Laparoscopic substitution of the right ureter by appendix onlay
- Authors: Guliev B.G.1,2, Komyakov B.K.1, Avazkhanov Z.P.1,2, Abdurahmanov O.S.2
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Affiliations:
- Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov (Head of Department – prof. Komyakov B.K.)
- Center of Urology with robot-assisted surgery of City Mariinsky hospital (Chief – prof. A.A. Zavrajnov)
- Issue: No 4 (2023)
- Pages: 12-18
- Section: Original Articles
- URL: https://journals.eco-vector.com/1728-2985/article/view/585716
- DOI: https://doi.org/10.18565/urology.2023.4.12-18
- ID: 585716
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Abstract
Introduction. In highly-selected patients with long narrowing of the middle and upper third of the right ureter, ureteroplasty with an appendix can be performed. In the literature, publications on the possibility of ureteroplasty onlay with a detubularized appendix have been appeared.
Aim. To study the results of laparoscopic ureteroplasty of the right ureter using appendix as onlay flap.
Materials and methods. In the Center of Urology of Mariinsky hospital, 5 patients (2 men and 3 women) with a long stricture of the middle or upper third of the right ureter underwent right-side ureteroplasty using appendix as onlay flap. The mean age of the patients was 42.5 years. In 4 cases, the stricture developed after ureteroscopy with lithotripsy, while in 1 patient, laparoscopic ureterolysis was previously performed. Three patients were admitted with nephrostomy tube, two with a ureteral stent. The average length of the stricture was 3.5 (2.8–5.2) cm. The ureteral stricture was visualized by laparoscopic access, dissected along its length and replaced with a detubularized appendix as onlay flap.
Results. The average procedure time was 225 (180–260) min, the volume of blood loss was 160 (70–245) ml, and the hospital stay was 3.6 (3–7) days. There were no intraoperative complications. In the postoperative period, fever was observed in one patient, and ileus, which resolved spontaneously, developed in another patient. With an average follow-up period of 13.5 (6.2–24.4) months, the procedure was effective in all cases. The urodynamics of the upper urinary tract recovered completely in 3 patients and improved in 2 cases. Pain disappeared in all patients. It was possible to remove external and internal drainage in all cases.
Conclusion. In patients with long strictures of the middle and proximal parts of the right ureter, laparoscopic ureteroplasty using the appendix as onlay flap may be the method of choice. This procedure is less traumatic and has a low complication rate.
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About the authors
B. G. Guliev
Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov (Head of Department – prof. Komyakov B.K.); Center of Urology with robot-assisted surgery of City Mariinsky hospital (Chief – prof. A.A. Zavrajnov)
Author for correspondence.
Email: gulievbg@mail.ru
ORCID iD: 0000-0002-2359-6973
Ph.D., MD, professor, Head of Center of Urology with robot-assisted surgery of City Mariinsky hospital, professor at the Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov
Russian Federation, Saint Petersburg; Saint PetersburgB. K. Komyakov
Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov (Head of Department – prof. Komyakov B.K.)
Email: komyakovbk@mail.ru
ORCID iD: 0000-0002-8606-9791
Ph.D., MD, professor, Head of the Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov
Russian Federation, Saint PetersburgZh. P. Avazkhanov
Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov (Head of Department – prof. Komyakov B.K.); Center of Urology with robot-assisted surgery of City Mariinsky hospital (Chief – prof. A.A. Zavrajnov)
Email: professor-can@mai.ru
Ph.D. student of the Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, urologist at the Center of Urology with robot-assisted surgery of City Mariinsky hospital
Russian Federation, Saint Petersburg; Saint PetersburgO. S. Abdurahmanov
Center of Urology with robot-assisted surgery of City Mariinsky hospital (Chief – prof. A.A. Zavrajnov)
Email: ovshen_19@mail.ru
ORCID iD: 0009-0002-0350-3538
urologist at the Center of Urology with robot-assisted surgery of City Mariinsky hospital
Russian Federation, Saint PetersburgReferences
- Komyakov B.K., Al-Attar T.H., Guliev B.G. Intestinal and appendicular plastic surgery of the ureter. Urologiia. 2021;2:14–20. Russian (Комяков Б.К., Аль-Аттар Т.Х., Гулиев Б.Г. Кишечная и аппендикулярная пластика мочеточника. Урология. 2021;2:14–20). doi: 10.18565/urology.2021.2.14–20.
- Komyakov B., Ochelenko V., Guliev B., Shevnin M. Ureteral substitution with appendix. Int. J Urol. 2020;27(8):663–669. doi: 10.1111/iju.14268.
- Lee Z., Lee M., Koster H., Cheng N. Collaborative of reconstructive robotic ureteral surgery. A multi-institutional experience with robotic ureteroplasty with buccal mucosa graft: an updated analysis of intermediate-term outcomes. Urology. 2021;147:306–310. doi: 10.1016/j.urology.2020.08.003.
- Guliev B.G., Komyakov B.K., Avazkhanov J.P. Laparoscopic buccal plasty of the proximal ureter. Urology. 2021;3:13–19. Russian (Гулиев Б.Г., Комяков Б.К., Авазханов Ж.П. Лапароскопическая буккальная пластика проксимального отдела мочеточника. Урология. 2021;3:13–19). doi: 10.18565/urology.2021.3.13-19.
- Yang K., Fan S., Wang J., Yin L., Li Z. et al. Robotic-assisted lingual mucosal graft ureteroplasty for the repair of complex ureteral strictures: technique description and the medium-term outcome. Eur Urol. 2022;81:533–540. doi: 10.1016/j.eururo.2022.01.007.
- Guliev B.G., Komyakov B., Avazkhanov Zh., Shevnin M., Talyshinskii A. Laparoscopic ventral onlay ureteroplasty with buccal mucosa graft for complex proximal ureteral strictures. Int. Braz. J Urol. 2023;49(5):619–627. doi: 10.1590/S1677-5538.IBJU.2023.0170.
- Reggio E., Richstone L., Okeke Z., Kavoussi L.R. Laparoscopic ureteroplasty using onlay appendix graft. Urology. 2009;73(4):7–10. doi: 10.1016/j.urology.2008.06.034.
- Duty B.D., Kreshover J.E., Richstone L., Kavoussi L.R. Review of appendiceal onlay flap in the management of complex ureteric strictures in six patients. BJU Int. 2015;115(2):282–287. doi: 10.1111/bju.12651.
- Wang J., Xiong S., Fan S. et al. Appendiceal onlay flap ureteroplasty for the treatment of complex ureteral strictures: initial experience of nine patients. J Endourol. 2020;34(8):874–881. doi: 10.1089/end.2020.0176.
- Cheng S., Fan S., Wang L. et al. Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: oir experience and strategy. Int Urol. Nephrol. 2021;53(3):479–488. doi: 10.1007/s11255-020-02679-5.
- Jun M.S., Stair S., Xu A., Lee Z., Asghar A.M. et al. A multi-institutional experience with robotic appendiceal ureteroplasty. Urology. 2020;145:287–291. doi: 10.1016/j.urology.2020.06.062.
- Somerville J.J., Naude J.H. Segmental ureteric replacement: an animal study using a free non-pedicled graft. Urol Res. 1984;12(2):115–119. doi: 10.1007/bf00257176
- Naude J.H. Buccal mucosal grafts in the treatment of ureteric lesions. BJU Int. 1999;83(7):751–754. doi: 10.1046/j.1464-410x.1999.00019.x.
- Lee Z., Waldorf B.T., Cho E.Y., et al. Robotic ureteroplasty with buccal mucosa graft for the management of complex ureteral strictures. J Urol. 2017;198(6):1430–1435. doi: 10.1016/j.juro.2017.06.097.
- Zhao L.C., Weinberg A., Lee Z. et al. Robotic ureteral reconstruction using buccal mucosa graft: a multi-institutional experience. Eur Urol. 2018;73:419–426. doi: 10.1016/j.eururo.2017.11.05.
- Guliev B.G., Ilyin D.M., Avazkhanov Z.P. Robot-assisted pyeloplasty with buccal mucosa graft for the management of an extended recurrent ureteropelvic junction stricture. Urology Herald. 2021;9(4):122–126. (In Russ.) https://doi.org/10.21886/2308-6424-2021-9-4-122-126. Russian (Гулиев Б.Г., Ильин Д.М., Авазханов Ж.П. Робот-ассистированная буккальная пластика протяженной рецидивной стриктуры пиелоуретерального сегмента левой почки. Вестник урологии. 2021;4:122–126. doi: 10.21886/2308-6424-2021-9-4-122-126).
- Wang J., Li Z., Fan S., Xiong S., Meng C. et al. Robotic ureteroplasty with appendiceal onlay flap: an update on the outcomes of 18-month follow up. Transl Androl. Urol. 2022;11(1):20–29. doi: 10.21037/tau-21-840.
- Gabrielson A., Li O., Cohen A.J. Robotic-assisted augmented roof ureteroplasty with appendiceal onlay flap. Urology. 2023;176:243–245. doi: 10.1016/j.urolgy.2023.02.027.
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