Use of the da Vinci■surgical robotic system has expanded to numerous upper and lower urinary tract procedures.We describe our surgical technique and perioperative outcome of robotic distal ureterectomy with psoas hit...Use of the da Vinci■surgical robotic system has expanded to numerous upper and lower urinary tract procedures.We describe our surgical technique and perioperative outcome of robotic distal ureterectomy with psoas hitch and ureteroneocystostomy for distal ureteral pathologies.Eight patients with a median age of 69.5 years old underwent robotic distal ureterectomy with psoas hitch and ureteroneocystostomy between April 2009 and August 2014.The entirety of all cases was performed robotically by a single surgeon at a tertiary academic medical center.Median operative time was 285 min(range:210-360 min),estimated blood loss was 50 mL(range:50-75 mL)and median length of hospital stay was 2.5 days(range:1-6 days).There was one post-operative complication,a readmission for dehydration(Clavien Ⅰ).It suggests that robotic distal ureterectomy with psoas hitch and ureteroneocystostomy is a safe and effective minimally invasive alternative for patients with distal ureteral pathology.展开更多
Objective:To present our experience and technique with robot-assisted uretero-neocystos tomy(RAUN)procedure in adults.Methods:Between February 2015 and August 2018,a total of 30(34 ureters)patients who un-derwent RAUN...Objective:To present our experience and technique with robot-assisted uretero-neocystos tomy(RAUN)procedure in adults.Methods:Between February 2015 and August 2018,a total of 30(34 ureters)patients who un-derwent RAUN surgery under a single surgeon were retrospectively reviewed.Perioperative data such as age,sex,body mass index(BMI),American society of anesthes iologists score,esti-mated blood loss,surgical technique,operative time,complications,length of hospital stay,and stent removal time were recorded.During the follow-up,patients underwent renal func-tion test,urinalysis,and renal ultrasound examination for evaluation.Success was defined as symptomatic and radiologic relieve.Lastly,a literature search was conducted to review all published articles regarding RAUN surgery in adults.Results:The patients'mean age,BMI,EBL,operative time,and follow-up period were 45.4 years,23.1 kg/m^2,65.6 mL,182.9 min,and 21.3 months,respectively.The two most common indications for the surgery were benign ureteral strictures and ureteric injuries secondaryto a previous radical hysterectomy.Of the 34 cases,26(76.5%)and 8(23.5%)patients received pri-mary RAUN and RAUN with psoas hitch technique,respectively.Refluxing RAUN method was performed in all cases.No intraoperative complications were found.Two patients had a radio-logic and symptomatic recurrence;one was managed with a repeat surgery while the other received ureteral dilatation treatment.Conclusion:Both our study and the published literature showed that RAUN is a safe,less inva-sive,and effective surgical technique that can easily replicate the open ureteroneocystostomy for managing lower ureteral diseases.展开更多
BACKGROUND Disseminated peritoneal leiomyomatosis(DPL)with myxoid leiomyosarcoma is a rare variant of leiomysosarcoma,and hematuria as a presenting symptom has never been reported.Through this case report,we emphasize...BACKGROUND Disseminated peritoneal leiomyomatosis(DPL)with myxoid leiomyosarcoma is a rare variant of leiomysosarcoma,and hematuria as a presenting symptom has never been reported.Through this case report,we emphasize the investigation of the etiology,clinical presentation,diagnosis,treatment,and prognosis of DPL with malignant changes mimicking metastatic urinary tract cancer and to help develop further clinical management.CASE SUMMARY We describe a case of DPL with malignant transformation involving the right ureter after laparoscopic hysterectomy.An exploratory laparotomy was performed and all visible nodules were surgically removed.DPL with focal malignant transformation to myxoid leiomyosarcoma was confirmed based on pathology results.CONCLUSION Professionals who preoperatively diagnose DPL with malignant change to myxoid leiomyosarcoma involving the genitourinary tract should consider symptoms of abdominal pain,hematuria,and imaging of disseminated pelvic tumors in women,especially those with prior history of laparoscopic hysterectomy.Early complete removal of all tumors is the cornerstone to prevent DPL from malignant changes.展开更多
BACKGROUND Crossed fused renal ectopia is a rare congenital anomaly of the ascent of the kidney. This anomaly may be observed as a solitary kidney during initial evaluation. A solitary kidney must be evaluated for ass...BACKGROUND Crossed fused renal ectopia is a rare congenital anomaly of the ascent of the kidney. This anomaly may be observed as a solitary kidney during initial evaluation. A solitary kidney must be evaluated for associated anomalies such as duplication,horseshoe kidney,or crossed renal ectopia.CASE SUMMARY An anomaly was observed in a 9-mo-old male child who was subsequently diagnosed with crossed fused renal ectopia and vesicoureteral reflux(VUR). In this condition,recurrent febrile urinary tract infection can be a serious problem,and can easily cause renal damage due to relatively short ureters and high pressure in the kidney.CONCLUSION To prevent urosepsis and preserve renal function,early diagnosis and proper management including surgical correction should be considered for the management of renal ectopia with VUR.展开更多
文摘Use of the da Vinci■surgical robotic system has expanded to numerous upper and lower urinary tract procedures.We describe our surgical technique and perioperative outcome of robotic distal ureterectomy with psoas hitch and ureteroneocystostomy for distal ureteral pathologies.Eight patients with a median age of 69.5 years old underwent robotic distal ureterectomy with psoas hitch and ureteroneocystostomy between April 2009 and August 2014.The entirety of all cases was performed robotically by a single surgeon at a tertiary academic medical center.Median operative time was 285 min(range:210-360 min),estimated blood loss was 50 mL(range:50-75 mL)and median length of hospital stay was 2.5 days(range:1-6 days).There was one post-operative complication,a readmission for dehydration(Clavien Ⅰ).It suggests that robotic distal ureterectomy with psoas hitch and ureteroneocystostomy is a safe and effective minimally invasive alternative for patients with distal ureteral pathology.
文摘Objective:To present our experience and technique with robot-assisted uretero-neocystos tomy(RAUN)procedure in adults.Methods:Between February 2015 and August 2018,a total of 30(34 ureters)patients who un-derwent RAUN surgery under a single surgeon were retrospectively reviewed.Perioperative data such as age,sex,body mass index(BMI),American society of anesthes iologists score,esti-mated blood loss,surgical technique,operative time,complications,length of hospital stay,and stent removal time were recorded.During the follow-up,patients underwent renal func-tion test,urinalysis,and renal ultrasound examination for evaluation.Success was defined as symptomatic and radiologic relieve.Lastly,a literature search was conducted to review all published articles regarding RAUN surgery in adults.Results:The patients'mean age,BMI,EBL,operative time,and follow-up period were 45.4 years,23.1 kg/m^2,65.6 mL,182.9 min,and 21.3 months,respectively.The two most common indications for the surgery were benign ureteral strictures and ureteric injuries secondaryto a previous radical hysterectomy.Of the 34 cases,26(76.5%)and 8(23.5%)patients received pri-mary RAUN and RAUN with psoas hitch technique,respectively.Refluxing RAUN method was performed in all cases.No intraoperative complications were found.Two patients had a radio-logic and symptomatic recurrence;one was managed with a repeat surgery while the other received ureteral dilatation treatment.Conclusion:Both our study and the published literature showed that RAUN is a safe,less inva-sive,and effective surgical technique that can easily replicate the open ureteroneocystostomy for managing lower ureteral diseases.
文摘BACKGROUND Disseminated peritoneal leiomyomatosis(DPL)with myxoid leiomyosarcoma is a rare variant of leiomysosarcoma,and hematuria as a presenting symptom has never been reported.Through this case report,we emphasize the investigation of the etiology,clinical presentation,diagnosis,treatment,and prognosis of DPL with malignant changes mimicking metastatic urinary tract cancer and to help develop further clinical management.CASE SUMMARY We describe a case of DPL with malignant transformation involving the right ureter after laparoscopic hysterectomy.An exploratory laparotomy was performed and all visible nodules were surgically removed.DPL with focal malignant transformation to myxoid leiomyosarcoma was confirmed based on pathology results.CONCLUSION Professionals who preoperatively diagnose DPL with malignant change to myxoid leiomyosarcoma involving the genitourinary tract should consider symptoms of abdominal pain,hematuria,and imaging of disseminated pelvic tumors in women,especially those with prior history of laparoscopic hysterectomy.Early complete removal of all tumors is the cornerstone to prevent DPL from malignant changes.
文摘BACKGROUND Crossed fused renal ectopia is a rare congenital anomaly of the ascent of the kidney. This anomaly may be observed as a solitary kidney during initial evaluation. A solitary kidney must be evaluated for associated anomalies such as duplication,horseshoe kidney,or crossed renal ectopia.CASE SUMMARY An anomaly was observed in a 9-mo-old male child who was subsequently diagnosed with crossed fused renal ectopia and vesicoureteral reflux(VUR). In this condition,recurrent febrile urinary tract infection can be a serious problem,and can easily cause renal damage due to relatively short ureters and high pressure in the kidney.CONCLUSION To prevent urosepsis and preserve renal function,early diagnosis and proper management including surgical correction should be considered for the management of renal ectopia with VUR.
