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Surgical Reconstruction of Ureteral Defects: Strictures, External Trauma, Iatrogenic, and Radiation Induced

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Female Genitourinary and Pelvic Floor Reconstruction

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Abstract

Ureteral injury and stricture present a challenge for the urologist, both in terms of identification and repair. Signs of injury and stricture may be quite subtle or develop months after the initial insult. Multiple options are available to the urologist in terms of treatment from endoscopic repair to ureteral reconstruction depending on the location, timing, length, and etiology. It is imperative for the urologist to be facile with the multiple options available as the patient’s anatomy or disease may require change in plan during the operation in order to achieve a tension-free anastomosis. In some settings, the ureter may be unable to be reconstructed and options including bowel interposition, autotransplantation, or nephrectomy may need to be considered. This chapter reviews etiology of strictures as well as options for surgical management and possible emerging technologies for repair.

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References

  1. Roberts W, Caddedu J, Micali S, et al. Ureteral stricture formation after removal of impacted stone. J Urol. 1998;159:723.

    Article  CAS  PubMed  Google Scholar 

  2. Roberts DB, Pearl M. Complications of ureteroscopy. Urol Clin North Am. 2004;31:157.

    Article  Google Scholar 

  3. El-Abd A, Suliman M, Farha M, et al. The development of ureteric strictures after ureteroscopic treatment for ureteric calculi: a long-term study at two academic centers. Arab J Urol. 2014;12:168.

    Article  PubMed  Google Scholar 

  4. Huffman JL. Ureteroscopic injuries to the upper urinary tract. Urol Clin North Am. 1989;16:249.

    Article  CAS  PubMed  Google Scholar 

  5. Bas O, Tuygun C, Dede O, et al. Factors affecting complication rates of retrograde flexible ureteroscopy: analysis of 1571 procedures-a single center experience. World J Urol. 2017;35:819.

    Article  PubMed  Google Scholar 

  6. Tran H, Arsovska O, Paterson R, et al. Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution. Can Urol Assoc J. 2015;9:E921.

    Article  PubMed  PubMed Central  Google Scholar 

  7. McIntyre J, Eifel P, Levenback C, et al. Ureteral stricture as a late complication of radiotherapy for stage IB carcinoma of the uterine cervix. Cancer. 1995;75:836.

    Article  CAS  PubMed  Google Scholar 

  8. Fokdal L, Tanderup K, Potter R, et al. Risk factors for ureteral stricture after radiochemotherapy including image guided adaptive brachytherapy in cervical cancer: results from the EMBRACE studies. Int J Radiat Oncol Biol Phys. 2019;103:887.

    Article  PubMed  Google Scholar 

  9. Brandes S, Eswara J. Upper urinary tract trauma. In: Wein AJ, Kavoussi LR, Campbell MF, Walsh PC, editors. Campbell-Walsh urology. Philadelphia: Elsevier; 2020.

    Google Scholar 

  10. Amato J, Billy L, Gruber R, et al. Vascular injuries. An experimental study of high and low velocity missile wounds. Arch Surg. 1970;101:167.

    Article  CAS  PubMed  Google Scholar 

  11. Vasudevan V, Johnson E, Wong K, et al. Contemporary management of ureteral strictures. J Clin Urol. 2019;12:20.

    Article  Google Scholar 

  12. Gild P, Kluth L, Vetterlein M, et al. Adult iatrogenic ureteral injury and stricture – incidence and treatment strategies. Asian J Urol. 2018;5:101.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Burks F, Santucci R. Management of iatrogenic ureteral injury. Ther Adv Urol. 2014;6:115.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wong J, Bortoletto P, Tolentino J, et al. Urinary tract injury in gynecologic laparoscopy for benign indication: a systematic review. Obstet Gynecol. 2018;131:100.

    Article  PubMed  Google Scholar 

  15. Tanaka Y, Asada H, Kuji N, et al. Ureteral catheter placement for prevention of ureteral injury during laparoscopic hysterectomy. J Obstet Gynaecol Res. 2008;34:67.

    PubMed  Google Scholar 

  16. Elliott S, McAninch J. Ureteral injuries: external and iatrogenic. Urol Clin North Am. 2006;33:55.

    Article  PubMed  Google Scholar 

  17. Eswara J, Raup V, Potretzke AM, et al. Outcomes of iatrogenic genitourinary injuries during colorectal surgery. Urology. 2015;86:1228.

    Article  PubMed  Google Scholar 

  18. Brandes S, McAninch J. Reconstructive surgery for trauma of the upper urinary tract. Urol Clin North Am. 1999;26:183.

    Article  CAS  PubMed  Google Scholar 

  19. Amin K, Vertosick E, Stearns G, et al. Predictors of benign uretero-enteric anastomotic strictures after radical cystectomy and urinary diversion. Urology. 2020;144:225.

    Article  PubMed  Google Scholar 

  20. Ostrenzski A, Radolinski B, Ostrzenka K. A review of laparoscopic ureteral injury in pelvic surgery. Obstet Gyneol Surv. 2003;58:794.

    Article  Google Scholar 

  21. Parpala-Sparman T, Paananen I, Santala M, et al. Increasing number of ureteric injuries after the introduction of laparoscopic surgery. Scand J Urol Nephrol. 2008;42:422.

    Article  PubMed  Google Scholar 

  22. Ambani S, Skupin P, Małaeb B, et al. Does early ureteroneocystostomy after iatrogenic ureteral injury jeopardize outcome? Urology. 2020;136:245.

    Article  PubMed  Google Scholar 

  23. Ahn M, Loughlin L. Psoas Hitch reimplantation in adults – analysis of a modified technique and timing of repair. Urology. 2001;58:184.

    Article  CAS  PubMed  Google Scholar 

  24. Lee Z, Lee M, Lee R, et al. Ureteral rest is associated with improved outcomes in patients undergoing robotic ureteral reconstruction of proximal and middle ureteral strictures. Urology. 2021;152:160.

    Article  PubMed  Google Scholar 

  25. Palaniappa N, Telem D, Ranasinghe N, et al. Incidence of iatrogenic ureteral injury after laparoscopic colectomy. Arch Surg. 2012;147:267.

    Article  PubMed  Google Scholar 

  26. Chou M, Wang C, Lien R. Prophylactic ureteral catheterization in gynecologic surgery: a 12-year randomized trial in a community hospital. Int Urogynecol J. 2009;20:689.

    Article  Google Scholar 

  27. Coakley K, Kasten K, Sims S, et al. Prophylactic ureteral catheters for colectomy: a national surgical quality improvement program-based analysis. Dis Colon Rectum. 2018;61:84.

    Article  PubMed  Google Scholar 

  28. Desmanes D, Banerjee R, Cahan B, et al. Ureteral stent insertion for gynecologic interstitial high-dose-rate brachytherapy. Brachytherapy. 2015;14:245.

    Article  Google Scholar 

  29. Bothwell W, Bleicher R, Dent T. Prophylactic ureteral catheterization in colon surgery. A systematic review. Dis Colon Rectum. 1994;37:330.

    Article  CAS  PubMed  Google Scholar 

  30. Nakada S, Best S. Management of upper urinary tract obstruction. In: Wein AJ, Kavoussi LR, Campbell MF, Walsh PC, editors. Campbell-Walsh urology. Philadelphia: Elsevier; 2020.

    Google Scholar 

  31. Gnessin E, Yossepowitch O, Holland R, et al. Holmium laser endoureterotomy for benign ureteral stricture: a single center experience. J Urol. 2009;182:2775.

    Article  PubMed  Google Scholar 

  32. Wolf J, Elashry O, Clayman R. Long-term results of endoureterotomy for benign ureteral and ureteroenteric strictures. J Urol. 1997;158:759.

    Article  PubMed  Google Scholar 

  33. Lu C, Zhang W, Peng Y, et al. Endoscopic balloon dilatation in the treatment of benign ureteral strictures: a meta-analysis and systematic review. J Endourol. 2019;33:255.

    Article  PubMed  Google Scholar 

  34. Meretyk S, Albala D, Cayman R, et al. Endoureterotomy for treatment of ureteral strictures. J Urol. 1992;147:1502.

    Article  CAS  PubMed  Google Scholar 

  35. Koukouras D, Petsas T, Liatsikos E, et al. Percutanous minimally invasive management of iatrogenic ureteral injuries. J Endourol. 2010;24:1921.

    Article  PubMed  Google Scholar 

  36. Glenn G. Ureteral stricture. In: Glenn J, Keane T, Brendler C, et al., editors. Glenn’s urologic surgery. Philadelphia: Lippincott Williams & Wilkins; 2004.

    Google Scholar 

  37. Zimmerman I, Precourt W, Thompson C. Direct uretero-cysto-neostomy with the short ureter in the cure of ureterovaginal fistula. J Urol. 1960;83:115.

    Article  Google Scholar 

  38. Graziano M, Thompson P. The story of the Boari flap. J Urol. 2008;179:309.

    Article  Google Scholar 

  39. Wenske S, Olsson C, Benson M. Outcomes of distal ureteral reconstruction through reimplantation with Psoas Hitch, Boari flap, or ureteroneocystostomy for benign or malignant ureteral obstruction or injury. Urology. 2013;82:231.

    Article  PubMed  Google Scholar 

  40. Van den Heijkant F, Vermeer T, Vrijhof E, et al. Psoas hitch ureteral reimplantation after surgery for locally advanced and locally recurrent colorectal cancer: complications and oncological outcome. Eur J Surg Oncol. 2017;43:1869.

    Article  PubMed  Google Scholar 

  41. Federico A, Gallotta V, Foscha N, et al. Surgical outcomes of segmental ureteral resection with ureteroneocystostomy after major gynecologic surgery. Eur J Surg Oncol. 2020;46:1366.

    Article  PubMed  Google Scholar 

  42. Paick J, Hong S, Park M, et al. Management of postoperatively detected iatrogenic lower ureteral injury: should ureteroureterostomy really be abandoned? Urology. 2006;67:237.

    Article  PubMed  Google Scholar 

  43. Crissell M, Rushton H. Transureteroureterostomy. In: Glenn J, Keane T, Brendler C, et al., editors. Glenn’s urologic surgery. Philadelphia: Lippincott Williams & Wilkins; 2004.

    Google Scholar 

  44. Pisters P, Pettaway C, Liu P, et al. Is transureteroureterostomy performed during multi-organ resection for non-urothelial malignancy safe and effective? J Surg Oncol. 2012;106:62.

    Article  PubMed  Google Scholar 

  45. Iwaszko M, Krambeck A, Chów G, et al. Transureteroureterostomy revisited: long-term surgical outcomes. J Urol. 2010;183:1055.

    Article  PubMed  Google Scholar 

  46. Grimm MO, Ackerman A. Ureteral reconstruction. In: Glenn J, Keane T, Brendler C, et al., editors. Glenn’s urologic surgery. Philadelphia: Lippincott Williams & Wilkins; 2004.

    Google Scholar 

  47. Austen M, Kalble T. Secondary forms of malignancy in different forms of urinary diversion using isolated gut. J Urol. 2004;172:831.

    Article  CAS  PubMed  Google Scholar 

  48. Armatys S, Mellon M, Beck S. Use of ileum as ureteral replacement in urological reconstruction. J Urol. 2009;181:177.

    Article  PubMed  Google Scholar 

  49. Ali-el-Dein B, El Hafnawy A, D’Elia G, et al. Long-term outcome of Yang-Monti Ileal ureter: a technique suitable for mild, moderate loss of kidney function and solitary kidney. Urology. 2021;152:153.

    Article  PubMed  Google Scholar 

  50. Atala A, Kavoussi L, Goldstein D, et al. Laparoscopic correction of vesicoureteral reflux. J Urol. 1993;150:748.

    Article  CAS  PubMed  Google Scholar 

  51. Yohannes P, Gershbaum D, Rotariu P. Management of ureteral stricture disease during laparoscopic ureteroneocystostomy. J Endourol. 2001;15:839.

    Article  CAS  PubMed  Google Scholar 

  52. Andrade H, Kaouk J, Zargar H, et al. Robotic ureteroureterostomy for treatment of a proximal ureteric stricture. Int Braz J Urol. 2016;42:1041.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Raheem A, Alatawi A, Kim D, et al. Feasibility of robot-assisted segmental ureterectomy and ureteroureterostomy in patient with high medical comorbidity. Int Braz J Urol. 2017;43:779.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Sun G, Yan L, Ouyang W, et al. Management for ureteral stenosis: a comparison of robotic-assisted laparoscopic ureteroureterostomy and conventional laparoscopic ureteroureterostomy. J Laparoendosc Adv Surg Tech A. 2019;29:1111.

    Article  PubMed  Google Scholar 

  55. Babbar P, Yerram N, Sun A, et al. Robot-assisted ureteral reconstruction – current status and future directions. Urol Ann. 2008;10:7.

    Google Scholar 

  56. Lee D, Schwab C, Harris A. Robotic-assisted ureteroureterostomy in the adult: initial clinical series. Urology. 2010;75:570.

    Article  PubMed  Google Scholar 

  57. Patil N, Mottrie A, Sundaram B, et al. Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch. A multi-institutional, multinational evaluation. Urology. 2008;72:47.

    Article  PubMed  Google Scholar 

  58. Wason S, Lance R, Given R, et al. Robotic-assisted ureteral re-implantation: a case series. J Laparoendosc Adv Surg Tech A. 2015;25:503.

    Article  PubMed  Google Scholar 

  59. Elsamra S, Theckumparampil N, Garden B, et al. Open, laparoscopic, and robotic ureteroneocystostomy for benign and malignant ureteral lesions: a comparison of over 100 minimally invasive cases. J Endourol. 2014;28:1455.

    Article  PubMed  Google Scholar 

  60. Naude J. Buccal mucosa grafts in the treatment of ureteric lesions. BJU Int. 1999;83:751.

    Article  CAS  PubMed  Google Scholar 

  61. Zhao L, Weinberg A, Lee Z, et al. Robotic ureteral reconstruction using buccal mucosa grafts: a multi-institutional experience. Eur Urol. 2017;73:419.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Carolinas Medical Center, Charlotte, NC, USA

    Gillian Stearns

  2. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jaspreet S Sandhu

Authors
  1. Gillian Stearns
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  2. Jaspreet S Sandhu
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Corresponding author

Correspondence to Jaspreet S Sandhu .

Editor information

Editors and Affiliations

  1. University of Lisbon, Lisbon, Portugal

    Francisco E. Martins

  2. University of Oslo, Oslo, Norway

    Henriette Veiby Holm

  3. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jaspreet Sandhu

  4. Eastern Virginia Medical School, Norfolk, VA, USA

    Kurt A McCammon

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Stearns, G., Sandhu, J.S. (2023). Surgical Reconstruction of Ureteral Defects: Strictures, External Trauma, Iatrogenic, and Radiation Induced. In: Martins, F.E., Holm, H.V., Sandhu, J., McCammon, K.A. (eds) Female Genitourinary and Pelvic Floor Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-030-71112-2_51-1

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  • DOI: https://doi.org/10.1007/978-3-030-71112-2_51-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-71112-2

  • Online ISBN: 978-3-030-71112-2

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