the secretion rate of urine was changing: The discharge interval shortened when urinary output increased abruptly and the discharge interval prolonged when urinary output was reduced. When the urine volume resumed to be constant, the shortened or prolonged interval gradually returned to the values seen before the alteration of urine output.ii) Showing no relation with secretion rate of urine, conduction velocity of the action potential altered parallel to the alteration of the discharge interval. The amplitude and duration remained almost constant, regardless of the change in urine volume or in the discharge interval.5. Ureteral response to the intravesical infusionWhen the bladder was infused to some degree with a physiologic saline solution, the discharge interval began to shorten. The time lapsed from the onset of the infusion till appearance of the phenomenon became shorter with larger urine output. Further, the phenomenon occurred with small intravesical content as the urine output became larger.6. Normal values in electro-ureterogramTaking 99.8% confidence limits of the values measured in 66 normal adults, the normal ranges of various measurements of the action potential were decided as follows discharge interval 6.0-33.7 sec.; amplitude 0.13-1.02mV; duration 0.2-1.1sec.; conduction velocity 2.0-66.6mm/sec.7. On retrograde peristalsisi) Genetic ways of retrograde peristalsis could be divided into five types: appearance of a retrograde peristalsis in group, appearence of a retrograde peristalsis between consecutive antegrade peristalses, appearance of an antegrade peristalsis between two consecutive retrograde peristalses, appearance of retrograde peristalses only, and alternative appearance of ante- and retrograde peristalses. The frequency of these five types was found to be in the abovementioned order.ii) Transition from antegrade peristalsis to retrograde peristalsis occurred after abnormally longer discharge interval of the former. On the other hand, transition from retrograde peristalsis to antegrade peristalsis occurred after shorter discharge interval, compared to the preceded retrograde peristalsis. In rare occasions, above-mentioned relation became re
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【Objective】To evaluate the value of radical nephroureterectomy by retroperitoneal laparascopy com-bined transurethral cuff excision of ureter on distal ureter carcinoma. 【Method】7 patients,including 5 transitional cell carcinoma of renal pelvis and 2 ureter carcinoma,were underwent nephroureterectomy by retroperitoneal laparascopy combined transurethral cuff excision of ureter.【Results】All the operations were successful. The average operating time was 17 min,and the volume of blood loss during operation was less than 20 mL. The drainage tubes and catheters were removed 2～4 days and 7 days after operation. No leakeage of urine and infection of incisional wound were reported. Cacinoma were verified from patheology result,4G1,3G2,4 T1N0M0,3 T2N0M0. Patients were followed up from 8 to 22 months,no recurrence,metastasis or incisional implant was reported. 【Conclusion】Combined transurethral cuff excision of ureter in radical nephroureterectomy by retroperitoneal laparascopy on distal ureter carcinoma is convenient and fast for the operators and may shorten the learning curve and reduce the positive margin rate or hemorrhea,which is of shorter operating time,smaller wound and lower recurrence rate.
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Abstract The widely held dogma of three physiological narrowings in the upper urinary tract has proven incorrect by recent several studies using computed tomography images. There are only two common obstruction sites: the upper ureter and the ureterovesical junction. The second narrowing, where the ureter crosses the iliac vessels, cannot be regarded anymore as a common obstruction site. The mechanism by which stones lodge in the upper ureter is explained anatomically by the change in ureteral mobility and compliance at the level where the ureter exits the perirenal space. This level can be identified radiologically as the point where the ureter crosses under the ipsilateral gonadal veins, termed the “crossing point”. Kinking of the upper ureter is another manifestation of this anatomical phenomenon, visible in radiological images. It is caused by loosening of the ureter at or above the crossing point (within the perirenal space), corresponding with renal descent such as during the inspiratory phase. This new anatomical discovery in the retroperitoneum will not only bring about a paradigm shift in terms of the physiological narrowings in the upper urinary tract, but may also lead to the development of new surgical concepts and approaches in the area.
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No AccessJournal of UrologyClinical Urology: Original Articles1 Feb 1999A NOVEL TECHNIQUE FOR MANAGEMENT OF THE EN BLOC BLADDER CUFF AND DISTAL URETER DURING LAPAROSCOPIC NEPHROURETERECTOMY INDERBIR S. GILL, JON J. SOBLE, SCOTT D. MILLER, and GYUNG TAK SUNG INDERBIR S. GILLINDERBIR S. GILL More articles by this author , JON J. SOBLEJON J. SOBLE More articles by this author , SCOTT D. MILLERSCOTT D. MILLER More articles by this author , and GYUNG TAK SUNGGYUNG TAK SUNG More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)61913-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The optimal technique of excising the juxtavesical ureter and bladder cuff during laparoscopic nephroureterectomy is still evolving. We report on a novel transvesical needlescopic (2 mm. instrumentation) assisted technique of en bloc retrieval of the juxtavesical ureter and bladder cuff during laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma. Materials and Methods: Retroperitoneal laparoscopic nephroureterectomy was performed in 8 patients using this technique. Two needlescopic ports (2 mm.) inserted suprapubically into the bladder were used in combination with a cystoscopically positioned Collins knife. Results: Satisfactory circumferential detachment of the bladder cuff and en bloc mobilization of 3 to 4 cm. of the intact pelvic extravesical ureter were achieved transvesically in each case in a manner comparable to open surgery. Conclusions: This technique simulates established open surgical principles of treating the distal ureter during laparoscopic nephroureterectomy. References 1 : Laparoscopic nephroureterectomy for upper tract transitional cell cancer: the Washington University experience. J. Urol.1995; 153: 975. Google Scholar 2 : Initial experience with retroperitoneoscopic nephroureterectomy: use of a double-balloon technique. Urology1995; 46: 747. Google Scholar 3 : The technique of transperitoneal laparoscopic nephrectomy, adrenalectomy and nephroureterectomy. Eur. Urol.1993; 23: 425. Google Scholar 4 : Retroperitoneal laparoscopic nephrectomy. Urol. Clin. N. Amer.1998; 25: 343. Google Scholar 5 : Nephro-ureterectomy: a new technique. J. Urol.1952; 67: 804. Link, Google Scholar 6 : Transurethral resection of the intramural ureter as the first step of nephroureterectomy. J. Urol.1995; 154: 43. Link, Google Scholar 7 : Nephroureterectomy. Brit. J. Urol.1987; 59: 99. Google Scholar 8 : Modified nephroureterectomy: a risk of tumor implantation. Brit. J. Urol.1986; 58: 368. Google Scholar 9 : A cautionary tale of the modified “pluck” nephroureterectomy. Brit. J. Urol.1993; 71: 486. Google Scholar 10 : Modified nephro-ureterectomy long-term follow-up with particular reference to subsequent bladder tumors. Brit. J. Urol.1998; 61: 198. Google Scholar 11 : Needlescopic urology: incorporating 2 mm instrumentation in laparoscopic surgery. Urology1998; 52: 187. Google Scholar 12 : Needlescopic adrenalectomy-initial series: comparison with conventional laparoscopic adrenalectomy. Urology1998; 52: 180. Google Scholar From the Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, The Cleveland Clinic Foundation, Cleveland, Ohio, and Perimeter Urology, Atlanta, Georgia(GILL) Requests for reprints: Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, Ohio 44195.© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byAboumohamed A, Krane L and Hemal A (2018) Oncologic Outcomes Following Robot-Assisted Laparoscopic Nephroureterectomy with Bladder Cuff Excision for Upper Tract Urothelial CarcinomaJournal of Urology, VOL. 194, NO. 6, (1561-1566), Online publication date: 1-Dec-2015.Berger A, Haber G, Kamoi K, Aron M, Desai M, Kaouk J and Gill I (2018) Laparoscopic Radical Nephroureterectomy for Upper Tract Transitional Cell Carcinoma: Oncological Outcomes at 7 YearsJournal of Urology, VOL. 180, NO. 3, (849-854), Online publication date: 1-Sep-2008.Ou C and Yang W (2018) Hand Assisted Retroperitoneoscopic Nephroureterectomy With the Patient Spread-Eagled: An Approach Through a Completely Supine PositionJournal of Urology, VOL. 180, NO. 5, (1918-1922), Online publication date: 1-Nov-2008.Kurzer E, Leveillee R and Bird V (2018) Combining Hand Assisted Laparoscopic Nephroureterectomy With Cystoscopic Circumferential Excision of the Distal Ureter Without Primary Closure of the Bladder Cuff—Is it Safe?Journal of Urology, VOL. 175, NO. 1, (63-67), Online publication date: 1-Jan-2006.Ou C, Yang W, Tzai T, Tong Y, Chang C and Lin Y (2018) A Modified Supine Position to Speed Hand Assisted Retroperitoneoscopic Nephroureterectomy: The Johnnie Walker PositionJournal of Urology, VOL. 176, NO. 5, (2063-2067), Online publication date: 1-Nov-2006.MATIN S and GILL I (2018) RECURRENCE AND SURVIVAL FOLLOWING LAPAROSCOPIC RADICAL NEPHROURETERECTOMY WITH VARIOUS FORMS OF BLADDER CUFF CONTROLJournal of Urology, VOL. 173, NO. 2, (395-400), Online publication date: 1-Feb-2005.CHUEH S, CHEN J, HSU W, HSIEH M and LAI M (2018) HAND ASSISTED LAPAROSCOPIC BILATERAL NEPHROURETERECTOMY IN 1 SESSION WITHOUT REPOSITIONING PATIENTS IS FACILITATED BY ALTERNATING INFLATION CUFFSJournal of Urology, VOL. 167, NO. 1, (44-47), Online publication date: 1-Jan-2002.LAGUNA M and de la ROSETTE J (2018) THE ENDOSCOPIC APPROACH TO THE DISTAL URETER IN NEPHROURETERECTOMY FOR UPPER URINARY TRACT TUMORJournal of Urology, VOL. 166, NO. 6, (2017-2022), Online publication date: 1-Dec-2001.GILL I, PONSKY L, DESAI M, KAY R and ROSS J (2018) LAPAROSCOPIC CROSS-TRIGONAL COHEN URETERONEOCYSTOSTOMY: NOVEL TECHNIQUEJournal of Urology, VOL. 166, NO. 5, (1811-1814), Online publication date: 1-Nov-2001.GONZALEZ C, BATLER R, SCHOOR R, HAIRSTON J and NADLER R (2018) A NOVEL ENDOSCOPIC APPROACH TOWARDS RESECTION OF THE DISTAL URETER WITH SURROUNDING BLADDER CUFF DURING HAND ASSISTED LAPAROSCOPIC NEPHROURETERECTOMYJournal of Urology, VOL. 165, NO. 2, (483-485), Online publication date: 1-Feb-2001.GILL I, SUNG G, HOBART M, SAVAGE S, MERANEY A, SCHWEIZER D, KLEIN E and NOVICK A (2018) LAPAROSCOPIC RADICAL NEPHROURETERECTOMY FOR UPPER TRACT TRANSITIONAL CELL CARCINOMA: THE CLEVELAND CLINIC EXPERIENCEJournal of Urology, VOL. 164, NO. 5, (1513-1522), Online publication date: 1-Nov-2000.GILL I, SAVAGE S, SENAGORE A and SUNG G (2018) LAPAROSCOPIC ILEAL URETERJournal of Urology, VOL. 163, NO. 4, (1199-1202), Online publication date: 1-Apr-2000.FAZELI-MATIN S, GILL I, HSU T, SUNG G and NOVICK A (2018) LAPAROSCOPIC RENAL AND ADRENAL SURGERY IN OBESE PATIENTS: COMPARISON TO OPEN SURGERYJournal of Urology, VOL. 162, NO. 3 Part 1, (665-669), Online publication date: 1-Sep-1999. Volume 161Issue 2February 1999Page: 430-434 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information INDERBIR S. GILL More articles by this author JON J. SOBLE More articles by this author SCOTT D. MILLER More articles by this author GYUNG TAK SUNG More articles by this author Expand All Advertisement PDF downloadLoading ...
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Objective: To analyze the causes of failed removal of double J ureteral stents following the operation of upper urinary tract and evaluate the application value of uretroscopy to remove them under urethral mucosae anesthesia.Methods: From Sept.1998 to May 2006,a total of 21 cases of failed removal of double J ureteral stents following the operation of upper urinary tract were treated by the way of uretroscopy under urethral mucosae anesthesia.Results: For the causes of failed removal of double J ureteral stents,3 of the 21 cases related to the genesis of encrusted stone,meanwhile,6 cases were sutured on the upper end of double J ureteral stent,and 9 due to the remove upward the ureter.Another 3 cases could not be placed in bladder for the obstruction of lower ureter.One case of negative stone in lower ureter was replaced with a new double J ureteral stent after removing double J ureteral stent following treatment with transurethral ureteroscopy ballast lithotrity.Two cases with the stricture of lower ureter also were replaced with a new double J ureteral stent after removing.The double J ureteral stents were removed in the other 18 cases successfully.The mean operative time was 3.6 min,without serious complications and cessation of operation because of pain.Conclusion: The keys to avoid the failed removal of double J ureteral stent are the correct operation plan and accurate method to place it and familiarity of the anatomy of urinary tract thoroughly.It's an efficient,safe and convenient treatment to remove them using ureteroscope under urethral mucosae anesthesia.
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S-stents were introduced to the upper urinary tracts of experimental dogs on a period from 1 week to 11 months. It was found mild ureter dilation, the increased ureter pressure, refluxes along the upper urinary tract, the lowered flow resistance during perfusion and diuretic loads. Isolated ureter wall fragments demonstrated the diminished contractility in vitro, and the mode of their contractile force adrenergic regulation was modified. The reduced ureter pressure during large flows after indwelling S-stents to the ureters may be the factor that facilitated the renal and ureter stones removing but the decreased contractility and ureter refluxes emphasized that the period of stent implantation to the upper urinary tracts must be pathogenetically and clinically evident.
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Upper urinary tract
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Megaureter
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