Laparoscopic reconstruction of the ureter: a survival canine study

Laparoscopic reconstruction of the ureter is a rarely visited domain in literature. Such reconstructive procedures, performed via conventional surgery, are common in our practice for management of Bilharzial and Tuberculous ureteric strictures, congenital malformations and iatrogenic trauma to the ureter. Ureteroneocystostomy, Boari flap and ileal replacement of the ureter are the procedures of choice in management of the whole spectrum of ureteral defects with high success rates for the open surgical procedures. To present our initial experience with experimental laparoscopic ureteroneocystostomy, Boari flap and ileal replacement of the ureter aiming at evaluation of such procedure and gaining experience prior to clinical application. Twelve healthy Mongrel dogs stratified into three groups. Each dog was subjected to one of three different levels of ureteric obstruction for one renal unit. Group 1 included 4 females for which juxtavesical obstruction of one ureter was done, Group 2 included 4 females for which obstruction was made at the lower part of the lumbar ureter and Group 3 which included 3 males and 1 female for which high lumbar obstruction was performed. Laparoscopic ureteroneocystostomy was performed for group I dogs, laparoscopic Boari flap for group 2 and laparoscopic ileal replacement of the ureter for group 3. All dogs survived the procedures, operative time ranged from 140 to 360 minutes [mean 253 +/- 70 minutes] and overall success rate was 83.33% as one renal unit lost function and one dog died on the second postoperative day. Laparoscopic reconstruction of the ureter with simple or complex procedures is technically feasible and safe. Standard laparoscopic armamentarium is quite sufficient for such procedures. Further experimentation is needed to outline the learning curve and to evaluate more techniques. Owing to our initial experience, we can conclude that clinical application of such procedures would be an achievable target in the hands of devoted laparoscopic surgeons who have good experience with reconstructive laparoscopic surgery

Intramural extravesical tunnel, a modified antireflux uretero-neocystotomy for treatment of bilharzial lower ureteric stricture

In this work, intramural extravesical tunnel as a modified method of antireflux ureteral re-implantation in the surgical treatment of bilharzial stricture of lower end ureters was evaluated. This prospective study was carried out on 48 adult patients with bilharzial stricture lower end ureters. Ureteral obstruction was documented by intravenous urography [IVU]. Washout diethylene triamine pentaacetic acid [DTPA] renogram was required in 13 patients for confirmation and ureteral re-implantation with intramural extravesical tunnel was done for them. Out of the forty-eight patients who underwent re- implantation, forty-two were available for follow up; thirty-seven revealed patent non-refluxing ureters, three revealed low grade reflux and re-obstruction was detected in two

Diuretic ultrasonography: its value in the diagnosis of lion pain

This study included one hundred patients complaining of loin pain, while their kidneys [under usual conditions] were sonographically normal. Diuretic ultrasonography was done for these, good orally hydrated, patients 15-20 minutes after intravenous injection of 40 mg furosemide. Patients with urinary tract infection, crystalluria and patients who had detectable cause on ultrasonographic examination without diuresis were excluded from the study. Out of these one hundred patients, 26% showed pelvicalyceal dilatation on diuretic ultrasonography [previously normal on ultrasonography without diuresis]. All except one showed down stream obstruction on confirmatory investigation [96% sensitivity]. None of the patients who were found to be normal on diuretic ultrasonography proved to have down stream obstruction [100% specificity]. Carefully performed, diuretic ultrasonography clearly distinguished patients with loin pain due to obstruction from those due to other causes. Therefore, the number of radiographic examination can be reduced to minimum and the problem of subtle ureteral obstruction can be resolved as well. Diuretic ultrasonography thus appears to be promising easy and noninvasive method for evaluation of patients complaining of loin pain