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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

Combined Y-shaped common channel TUU with Boari flap. (A) and (B) showed the “combined Y-shaped common channel TUU with Boari flap” with bilateral double-J catheters (a) right ureter (b) left ureter (c) Boari flap.
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Fig2: Combined Y-shaped common channel TUU with Boari flap. (A) and (B) showed the “combined Y-shaped common channel TUU with Boari flap” with bilateral double-J catheters (a) right ureter (b) left ureter (c) Boari flap.

Mentions: We transected the bilateral ureters at the middle third of ureters, and placed a 3–0 synthetic absorbable stay suture in the proximal cut end of the bilateral ureters and ligated the distal stump of the bilateral ureters. After mobilizing the bladder, a psoas hitch onto the left psoas tendon was done with three interrupted sutures. We designed a Boari flap with the width 2.5 cm at the tip and 5 cm wide at the base. The right ureter was brought to the left side through the retrocolon channel. The bilateral ureters were reconstructed into a common channel, then directly anastomosed the common channel of both ureters to the edge of the Boari flap (Figure 2). Prior to closure, we inserted two double-J catheters into both ureters. We placed two closed-suction drains at the site of perivesical region and Cul-de-sac, and closed the surgical wound.


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)

Combined Y-shaped common channel TUU with Boari flap. (A) and (B) showed the “combined Y-shaped common channel TUU with Boari flap” with bilateral double-J catheters (a) right ureter (b) left ureter (c) Boari flap.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Combined Y-shaped common channel TUU with Boari flap. (A) and (B) showed the “combined Y-shaped common channel TUU with Boari flap” with bilateral double-J catheters (a) right ureter (b) left ureter (c) Boari flap.
Mentions: We transected the bilateral ureters at the middle third of ureters, and placed a 3–0 synthetic absorbable stay suture in the proximal cut end of the bilateral ureters and ligated the distal stump of the bilateral ureters. After mobilizing the bladder, a psoas hitch onto the left psoas tendon was done with three interrupted sutures. We designed a Boari flap with the width 2.5 cm at the tip and 5 cm wide at the base. The right ureter was brought to the left side through the retrocolon channel. The bilateral ureters were reconstructed into a common channel, then directly anastomosed the common channel of both ureters to the edge of the Boari flap (Figure 2). Prior to closure, we inserted two double-J catheters into both ureters. We placed two closed-suction drains at the site of perivesical region and Cul-de-sac, and closed the surgical wound.

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