AI Summary & Key Takeaways
AI InsightConclusions: Laparoscopic management of ureteral pathologies is a promising option and can be applied effectively in the management ureteral strictures refractory to endoscopic treatment alternatives.
📌 3 Key Takeaways
Abstract
Introduction: Laparoscopic management of ureteric pathologies such as vesicoureteral reflux, retroperitoneal fibrosis, ureteropelvic obstruction has been proved to be highly effective. We evaluated the role of laparoscopy in the management of distal ureteral strictures refractory to endoscopic treatment. We describe the laparoscopic technique and present our initial experience in regard to feasibility, safety and short-term results. Materials and Methods: Between August 2003 and May 2005, nine patients, with a history of failed endoscopic management of urethral strictures, underwent laparoscopic surgery. There were 2 men and 7 women. Their median age was 55.5 (23-78) years. Patients were preoperatively evaluated with excretory urography, ultrasonography, retrograde ureterography, and computerized tomography. The stricture was located on the right ureter in 7 and on the left side in 2 patients. The etiologies of ureteral strictures were ureteroscopic laser therapy for ureteral tumor (n: 1), recurrent stone disease with endoscopic stone manipulations (n: 1), retroperitoneal fibrosis (n: 1), chronic appendicitis (n: 1), iatrogenic ureteral injury during pelvic operations (n: 2), pelvic radiotherapy (n: 1), chronic infection (n: 1) and retrocaval ureter (n: 1). Obstruction site was distal ureter in 7 patients and abdominal ureter in two patients. Obstructed ureter length varied from 2 to 6 cm and median stricture length was 3.0 cm. For temporary relief of obstruction two patients had a percutaneous nephrostomy catheter and seven patients had pig-tail stent. Results: Laparoscopic reconstructive ureteral surgery, including psoas hitch with Boari flap ureteroneocystotomy in 3 patients, psoas hitch ureteroneocystotomy in 5 patients, and ureteroureterostomy in one patient, was performed without need for open conversion. No intraoperative complication was observed. Postoperatively, prolonged ileus, that resolved spontaneously, was encountered in one patient. Median operation time was 197 (range: 75-228) minutes. The average blood loss was 263 cc (range: 140-450). Oral intake and ambulation started at the second day postoperatively. After a mean follow-up of 11 (range: 7-12) months, radiological imaging studies showed a good relief of obstruction or no hydronephrosis. No recurrence was observed. No patient complained of pain, urinary tract infections or obstruction during this follow-up. Conclusions: Laparoscopic management of ureteral pathologies is a promising option and can be applied effectively in the management ureteral strictures refractory to endoscopic treatment alternatives.
Özet
Günümüzde laparoskopik cerrahi üreteropelvik bileşke darlığı, üreter taşları, retroperitoneal fibrozis tedavisinde başarı ile uygulanmaktadır. Çalışmamızda, endoskopik tedaviden fayda bulmayan üreter darlıklarının tedavisinde laparoskopinin yerini ve güvenirliğini araştırdık, kısa dönemdeki ilk deneyimlerimizi bildirdik. Kliniğimizde Ağustos 2003 ve Mayıs 2005 tarihleri arasında, üreter darlığının daha önceki endoskopik tedavisi başarısız olmuş, ortalama yaşı 55,5 (23-78) olan, dokuz hasta (2 erkek, 7 kadın) laparoskopik olarak ameliyat edildi. Darlık, 7 hastada sağ üreterde, 2 hastada ise sol üreterdeydi. Hastalar ameliyat öncesi intravenöz ürogafi, retrograd üretero-piyelografi, ultrasonografi ve bilgisayarlı tomografi ile incelendi. Hastaların 3'üne psoas hitch ve Boari flap üreteroneosistosomi, 5'ine psoas hitch üreteroneosistosomi ve 1'ine üreteroüreterostomi yapıldı. Tüm hastalarda laparoskopik üreter onarımı açık cerrahiye geçilmeden tamamlanabildi. Ortalama ameliyat süresi 197 (75-228) dakika ve ortalama kan kaybı 263 (140-450) cc olarak kaydedildi. Ameliyat sırasında istenmeyen yan etki gözlenmedi. Ameliyat sonrası bir olguda uzun süren bir ileus tablosu görüldü. Hastalar ameliyat sonrası ikinci günde mobilize edilerek ağızdan besin alınımına geçildi. Ameliyat sonrası ortalama 11 aylık takip süresi sonrası hastalarda ağrı ve enfeksiyon saptanmadı. Yapılan radyolojik kontrollerde obstrüksiyon bulgusu saptanmadı. Üreter patolojilerinin laparoskopik tedavisinin ilk sonuçlarının umut verici olduğu görülmektedir. Bulgularımız endoskopik tedavinin başarısız olduğu üreter darlıklarında da laparoskopinin başarı ile uygulanabileceğini göstermektedir.