Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy

Purpose To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios. Methods From March 2018 to January 2020, 53 patients with lo...

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Veröffentlicht in:International urology and nephrology 2021-03, Vol.53 (3), p.479-488
Hauptverfasser: Cheng, Sida, Fan, Shubo, Wang, Jie, Xiong, Shengwei, Li, Xinfei, Xu, Yangyang, Li, Zhihua, Guan, Hua, Zhang, Peng, Zhu, Hongjian, Huang, Chen, Zhang, Lei, Yang, Kunlin, Li, Xuesong, Zhou, Liqun
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container_end_page 488
container_issue 3
container_start_page 479
container_title International urology and nephrology
container_volume 53
creator Cheng, Sida
Fan, Shubo
Wang, Jie
Xiong, Shengwei
Li, Xinfei
Xu, Yangyang
Li, Zhihua
Guan, Hua
Zhang, Peng
Zhu, Hongjian
Huang, Chen
Zhang, Lei
Yang, Kunlin
Li, Xuesong
Zhou, Liqun
description Purpose To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios. Methods From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2–6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures. Results A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2–6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time ( P  = 0.008), shorter postoperative hospital stay ( P  = 0.011) but higher hospital cost ( P  
doi_str_mv 10.1007/s11255-020-02679-5
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Methods From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2–6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures. Results A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2–6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time ( P  = 0.008), shorter postoperative hospital stay ( P  = 0.011) but higher hospital cost ( P  &lt; 0.001). At a mean follow-up of 12.8 months, the overall success rate was 94.3%. There was no difference in postoperative complications or the success rate between the approaches. Conclusion Laparoscopic and robotic onlay flap/graft ureteroplasty can be safe and feasible to repair long proximal/middle ureteral strictures while robotic procedures showed higher efficiency, faster recovery but higher cost. Our algorithmic strategies may provide beneficial references for their standardization and dissemination into clinical care.</description><identifier>ISSN: 0301-1623</identifier><identifier>EISSN: 1573-2584</identifier><identifier>DOI: 10.1007/s11255-020-02679-5</identifier><identifier>PMID: 33037521</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Hospital costs ; Laparoscopy ; Medicine ; Medicine &amp; Public Health ; Mucosa ; Nephrology ; Robotics ; Standardization ; Stricture ; Urology ; Urology - Original Paper</subject><ispartof>International urology and nephrology, 2021-03, Vol.53 (3), p.479-488</ispartof><rights>Springer Nature B.V. 2020</rights><rights>Springer Nature B.V. 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-2c7a58b06de0eb6fd57e8c8f85cdfbeac3889f020895cf5c4e7176a00014629b3</citedby><cites>FETCH-LOGICAL-c375t-2c7a58b06de0eb6fd57e8c8f85cdfbeac3889f020895cf5c4e7176a00014629b3</cites><orcidid>0000-0003-1591-9581</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11255-020-02679-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11255-020-02679-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33037521$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cheng, Sida</creatorcontrib><creatorcontrib>Fan, Shubo</creatorcontrib><creatorcontrib>Wang, Jie</creatorcontrib><creatorcontrib>Xiong, Shengwei</creatorcontrib><creatorcontrib>Li, Xinfei</creatorcontrib><creatorcontrib>Xu, Yangyang</creatorcontrib><creatorcontrib>Li, Zhihua</creatorcontrib><creatorcontrib>Guan, Hua</creatorcontrib><creatorcontrib>Zhang, Peng</creatorcontrib><creatorcontrib>Zhu, Hongjian</creatorcontrib><creatorcontrib>Huang, Chen</creatorcontrib><creatorcontrib>Zhang, Lei</creatorcontrib><creatorcontrib>Yang, Kunlin</creatorcontrib><creatorcontrib>Li, Xuesong</creatorcontrib><creatorcontrib>Zhou, Liqun</creatorcontrib><title>Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy</title><title>International urology and nephrology</title><addtitle>Int Urol Nephrol</addtitle><addtitle>Int Urol Nephrol</addtitle><description>Purpose To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios. Methods From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2–6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures. Results A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2–6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time ( P  = 0.008), shorter postoperative hospital stay ( P  = 0.011) but higher hospital cost ( P  &lt; 0.001). At a mean follow-up of 12.8 months, the overall success rate was 94.3%. There was no difference in postoperative complications or the success rate between the approaches. Conclusion Laparoscopic and robotic onlay flap/graft ureteroplasty can be safe and feasible to repair long proximal/middle ureteral strictures while robotic procedures showed higher efficiency, faster recovery but higher cost. 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Methods From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2–6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures. Results A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2–6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time ( P  = 0.008), shorter postoperative hospital stay ( P  = 0.011) but higher hospital cost ( P  &lt; 0.001). At a mean follow-up of 12.8 months, the overall success rate was 94.3%. There was no difference in postoperative complications or the success rate between the approaches. Conclusion Laparoscopic and robotic onlay flap/graft ureteroplasty can be safe and feasible to repair long proximal/middle ureteral strictures while robotic procedures showed higher efficiency, faster recovery but higher cost. Our algorithmic strategies may provide beneficial references for their standardization and dissemination into clinical care.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>33037521</pmid><doi>10.1007/s11255-020-02679-5</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-1591-9581</orcidid></addata></record>
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subjects Hospital costs
Laparoscopy
Medicine
Medicine & Public Health
Mucosa
Nephrology
Robotics
Standardization
Stricture
Urology
Urology - Original Paper
title Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy
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