Search Results (118)

Iatrogenic urinary tract injury is a known complication of pelvic surgery, most commonly occurring during gynecological procedures. The bladder and ureters are particularly vulnerable due to their close anatomical proximity to the uterus. Urinary tract damage can result from various mechanisms, including laceration, ligation, and thermal injury. Incidence rates vary according to the affected organ and surgical type; bladder injuries occur in 0.24% of benign and 0.4–3.7% of oncologic surgeries, whereas ureteral injuries are reported in 0.08% of benign and 0.39–1.1% of oncologic procedures. Timely diagnosis is essential for effective management. When detected intraoperatively, the injury can often be repaired immediately. Surgical treatment options vary depending on the specific nature and location of the bladder or ureteral damage. Delayed diagnosis can significantly impact the patient’s quality of life, increasing the risk of severe complications such as genitourinary fistulas. This narrative review aims to summarize current evidence on the diagnosis, prevention, and treatment of urinary tract injuries occurring during gynecological surgery. It evaluates risk factors, incidence, management, complications, and prevention strategies for iatrogenic bladder and ureteral injuries. Additionally, it highlights the innovative role of artificial intelligence in preventing urologic damage during gynecological procedures. The relevant literature was identified through a structured search of the PubMed database using predefined keywords related to gynecological surgery and urinary tract injury. Full article

Introduction: Ureteral stents are widely used in the specialty of urology to preserve renal function and provide ureteral patency in cases of urolithiasis, strictures, malignancy, and trauma. This paper presents a novel application of prophylactic ureteral stents deployed under MRI-guidance for ureteral protection in the setting of in-bore salvage cryoablation therapy for recurrent and metastatic prostate cancer. This is the first known case series of ureteral stent placement using near real-time MRI. Materials and Methods: A retrospective chart review was performed for all patients who underwent MRI-guided ureteral stent placement prior to in-bore cryoablation therapy from 2021 to 2022. Each case was managed by an interdisciplinary team of urologists and interventional radiologists. Preoperative and postoperative data were collected for descriptive analysis. Physics safety testing was conducted on the cystoscope and viewing apparatus prior to its implementation for stent deployment. Results: A total of seven males, mean age 73.4 years (range 65–81), underwent successful prophylactic, cystoscopic MRI-guided ureteral stent placement prior to cryoablation therapy of their prostate cancer. No intraoperative complications occurred. A Grade 2 postoperative complication of pyelonephritis and gross hematuria following stent removal occurred in one case. The majority of patients were discharged the same day as their procedure. Conclusions: This case series demonstrates the feasibility of in-bore cystoscopic aided MRI guidance for ureteral stent placement. Ureteral stents can be used to increase the safety margin of complex cryoablation treatments close to the ureter. Furthermore, by following the meticulous MRI safety protocols established by MRI facility safety design guidelines, MRI conditional tools can aid therapy in the burgeoning interventional MRI space. Full article

Background: Total laparoscopic hysterectomy (TLH) is widely accepted as the preferred minimally invasive technique for the treatment of benign gynecologic conditions. However, significant heterogeneity persists in the literature regarding the operative sequence, particularly for steps such as uterine artery ligation, ureteral identification, and vaginal cuff closure. This lack of standardization may affect complication rates, reproducibility in surgical training, and procedural efficiency. The objective of this study was to develop and evaluate a standardized, anatomically justified surgical protocol for TLH primarily designed for training purposes but applicable to most clinical cases. Methods: This retrospective observational study analyzed 109 patients who underwent TLH between January 2016 and July 2020 at a single tertiary care center. A fixed sequence of surgical steps was applied in all cases, emphasizing early uterine artery ligation at its origin, broad ligament fenestration above the ureter, and laparoscopic figure-of-eight vaginal cuff closure. Patient demographics, operative data, and perioperative outcomes were extracted and analyzed. Results: The mean operative time was 67.2 ± 18.4 min, and the mean uterine weight was 211.9 ± 95.3 g. Intraoperative complications were observed in 3.7% of cases and included bladder injury in 1.8% and small bowel injury in 1.8%, all of which were managed laparoscopically without conversion. Vaginal cuff dehiscence occurred in 1.8%, and postoperative vaginal bleeding in 3.7% of patients. One patient (0.9%) required reoperation due to a vaginal cuff hematoma/abscess. No postoperative infections requiring intervention were reported. The mean hemoglobin drop on the first postoperative day was 1.2 ± 0.9 g/dL. Conclusions: Our findings support the feasibility, reproducibility, and safety of a structured TLH protocol based on anatomical landmarks and early vascular control. Widespread adoption of similar protocols may improve consistency and training, with broad applicability in routine surgical practice and potential adaptation in severely complex cases; however, further validation in multicenter studies is warranted. Full article

Vesicoureteral reflux (VUR) management in children with neurogenic bladder dysfunction (NBD) remains a clinical challenge. Total endoscopic management (TEM), combining intradetrusor Onabotulinum Toxin-A (BTX-A) and subureteric dextranomer/hyaluronic acid (Deflux^(R)) injection, offers a minimally invasive alternative. The aim of this retrospective study is to evaluate the long-term effectiveness of TEM. Inclusion criteria: symptomatic II–V grade VUR (also I in bilateral VUR) in NBD children with follow-up ≥12 months. Nineteen patients were enrolled, 24 ureters (grade I–II: 2, grade III–V: 22); 5 patients (20.8%) had bilateral VUR. Mean age at surgery: 7.6 years (1.3–17). No complications were reported. TEM was effective in 11 patients (57.9%), 3/11 requiring a second TEM treatment. VUR resolution appeared in 14 ureters (58.3%), downgrading in 6 (42.9%), persistence in 4 (28.6%). Among non-responders’ patients (8/19, 42.1%), five (26.3%) required bladder augmentation (one combined with ureteral reimplantation), one (5.3%) underwent reimplantation, and two (10.5%) continued conservative management. At bladder biopsy, 11 patients (57.9%) had chronic inflammation, 8 (42.1%) showed fibrosis; no difference in success rate was recorded. All responders required repeated BTX-A injections. Mean follow-up: 3.2 years (range 1–4.7). In selected patients, TEM appears to be a safe and effective strategy, potentially delaying or avoiding major reconstructive surgery. Full article

Background/Objectives: Ureteral stents are indispensable tools in contemporary urological practice; however, their prolonged indwelling is frequently associated with a spectrum of complications. This study aims to evaluate the correlation between indwelling duration and the extent of stent encrustation, as well as the impact on extraction difficulty. Methods: A retrospective analysis was conducted on 33 patients treated at Clinical County Emergency Hospital of Brașov between December 2023 and December 2024. All patients had polyurethane double-J ureteral stents placed. Parameters assessed included the degree of stent encrustation, discoloration, incidence of urinary tract infections (UTIs), and extraction difficulty. These were analyzed in relation to indwelling time and patient comorbidities. Statistical processing was performed using SPSS 23.0 software, with significance set at p < 0.05. Results: A statistically significant association was observed between longer stent indwelling times and higher grades of encrustation, particularly for the intervals of 45–90 days and over 90 days (p = 0.008 and p = 0.01, respectively). Low encrustation demonstrated correlations with certain comorbidities, whereas no statistically relevant associations were found for moderate and severe encrustation. Black coloration of the stents was strongly associated with UTIs caused by Escherichia coli, Klebsiella spp., and Enterococcus spp. (p < 0.001), as well as with extended indwelling durations (p < 0.001). No significant correlation was identified between the presence of UTIs and the degree of stent encrustation. Conclusions: Indwelling time is a critical determinant of both ureteral stent encrustation and discoloration, with direct implications for clinical decision-making regarding stent management and extraction planning. Timely removal and close monitoring are essential to reduce the risk of complications associated with long-term stent placement. Full article

Background/Objectives: Renal transplantation (RT) remains the gold standard for end-stage renal disease, offering superior outcomes versus dialysis. Despite advances, ureteric complications (leaks/strictures) persist, primarily from ischemic injury, posing substantial graft risks. We review etiology, incidence, and management strategies for post-RT ureteric complications, focusing on surgical reconstruction techniques. Methods: Literature assessment examined ischemic-related ureteric complications. Primary outcomes: incidence, success, complication rates, operative times, and long-term patency. Secondary outcomes: graft/patient survival and reoperation rates. Techniques evaluated included extravesical Lich–Gregoir (L-G) and transvesical Leadbetter–Politano (L-P) ureteroneocystostomy (UNC), Boari flap with psoas hitch, pyelo/ureteroureterostomy, pyelovesicostomy, and ureteroenterostomy. Surgical indications, procedural details, advantages, disadvantages, and quantitative outcomes were systematically analyzed. Results: Ureteric complication incidence ranged from 1 to 15%, with ischemic injury as the primary cause. L-G UNC demonstrated lower complication rates than L-P (6.15% vs. 8.33%) with reduced operative times. Pyelo/ureteroureterostomy achieved excellent salvage outcomes (>90% success, 3.9% reintervention rate). Boari flap provides a suitable option for extensive ureteric defects, consistently preserving graft function without stricture recurrences. Pyelovesicostomy showed 80% long-term success in complex cases. Ureteroenterostomy achieved comparable 5-year graft survival (63%) to standard drainage, despite higher infection rates (65%). Pyelovesicostomy and ureteroenterostomy remain important solutions for specific challenging scenarios. Conclusions: Urinary reconstruction technique selection should be individualized based on anatomical considerations, pathology, and surgical expertise. Comprehensive understanding of reconstruction techniques enables effective management of ureteric complications, preserving graft function and improving outcomes. Full article

Background/Objective: Iatrogenic ureteral injury is a rare but serious complication of colorectal cancer surgery. Although prophylactic ureteral catheterization (PUC) is used to facilitate intraoperative ureter identification and reduce the risk of ureteral injury, its efficacy is debated. We aimed to evaluate the clinical utility and outcomes of PUC in colorectal cancer surgery. Methods: This retrospective study included 42 patients who underwent PUC before colorectal cancer surgery at the Tohoku University Hospital between February 2010 and September 2024. Preoperative ureteral stents were inserted via cystoscopy under general anesthesia. Patient demographics, surgical techniques, indications for catheterization, and post-procedural complications were reviewed. Results: PUC was most frequently performed in patients with left-sided colorectal cancer (61.9%) and local recurrence of rectal cancer (31%). Ureteral catheterization was indicated in patients with a history of pelvic surgery (47.6%) or tumor proximity to the ureter (26.2%). Open surgery was performed in 90.5% of the cases, whereas robotic surgery with fluorescent ureteral catheters was used in selected patients. No intraoperative ureteral injury was observed in the stent group. Catheter-related complications, including hematuria (14.3%) and urinary tract infections (9.5%), were minor and resolved before discharge. Conclusions: PUC may be beneficial in patients with a history of pelvic surgery or local recurrence of rectal cancer, in whom the risk of ureteral injury is inherently higher. Full article

The use of ileum for ureteral reconstruction was first described in 1906. Since then, its utilization has evolved considerably. Early in the history of ileal ureters, urologists were limited by a lack of familiarity with bowel harvesting and handling. The popularization of ileal conduits for urinary diversions, however, allowed urologists to familiarize themselves with the use of ileum and paved the way for broader applications. With the emergence of laparoscopy and, later, robotic-assisted surgery, the application of ileal ureteral replacement expanded the capabilities of reconstructive urologists. This article describes the historical development of surgical techniques for ileal ureter replacement and the integration of new technologies aiding in improved outcomes, and anticipates potential future directions. In contemporary practice, robotic-assisted ileal ureteral replacement is used in cases of extensive ureteral obstruction or damage. Advantages of the robotic platform include reduced blood loss, shorter recovery time and hospital length of stay, and superior operative ergonomics. Although robotic ileal ureter replacement is a complex and challenging surgery with notable complications, studies have demonstrated the efficacy and safety of this technique in patients with an otherwise end-stage ureter. In addition, the robotic approach has provided urologists the ability to conduct complex reconstructive surgeries including bilateral ureteral replacement in conjunction with bladder augmentation or a urinary diversion. Long-term studies and continued innovation are necessary to further improve the surgical techniques, outcomes, and scope of ileal ureter reconstruction. Full article

The COVID-19 pandemic disrupted healthcare delivery worldwide, potentially impacting the management of urolithiasis. This study aimed to evaluate changes in referral patterns, perioperative care, and surgical outcomes among patients undergoing ureteroscopic treatment for upper ureteral stones at a Japanese institution. A retrospective cohort of 467 patients who underwent ureteroscopic lithotripsy or retrograde intrarenal surgery between March 2018 and May 2022 was analyzed. The patients were divided into pre-pandemic (March 2018–March 2020, n = 244) and post-pandemic (April 2020–May 2022, n = 223) groups. Clinical characteristics and outcomes were compared. Baseline demographics were similar. After the pandemic onset, preoperative ureteral stenting increased (30.3% vs. 42.6%, p = 0.006), while surgical waiting times (36 days vs. 28 days, p = 0.005) and operative durations (77 min vs. 67 min, p = 0.018) decreased. Referral sources shifted (p = 0.045), with fewer primary care referrals and more from emergency or higher-level hospitals. Stone-free rates (65.6% vs. 58.7%, p = 0.128) and postoperative complication rates were comparable. Despite systemic constraints during the pandemic, timely adaptations in scheduling and perioperative management allowed for the continued delivery of safe and effective ureteroscopic treatment. These findings emphasize the importance of flexible clinical strategies during healthcare crises. Full article

Background/Objectives: Intrarenal pressure (IRP) plays a critical role in ensuring the safety of retrograde intrarenal surgery (RIRS), as elevated IRP is associated with complications such as pyelovenous backflow, infection, and renal injury. LithoVue™ Elite (LVE) is the first commercially available ureteroscope (URS) capable of providing real-time IRP measurements. Conventionally, IRP has been measured via a percutaneous nephrostomy catheter (PNC), which may not accurately reflect dynamic changes during endoscopic procedures. Recently, small ureteral access sheaths (UASs) have been increasingly used to minimize ureteral injury risk. This study aimed (1) to assess the accuracy of LVE compared with that of IRP measured by a PNC and (2) to evaluate appropriate irrigation settings suitable for small UASs using porcine kidney models and LVE. Methods: An 11/13-Fr UAS and a 10/12-Fr UAS were inserted into each model, and an automatic irrigation pump (AIP) and hand pumping (HP) with a 20-cc syringe were used. IRP was measured at various LVE tip positions (renal pelvis and upper, middle, and lower calyces) with different irrigation settings, repeated four times in each. Simultaneously, the IRP via the PNC located in the upper calyx and renal pelvis was measured. Results: LVE showed high concordance with the PNC across the upper, middle, and lower calyces (p > 0.05). However, at the renal pelvis, LVE measured IRP values that were significantly higher than the PNC by a mean of 1.93 ± 0.93 mmHg (p < 0.001). For the 11/13-Fr UAS, the IRP remained below 30 mmHg across all irrigation settings with an AIP and HP. In contrast, the 10/12-Fr UAS maintained 30 mmHg only with limited AIP settings, while HP resulted in high IRP, exceeding 100 mmHg at any location. Intergroup comparisons demonstrated that the IRP with the 10/12-Fr UAS was significantly higher than that with the 11/13-Fr UAS at any irrigation pressure setting across all URS tip positions (p < 0.05). Intragroup comparisons indicated a significant pressure difference between the upper, middle, and lower calyces and the renal pelvis in both models at all irrigation settings (p < 0.05). Conclusions: LVE provided accurate IRP measurements compared to the PNC. The IRP was significantly influenced by UAS size, irrigation setting, and URS tip position. When using small UASs, selecting appropriate irrigation settings is essential to maintain the safe threshold. Full article

Kidney transplantation significantly improves outcomes in patients with end-stage renal disease; however, postoperative complications remain a substantial concern. This review summarizes the incidence, risk factors, and management strategies for common complications after kidney transplantation. Reported incidence varies widely due to differences in definitions, diagnostic methods, and study designs. Ureteral stenosis occurs in 2.8–18.0% of recipients, vesicoureteral reflux in 0.5–86%, and urinary leakage in 1.1–7.2%. Lymphatic complications, including lymphocele and lymphorrhea, range from 0.6% to 35.2%, with one-third of complications requiring intervention. The incidence of urinary tract infections ranges from 20 to 43%, while asymptomatic bacteriuria is reported in up to 53% of recipients. Surgical site infections have a median incidence of 3.7%, and incisional hernias develop in 2.5–10% of cases, depending on follow-up duration. Vascular complications affect approximately 10% of recipients, with renal artery stenosis and thrombosis being the most prevalent. Neurologic complications, such as femoral nerve palsy and immunosuppression-related neurotoxicity, though less frequent, can impair recovery. Management strategies vary depending on severity, ranging from observation to surgical intervention. Preventive measures—including optimized ureteral stenting protocols, early catheter removal, careful immunosuppression, and appropriate antimicrobial use—play a crucial role in reducing complication risk. Despite advances in transplantation techniques and perioperative care, these complications continue to affect graft survival and patient outcomes. Further research is needed to standardize definitions and establish evidence-based protocols. Full article

Background and Objectives: Gestational hydronephrosis (GH) is a physiological condition commonly observed during pregnancy, resulting from hormonal effects and mechanical compression of the ureters by the enlarging uterus. Although often asymptomatic, GH can cause urinary stasis, recurrent infections, and renal function impairment in symptomatic cases. The optimal management of such cases remains controversial, especially regarding the role of ureteral stent placement. This study aimed to compare clinical outcomes—including renal function, inflammatory markers, and obstetric parameters—in pregnant women with symptomatic GH who underwent ureteral stent placement versus those managed conservatively. Materials and Methods: We conducted a retrospective cohort study at Düzce University Hospital between 2020 and 2024, including 40 pregnant women diagnosed with symptomatic GH. The patients were divided into the following two groups: those who received a ureteral stent (n = 20) and those who were managed with conservative treatment (n = 20). Conservative management included hydration therapy, acetaminophen-based analgesia, and close clinical monitoring. The parameters assessed included serum creatinine, estimated glomerular filtration rate (GFR), inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, and white blood cell count), urinary findings, obstetric outcomes, and postpartum complications. Statistical significance was set at p < 0.05. Results: Gestational age at diagnosis was significantly higher in the stent group (29.1 ± 3.2 weeks) than in the non-stent group (27.1 ± 3.5 weeks; p = 0.045), possibly reflecting increased mechanical compression in later pregnancy. Renal function parameters (serum creatinine and GFR), inflammatory markers (CRP, ESR, and WBC count), and obstetric outcomes (birth weight, Apgar scores) showed no significant differences between groups (p > 0.05). Interestingly, gestational diabetes mellitus (GDM) was more prevalent in the non-stent group (20% vs. 5%; p = 0.042), although no significant differences were found in fasting glucose levels. Conclusions: Ureteral stent placement in symptomatic GH does not appear to significantly improve renal function or obstetric outcomes. However, it may provide symptom relief in select patients with persistent or severe discomfort. Given the limitations of retrospective data and a small sample size, further prospective studies with larger cohorts and quality-of-life assessments are warranted to optimize management strategies and enhance patient-centered care. Full article

Background/Objectives: Acute obstructive pyelonephritis caused by ureteral calculi is a severe urological emergency that can rapidly progress to life-threatening complications, including urosepsis. Early risk stratification is critical for timely intervention and improved patient outcomes. Although Hu’s nomogram has been proposed as a predictive tool for urosepsis, its external validation remains limited. This study aims to validate Hu’s nomogram in an independent cohort and identify novel clinical and imaging predictors of urosepsis. Methods: This retrospective cohort study included 341 patients diagnosed with ureteral calculi who underwent surgical intervention at a single institution between January 2019 and October 2023. Clinical, laboratory, and imaging data were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of urosepsis. The predictive accuracy of Hu’s nomogram was evaluated using receiver operating characteristic curve analysis. Results: Among 341 patients, 66 (19.4%) developed urosepsis. Multivariate analysis identified female gender, corticosteroid use, lower platelet count, elevated C-reactive protein levels, positive urine white blood cell count, lower computed tomography attenuation values of calculi, and higher computed tomography attenuation values of hydronephrosis as independent predictors of urosepsis. Hu’s nomogram demonstrated a strong predictive performance (area under the curve: 0.761; 95% CI: 0.701–0.821), reaffirming its clinical utility for risk stratification. Conclusions: This study provides an external validation of Hu’s nomogram and identifies novel risk factors for urosepsis prediction, including corticosteroid use and imaging-based parameters. Incorporating these findings into clinical practice may enhance early risk stratification, facilitate timely interventions, and ultimately improve patient outcomes. Full article

Congenital anomalies of the kidney and urinary tract (CAKUT) are common developmental malformations and a leading cause of pediatric renal dysfunction. Severe hydronephrosis, especially when accompanied by ureteral duplication, ureterocele, or neurogenic bladder, poses significant diagnostic and therapeutic challenges. This case report presents a 7-year-old male with prenatally diagnosed bilateral grade IV/V hydronephrosis (according to the radiology hydronephrosis grading system), complicated by the right pyeloureteral duplication, the left ureterocele, and the neurogenic bladder. The patient’s clinical course was marked by recurrent urinary tract infections (UTIs), progressive renal dysfunction, and multiple surgical interventions. Initial decompression via bilateral ureterostomy and stenting led to significant improvements in renal function. However, the patient experienced recurrent febrile UTIs caused by multidrug-resistant pathogens, necessitating repeated hospitalizations and intravenous antibiotic therapy. Serial imaging studies documented persistent hydronephrosis, a neurogenic bladder, and vesicoureteral reflux. Subsequent surgical interventions included bilateral ureteral reimplantation, excision of the left ureterocele, and removal of a fibroepithelial polyp from the bladder wall. Despite these interventions, residual left hydronephrosis and right kidney hypoplasia persisted, underscoring the need for long-term surveillance. This case highlights the diagnostic and therapeutic challenges of managing CAKUT and emphasizes the importance of a multidisciplinary approach integrating imaging, functional assessment, and surgical planning. Early diagnosis and timely intervention can stabilize renal function, but ongoing monitoring and individualized treatment remain crucial for optimizing long-term outcomes in children with complex CAKUT. Full article

Iatrogenic ureteral strictures are uncommon but challenging to manage. We present our expertise in laparoscopic and robot-assisted laparoscopic ureteroureterostomy (LUU and RAUU) for lumbar and iliac strictures and laparoscopic ureteral reimplantation for pelvic strictures. A descriptive study was conducted on nine adult patients who underwent minimally invasive procedures. Six had lumbar or iliac ureteral strictures—five due to ureterorenoscopy and one following pancreaticoduodenectomy for pancreatic cancer. Three developed pelvic strictures after ureterorenoscopy. Preoperative evaluation included a medical history review, abdominal ultrasound, and CT scan. Success was characterized by the absence of symptoms and the lack of obstruction on follow-up imaging at one year. All procedures were technically feasible, with a median operating time of 105 min and a median hospital stay of four days. No major complications occurred. One patient experienced ureteral stricture recurrence following a laparoscopic approach for a lumbar stricture, and required a permanent double-J stent. At a median follow-up of 38 months, 88.88% of patients remained asymptomatic with preserved renal function. Our findings suggest that robotic and laparoscopic ureteral reconstruction performed by experienced surgeons at a tertiary center is a safe and effective option with a low complication rate. Full article