ABSTRACT
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
Subject(s)
Animals , Plastic Surgery Procedures , Laparoscopy , Dogs , Replantation , Follow-Up StudiesABSTRACT
Ninty two bilharzial patients were subjected to different ureteroscopic manipulations for primary ureteric stones [5 7 patients], ureteric stricture with secondary stones [13 patients] and ureteric stricture [22 patients]. Difficulties of the technique included: failure to identify the ureteric orifice, shredding and cracking of the mucosa during dilatation, upward migration of stones in dilated ureters, restricturing after dilation and vesico-ureteral reflux. Different precautions had been used to avoid these difficulties. He concluded that although bilharzial affection of the ureter is not a contra-indication for ureteroscopy yet it imposes certain difficulties upon the procedure and must be cautiously handled
Subject(s)
Endoscopy/methods , Ureter/pathologyABSTRACT
After the installation of the third generation Dornier MPL 9000 multipurpose lithotripter in Assiut University Hospital and within one year 460 patients suffering from renal calculi were treated using a modified ellipsoid with a larger skin to focus distance with increased coupling surface area. Single stone was encountered in [214 patients], two stones [91 patients], branched stones [39 patients], multiple stones [116 patients] Succesful disintegration was achieved in 94% with an average number of sessions 2.28. The great majority of cases were premedicated by morphia or pithidine and one of the non steroidal anti-inflammatory drugs [NSAID]. Our preliminary reports concerning the use of Dornier MPL 9000 for treatment of nephrolithiasis indicated that the technique was easy, safe, effective and provided a maximal range of indications
Subject(s)
Lithotripsy/methodsABSTRACT
The pulsed-dye laser was tried in fragmentation of ureters calculi in 60 patients. The maneuver has been achieved successfully in 56 cases. 33 of those patients gave positive history of B. infestation and anti B. Treatment. The small diameter and flexibility of the laser fibre enabled us to pass it through the miniscope [6.9 F.] which was suitable for children and patients with bilharzial ureteral affection, as dilatation in such cases will lead to crack in the tough wall of bilharzial ureter, with great possibility of stenotic complications later on. All stones seen endoscopically and treated with pulsed dye laser were fragmented including those of calcium oxalate monohydrate. Late follow up [1 1/2 years revealed negligible complications