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Objective To discuss the safety and efficacy of inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture.Methods There was an retrospective analysis on operation videos and clinical data for 16 participants of inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture with the period from March in 2012 to September in 2015. And these were statistically analyzed including the operation time, intraoperative bleeding volume, postoperative drainage volume, removal time of drainage tube, admission time after operation and the incidence of postoperative complications of vesicoureteric reflux and stenosis.Results The operations of 16 participants were completed successfully without converting to open surgery. The operation time was 60 ~ 125 min (Mean time: 85 min); intraoperative bleeding volume was 20 ~ 50 ml (Mean volume: 32 ml); postoperative drainage volume was 60 ~ 400 ml (Mean volume: 106 ml); removal time of drainage tube was 3 ~ 6 d (Mean time: 4.2 d) and admission time after operation was 7 ~ 10 d (Mean time: 8.5 d). There was the follow-up with 6 ~ 18 months (Mean time: 12 months) for participants. No anastomotic stenosis was present. In addition, one participant was suffered from mild vesicoureteric relfux. And there was no aggravation during 18 months.Conclusions The inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture was safe and effective. It was found that the operation time was significantly shortened and the incidence of postoperative complications of vesicoureteric relfux and anastomotic stenosis was not increased. By contrast, the six-stitch suture could reduce the incidence of anastomotic stenosis.
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Objective To investigate the feasibility and clinical effect of immediate ureterovesical reimplantation after ureteral rupture during laparoscopic hysterectomy. Methods From August 2010 to December 2015, 5 cases of ureteral rupture during the operation of laparoscopic hysterectomy were treated with immediate ureterovesical reimplantation under laparoscopy. Results All operations were successfully performed without transversion to open surgery. No patients with urinary leakage occurred. The mean follow-up were 21 months (range 3-60 months) . No cases with ureteral stricture were observed. Slight urine reflux was found in two patients, of whom obvious hydronephrosis and renal damage were not found. Conclusion Immediate ureterovesical reimplantation under laparoscopy is a feasible, safe and minimal invasive method for treatment of ureteral ruputure during laparoscopic hysterectomy.
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Objective To report the experiences on the diagnosis and treatment of duplication of kidney ureter and bladder. Methods Nine cases of duplication of kidney ureter and bladder from 1996 to 2008 were reviewed.Six cases of duplicated kidney ureter occurred in the left side and 2 cases in the right side,1 case bilateral kidney ureteral duplication.Of 8 cases with unilateral duplicated,duplicated bladders were incompleteness.And the patient with bilateral duplicated,whose duplicated bladder was completeness,was diagnosed with duplication of urethra,uterine,bilateral ovary and oviduet tubes,and also suffered from duplicated uterine prolapse Ⅱ,vaginal anterior wall bulging and duplicated vesicocele.There were two cases whose duplicated kidney losed function because of severe hydronephrosis,and 7 cases existed kidney secretion function. Excision of duplicated kidney ureter and bladder were performed on 2 cases with non-functional duplicated kidney.6 cases had undergone duplicated bladder excision and duplicated ureteral bladder replantation.The special case had undergone duplicated urinary bladder urethra uterine and bilateral annexes excision,and duplicated ureteral bladder replantation. Results The operation was successful in all paients without leakage and ureter stump syndrome.Three months after operation,ureter bladder imaging showed no ureteral reflux in 7 cases of ureteral bladder replantation.IVU were reviewed 12 months after operation:2 cases undergoing duplicated kidney excision showed that the function of residual kidney were normal,7 cases of replantation that the shape and function of sick side kidney and duplicated kidney were good. The patient who suffered from duplicated uterine simultaneously got pregnancy 1.5 years after operation. Conclsions Image examinations may help to diagnose the duplication of kidney ureter and bladder. The main treatment is surgery. Understanding the function of duplicated kidney and the shape of kidney ureter and bladder should be considered before operation. The goal of surgery should be relieving pain,protecting the function of duplicated kidney and minimizing the risk of infection.
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Objective To introduce the new technique of transperitoneal laparoscopic ureterovesical reimplantation and to evaluate its feasibility and clinical significance. Methods Overall,17 cases (5 men and 12 women) of ureterovesical obstruction (left,7 and right,10) were included.Of them,10 cases were diagnosed with simple congenital ureter outlet stricture;1 had calculi and polyp formation at right ureter outlet;2 had recurrent ureter outlet stricture after open ureterovesical reimplantation (1 of them had 2 calculi at lower part of the ureter);1 had double nephroureteral upper unit ureter outlet stricture with 2 calculi;2 had recurrent ureter outlet stricture after holmium laser section;1 with urinary TB had right ureter outlet stricture after left nephrectomy.Among the 17 cases,severe hydronephrosis occurred in 12,and moderate,in 5.Transperitoneal laparoscopic ureterovesical reimplantation was performed in the 17 cases (ureterovesical anastomosis in 15 and bladder flap ureterovesical reimplantation in 2). Results The operations were all successful in 17 cases with operating time of 90～160 min (mean, 112 min) and blood loss of 60～100 ml.The drainage tubes were removed 1～3 days after surgery without urine leakage.The urinary catheters were removed 1 week after surgery and double J stents,1 month after surgery. Six months after surgery cystography showed Ⅲ?urine reflux in 6 cases, Ⅰ?-Ⅱ? urine reflux in 5 and no reflux in 6.One year after surgery cystography showed Ⅲ? urine reflux in 3 cases, Ⅰ?～Ⅱ? urine reflux in 4 and no reflux in 10.During 3～24 months' follow-up, ultrasound B and IVU showed moderate hydronephrosis in 4 cases,mild,in 5 and no obvious hydronephrosis in 8. Conclusions Laparoscopic ureterovesical reimplantation is a feasible,less painful and minimally invasive alternative method for treatment of ureterovesical diseases.By comparison,bladder flap ureterovesical reimplantation has better anti-urine reflux effect but more complicated than ureterovesical anastomosis does.Long term efficacies of the methods need further observation.