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Combined Y-shaped common channel transureteroureterostomy with Boari flap to treat bilateral long-segment ureteral strictures.

Chen CL, Tang SH, Cha TL, Meng E, Tsao CW, Sun GH, Yu DS, Chang SY, Wu ST - BMC Res Notes (2014)

Bottom Line: The renal function deteriorated during the follow-up period.However, the renal function still deteriorated.The patient recovered uneventfully.

View Article: PubMed Central - PubMed

Affiliation: Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No,325, Section 2, Cheng-Kung Road, Taipei 114, Taiwan. gu2028@yahoo.com.tw.

ABSTRACT

Background: Ureteral stricture is a complication of several etiologies including idiopathic retroperitoneal fibrosis, infection, radiotherapy, instrumentation, and surgical procedures. A variety of techniques have been reported for management. The transureteroureterostomy and bladder flap have been the standard procedures for repairing distal ureteral defects of unilateral ureter. Bilateral ureteral stricture is an uncommon condition that challenges usual reconstructive procedures. It is a difficult task to reconstruct the complex situation of bilateral ureteral strictures.

Case presentation: A 54-year-old female underwent concurrent chemoradiotherapy for stage IVB squamous cell carcinoma of cervix. Subsequently, she had stricture of bilateral distal ureters with bilateral hydroureteronephrosis which was found by computed tomography. The renal function deteriorated during the follow-up period. She had periodic change of double-J stents and percutaneous nephrostomy. However, the renal function still deteriorated. We performed a combined Y-shaped common channel transureteroureterostomy with Boari flap to reconstruct bilateral long-segment ureteral strictures. The patient recovered uneventfully.

Conclusion: Reconstruction of bilateral ureteral strictures is a difficult treatment. We developed a modified technique for the complex situation of bilateral ureteral strictures. To our knowledge, this has not been previously reported in the scientific literature and it is a feasible procedure to treat bilateral long-segment ureteral strictures.

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Related in: MedlinePlus

Bilateral ureteral strictures. (A) Retrograde pyelogram showed bilateral ureteral strictures involving middle third and lower third of ureters. (B) Left antegrade pyelogram showed complete obstruction at middle third of left ureter; 2 double-J catheters were inserted in right ureter. (C) Cystoscopy did not demonstrated obviously abnormal telangiectasia or inflammatory mucosa.
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Fig1: Bilateral ureteral strictures. (A) Retrograde pyelogram showed bilateral ureteral strictures involving middle third and lower third of ureters. (B) Left antegrade pyelogram showed complete obstruction at middle third of left ureter; 2 double-J catheters were inserted in right ureter. (C) Cystoscopy did not demonstrated obviously abnormal telangiectasia or inflammatory mucosa.

Mentions: A 54-year-old female patient, with a history of stage IVB squamous cell carcinoma of cervix, was treated by concurrent chemoradiotherapy 6 years ago. Subsequently, 6 months later, bilateral hydroureteronephrosis was found by the follow-up computerized tomography (CT), which showed the stricture segment included the middle third and lower third of both ureters. The level of serum creatinine increased from 1.0 to 2.7 mg/dL. She underwent bilateral insertion of double-J catheter to facilitate the upper urinary tract drainage. Unfortunately, the follow-up CT showed persistent bilateral hydronephrosis (left side worse than right side). Additionally, the renal function deteriorated and a gradual change of serum creatinine from 2.4 to 6.5 mg/dL was found. She underwent right insertion of a parallel second double-J catheter and left percutaneous nephrostomy (Figure 1). The level of serum creatinine decreased to 2.6 mg/dL. It was possible due to the complication of retroperitoneal fibrosis and bilateral ureteral strictures following previous radiation therapy. Afterward, she had periodic change of the right side double-J stents and left percutaneous nephrostomy.Figure 1


Combined Y-shaped common channel transureteroureterostomy with Boari flap to treat bilateral long-segment ureteral strictures.

Chen CL, Tang SH, Cha TL, Meng E, Tsao CW, Sun GH, Yu DS, Chang SY, Wu ST - BMC Res Notes (2014)

Bilateral ureteral strictures. (A) Retrograde pyelogram showed bilateral ureteral strictures involving middle third and lower third of ureters. (B) Left antegrade pyelogram showed complete obstruction at middle third of left ureter; 2 double-J catheters were inserted in right ureter. (C) Cystoscopy did not demonstrated obviously abnormal telangiectasia or inflammatory mucosa.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4150947&req=5

Fig1: Bilateral ureteral strictures. (A) Retrograde pyelogram showed bilateral ureteral strictures involving middle third and lower third of ureters. (B) Left antegrade pyelogram showed complete obstruction at middle third of left ureter; 2 double-J catheters were inserted in right ureter. (C) Cystoscopy did not demonstrated obviously abnormal telangiectasia or inflammatory mucosa.
Mentions: A 54-year-old female patient, with a history of stage IVB squamous cell carcinoma of cervix, was treated by concurrent chemoradiotherapy 6 years ago. Subsequently, 6 months later, bilateral hydroureteronephrosis was found by the follow-up computerized tomography (CT), which showed the stricture segment included the middle third and lower third of both ureters. The level of serum creatinine increased from 1.0 to 2.7 mg/dL. She underwent bilateral insertion of double-J catheter to facilitate the upper urinary tract drainage. Unfortunately, the follow-up CT showed persistent bilateral hydronephrosis (left side worse than right side). Additionally, the renal function deteriorated and a gradual change of serum creatinine from 2.4 to 6.5 mg/dL was found. She underwent right insertion of a parallel second double-J catheter and left percutaneous nephrostomy (Figure 1). The level of serum creatinine decreased to 2.6 mg/dL. It was possible due to the complication of retroperitoneal fibrosis and bilateral ureteral strictures following previous radiation therapy. Afterward, she had periodic change of the right side double-J stents and left percutaneous nephrostomy.Figure 1

Bottom Line: The renal function deteriorated during the follow-up period.However, the renal function still deteriorated.The patient recovered uneventfully.

View Article: PubMed Central - PubMed

Affiliation: Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No,325, Section 2, Cheng-Kung Road, Taipei 114, Taiwan. gu2028@yahoo.com.tw.

ABSTRACT

Background: Ureteral stricture is a complication of several etiologies including idiopathic retroperitoneal fibrosis, infection, radiotherapy, instrumentation, and surgical procedures. A variety of techniques have been reported for management. The transureteroureterostomy and bladder flap have been the standard procedures for repairing distal ureteral defects of unilateral ureter. Bilateral ureteral stricture is an uncommon condition that challenges usual reconstructive procedures. It is a difficult task to reconstruct the complex situation of bilateral ureteral strictures.

Case presentation: A 54-year-old female underwent concurrent chemoradiotherapy for stage IVB squamous cell carcinoma of cervix. Subsequently, she had stricture of bilateral distal ureters with bilateral hydroureteronephrosis which was found by computed tomography. The renal function deteriorated during the follow-up period. She had periodic change of double-J stents and percutaneous nephrostomy. However, the renal function still deteriorated. We performed a combined Y-shaped common channel transureteroureterostomy with Boari flap to reconstruct bilateral long-segment ureteral strictures. The patient recovered uneventfully.

Conclusion: Reconstruction of bilateral ureteral strictures is a difficult treatment. We developed a modified technique for the complex situation of bilateral ureteral strictures. To our knowledge, this has not been previously reported in the scientific literature and it is a feasible procedure to treat bilateral long-segment ureteral strictures.

Show MeSH
Related in: MedlinePlus