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The existing ureteral reconstruction treatment methods are unable to meet the clinical needs due to complications such as stricture, ureteral fistula and lack of donor. Tissue engineering provides a new feasible method. The main construction strategies, material selection and preparation methods for the study of tissue-engineered ureter at home and abroad are reviewed. The review focused on the current status of the development of tissue-engineered ureter based on textile technology, and concluded that ureteral reconstruction suffered from the contradiction between good reconstructive effect and short-term preparation time, as well as limited local smooth muscle growth. Micro-nano fiber aggregates prepared by textile technology can control the multi-level structure of fibers, yarns and fabrics. Further design of multi-layered structures of different materials combined with textile technology and investigation of their modulating effects on the behavior of various types of cells will provide new directions for the optimal design of tissue-engineered ureteral scaffold structures. [ABSTRACT FROM AUTHOR]

Internal hernias are difficult to diagnose clinically, and normal cross-sectional imaging has been documented in many patients. Transmesenteric hernias from congenital defects or prior abdominal surgery are most common. A 46-year-old previously healthy female presented to the emergency department with acute onset nausea and vomiting eight years after a right ureteral transection during a laparoscopic hysterectomy, with a delayed ureterolysis and reimplantation into the bladder. Rectal contrast CT scan demonstrated a partial large bowel obstruction that was unclear if it was due to an underlying mass, stricture, or internal herniation. The patient was taken for exploratory laparotomy which demonstrated redundant transverse colon herniated under the mobile right ureter; an extended right hemicolectomy was performed. This report describes alteration of retroperitoneal anatomy creating a potential space for colonic herniation and emphasizes that clinical suspicion must remain high for patients presenting with obstructive or partially obstructive symptoms. [ABSTRACT FROM AUTHOR]

Introduction: There is no standardised, universal method to assess physical conditions such as pressure in the pelvicalyceal system in real time during RIRS (retrograde intrarenal surgery). Therefore, the problem of increased pressure in the upper urinary tract during the procedure is underestimated. Moreover, it can potentially cause micro-damage and longer postoperative recovery. The aim of this study was to evaluate intrapelvic pressure (IPP) during RIRS procedures. Materials and Methods: The 3D printed models of the pelvicalyceal system were printed based on a CT scan of the real patient. They were used to perform 50 RIRS procedures with laser lithotripsy of artificially synthesised kidney stones with two different sizes of ureteral access sheath-UAS (10/12Fr vs. 12/14Fr) together with different energy settings generated by the holmium:YAG laser. IPP monitoring during RIRS was performed with the use of the PressureWire X Guidewire compatible with the CoroFlow system. Results and Conclusions: The results showed that a high IPP of up to 400 cmH2O would be achieved using a 10/12Fr UAS, while the use of a 12/14Fr UAS would significantly reduce the peak pressure to approximately 100 cmH2O; hence, the size of the UAS is a pivotal factor of the IPP generated during the procedure. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) causes pain and discomfort after surgery. The primary causes of immediate postoperative pain after PCNL are visceral pain from the ureters and kidneys, and body surface discomfort from incisions. Acute, untreated pain has the potential to develop into chronic pain, which remains a considerable burden for the rehabilitation of patients. The goal of this review was to describe the current options for treating pain post-PCNL. METHODS: We conducted a literature review of all published manuscripts on pain protocols for patients undergoing PCNL and related topics; 50 published manuscripts were identified and reviewed. RESULTS: PCNL morbidity must be reduced by an appropriate management of postoperative pain. Opioids, multimodal therapy, tubeless PCNL, reduced size of nephrostomy tube, and regional anesthesia are currently available for reducing postoperative pain. CONCLUSIONS: Implementing successful treatment strategies for postoperative pain after PCNL is key in reducing the morbidity and mortality of PCNL. [ABSTRACT FROM AUTHOR]

Simple Summary: Para-aortic lymphadenectomy is an essential part of gynecologic oncologic surgical treatment. The surgeon should be aware of the complex usual anatomy and its common variants. Vascular and urinary tract anatomic variants are common and may be found in one out of five patients during para-aortic lymphadenectomy, so the surgeon should always consider them. The most common vascular variant is the accessory renal artery, which is usually not detected on preoperative imaging. An abdominal CT should be interpreted jointly by a radiologist and a surgical gynecologist whenever possible. For optimal intraoperative management, it is strongly recommended that precise dissection be performed to facilitate exposure and provide valuable insight for potential vascular repair. Background: Para-aortic lymphadenectomy is an essential part of gynecologic oncologic surgical treatment. The surgeon should be aware of the complex usual anatomy and its common variants. Methods: Between January 2021 and May 2023, 58 women underwent para-aortic lymphadenectomy for gynecologic malignancies. Results: Vascular and urinary tract anatomic variants were retrospectively reviewed from the prospective institutional database and results were compared with preoperative contrast-enhanced abdominal CT. Of these 58 women, 47 women had no vascular or urinary tract variants. One woman had a double inferior vena cava, two patients were found to have a retro-aortic left renal vein, four had accessory renal arteries, two had a double left ureter, one had a ptotic kidney in the iliac fossa, and one patient had bilateral kidney malrotation. Anatomic variants in the preoperative CT were described by a radiologist in only two patients, and additional vascular and urinary tract variants were found incidentally at the time of surgery. Conclusions: Acknowledgment of vascular and urinary tract variants is helpful for the surgeon to establish an appropriate surgical plan and to avoid iatrogenic surgical trauma. [ABSTRACT FROM AUTHOR]

Background: Amyloidosis is a collection of disorders characterized by the extracellular deposition of amyloid, a specialized fibrous protein, in diverse tissues, leading to functional impairments. Case presentation: A 70-year old Asian-Japanese female was referred to our department for further examination of her left hydronephrosis come from lower ureteral obstruction. Contrast enhanced CT and retrograde pyelo-nephrography revealed left ureteral tumor. Though ureteroscropic biopsy did not show malignant pathological findings, ureteroscopic image suspected malignant disease, thus nephroureterectomy was performed. Pathological findings revealed localized ureteral amyloidosis. Whole body examination including gastro endoscopy and cardio ultrasonography could not reveal amyloidosis except ureter. She was free from recurrence 9 months postoperatively. Conclusion: We herein report a rare case of localized ureteral amyloidosis. [ABSTRACT FROM AUTHOR]

Ureteral ectopia is rare and requires surgical treatment after a thorough diagnostic workup. Open surgical techniques for repositioning ectopic ureters have been known for many years and are well described in the literature. However, to the best of our knowledge, no laparoscopic method of correcting this pathology has been described, which, in our opinion, would benefit the animal in terms of the healing process and overall clinical outcomes. This study aimed to evaluate the possibility of laparoscopic treatment of ureteral ectopia, which causes urinary incontinence in dogs. All of the operated ten dogs presented in this study were client-owned females with symptoms of urinary incontinence due to a unilateral intramural ectopic ureter. A three-trocar laparoscopic technique was used to perform the ureteroneocystostomy of the ectopic ureter. In this article, clinicopathological data, imaging features, procedural findings, complications, and short- and long-term outcomes are presented. The procedure was feasible in all cases. No major postoperative complications were observed. Among the minor complications, slight hematuria was observed in three dogs, which resolved spontaneously. In the period of at least one year after surgery, no negative impact of the procedure was observed. Seven of the ten operated dogs regained urinary continence. The remaining three dogs required additional surgery (urethral bulking) because of a lack of improvement after adjuvant pharmacological treatment. Overall, good-to-excellent long-term outcomes can be achieved; however, dogs that remain incontinent after laparoscopic ureteroneocystostomy may require additional treatment. [ABSTRACT FROM AUTHOR]

Objective: Ureteroscopy (URS) is a commonly used procedure for the management of ureteral stones. While elective URS has been extensively studied, the literature on emergency URS remains limited. The aim of the present study is to evaluate the efficacy and safeness of URS performed in emergency settings and to determine the ideal candidates for this type of intervention. Methods: Patients who underwent URS for ureteral stones in a single healthcare unit, “Saint John” Emergency Clinical Hospital, Bucharest, Romania, were included in a retrospective investigation between April 2022 and March 2023. The study group was divided into two subgroups: group A (138 patients who underwent semirigid URS in an emergency setting) which was subdivided into group A1 (95 patients with stone on the distal ureter) and group A2 (43 patients with stone on the proximal ureter), and group B (151 patients who underwent a double J stent insertion). The success rate defined as stone fragmentation and resolution of renal obstruction, along with intraoperative and postoperative complications were assessed. A URS procedure was considered unsuccessful if either the instrument could not be passed to access the stone or it was deemed unsafe to perform the URS. In such cases, patients were managed by inserting a ureteric stent and scheduled for a subsequent procedure. Results: It could be observed that most complications occurred in emergency ureteroscopy on distal ureter (95 cases) and the most severe ones on proximal ureter (two cases-Clavien 4). Double J stenting provided a reduced number of complications (51 cases). It should be mentioned that patients with emergency semirigid ureteroscopy had more complications than those with double J stent for every group of BMI, while most of the complications were observed in the groups with the highest BMI. The success of the URS procedure was determined based on complete stone fragmentation and extraction, and it was of 91.3% for cases with emergency ureteroscopy. Conclusion: Patients who underwent URS for ureteral stones at a single facility, “Saint John” Emergency Clinical Hospital, Bucharest, Romania, were included in a retrospective investigation. The success rates and complication rates of emergency URS were comparable to those of elective URS, providing valuable insights for clinical decision-making. [ABSTRACT FROM AUTHOR]

Objective: To prospectively compare power Doppler ultrasound diagnostic performance with reference standard cystoscopy in evaluating ureteral patency in a population at high risk of ureteral lesions. Methods: We analyzed 100 women who underwent pelvic organ prolapse repair. All ultrasound scans were obtained, at the end of the procedures, before cystoscopic evaluation. Bilateral simultaneous ureteral jet evaluation with power Doppler was performed at the level of the ureterovesical junctions with a pulse repetition frequency set to detect low flow for a maximum of 3 min. Results: According to the reference standard urethrocystoscopy, at least one ureter not ejaculating was observed in 6% of patients, for a total of seven ureters jets not visualized. No false‐negative results were obtained. Ultrasound with power Doppler showed 100% sensitivity and 95.9% specificity in detecting the lack of ureteral jet. The negative predictive value was 100%, and the positive predictive value was 46.7%. Conclusions: Ultrasound with power Doppler represents an effective and reliable non‐invasive screening test to exclude ureteral kinking and reduce the need for intraoperative cystoscopy. Synopsis: Power Doppler ultrasound represents an effective and reliable non‐invasive screening test to exclude ureteral kinking and reduce the need for intraoperative cystoscopy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical efficacy of ureteroscopic lithotripsy (URSL) in the treatment of proximal impacted ureter stones (PIUS) based on a new scoring standard in two medical centers. Methods: The data of 45 patients with Complicated PIUS (total stone score ≥ 3) and 350 with Simple PIUS (total stone score < 3) who underwent URSL were collected in this retrospective study between January 2015 and June 2022. The definition and scoring standards for preoperative high-risk factors associated with stones included whether the diameter of the stone was > 2 cm, stone density was > 1000 HU, there was a history of lithotripsy, the degree of hydronephrosis was greater than moderate, and there was an infection. Scores for stones were then assigned (yes = 1, no = 0), and the Complicated stone case was defined as a total stone score ≥ 3; the Simple stone case was defined as a total stone score < 3. During the same period, 45 patients were selected from the patients with Simple stone cases as the control group, matched at a 1:1 ratio to index Complicated stone cases with regard to age, sex, and BMI. Perioperative data were compared between the two groups. Results: All 90 operations were successfully completed. Compared to the Simple cases group, the surgical duration of the Complicated group was significantly longer (59.69 ± 28.06 min vs. 73.46 ± 27.12 min, p < 0.05), and stone-free rate (SFR) was significantly lower (88.89 vs. 68.9%, p < 0.05). There was a significant difference in complication rate between the two groups regarding Clavien grade I, II, or III complications (20.0% in Complicated cases group vs. 8.9% in Simple cases group, p = 0.037). As for the length of the hospital stay and the total treatment cost, the two groups have no difference. Conclusion: For Simple stone cases, URSL had a better SFR and higher surgical efficacy, whereas complicated stone cases had a high complication rate and long operation time. Thus, we suggest that URSL is the preferred choice for Simple stone cases rather than complicated stone cases. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study is to compare long-term outcome of endoscopic treatment of VUR using PPC or Dx/HA. Patients and methods: From October 2014 to April 2017 patients with VUR grades from 3 to 5 that needed endoscopic treatment were eligible for this RCT. Patients were randomized in two groups: PPC and Dx/HA. A VCUG was performed at 6 months; if VUR > 3 was still present a second ET was performed. We included for this long-term follow-up study those patients that were successfully treated at short-term follow-up. At 36 months postoperative VCUG was performed to assess outcome. Success was considered if postoperative VUR grade was 0 at 36 months, and there was no ureteral obstruction. Results: In the previous study, 60/73 ureters were successfully treated in 36/44 patients, and then we have analyzed 60 ureters in 36 patients. Three patients were lost in long-term follow-up, and then we analyzed 57 ureters in 33 patients divided. PPC group 18 patients (28 ureters); and Dx/HA group 15 patients (29 ureters). After 3 years of follow-up the VCUG showed a success rate of 26/28 of RU in PPC and 26/29 of DX/HA. Two RU in PPC group had ureteral obstruction, and then the successful rate for PPC group dropped to 24/28. The overall successful rate at long-term was 72.7% of the RU in PPC group and 70.3% in Dx/HA group. Conclusion: PPC and Dx/HA has similar long-term outcome in VUR resolution, but ureteral obstruction could be present at long-term follow-up in PPC group. [ABSTRACT FROM AUTHOR]

The purpose of this article is to review the effects of different types of pharmacotherapy on symptoms that affect the quality of a patient's life after stent insertion. A thorough Medline/PubMed nonsystematic review was conducted from 1987 to January 2023, using the terms: "pigtail" OR "ureteral stents" AND "lower urinary tracts symptoms" OR "LUTS" AND "pharmacotherapy" OR "drugs". Relevant studies conducted in humans and reported in English language were included. The available reviews and articles associating the use of drugs with stent‐related symptoms (SRS) provide conflicting results. Most of them show a clear benefit of alpha blockers, particularly alfuzosin, on treating urinary SRS, and hence there is a strong recommendation for the use of alpha blockers for the treatment of SRS in the guidelines of the European Association of Urology. Anticholinergics and mirabegron have shown a significant benefit in dealing with irritative bladder symptoms. In contrast, the findings for combination therapies are contradictory, with some studies showing that combination therapy is no superior to monotherapy with regards to most of the subsets of the Ureteral Stent Symptom Questionnaire (USSQ), whereas others present a clear benefit of combination therapies, specifically silodosin and solifenacin, in treating stent‐associated lower urinary tract symptoms (LUTS), in comparison with any other type of monotherapy or combination therapy. Many studies suggest that some categories of pharmacotherapy, such as alpha blockers, can alleviate SRS. However, there is conflicting evidence concerning most other types of medical treatment. Randomized trials with the largest number of patients are needed to investigate the effectiveness of novel approaches on SRS. [ABSTRACT FROM AUTHOR]

The objective: to determine the activity levels of total N-acetyl-β-D-glucosaminidase (NAG), its heat-stable isoenzyme NAG B and β-galactosidase (β-Gal) as enzymological criteria of the functional state of the kidney parenchyma, in particular its tubular part, in the urine of younger children age group with congenital megaureter (MU) depending on the degree of suppression of the urodynamics of the upper urinary tract (UUT). Materials and methods. Before reconstructive treatment 103 children aged 0.5 to 15 years with various clinical variants of congenital MU were examined. According to the degree of suppression of urodynamics of the UUT, the patients were divided into three groups: 1st group - 32 patients with I degree (initial degree), 2nd group - 41 children with II degree (medium one), 3rd group - 30 patients with III degree (expressed one). The control group included 25 practically healthy children. Patients were divided into two subgroups by age. Subgroup "a" included 29 patients aged from 0.5 to 3 years (average age - 1.4±0.5 years), of which 9 patients were examined in the 1st group, 13 persons - in the 2nd group, in 3d group - 7 patients. Subgroup "b" included 74 children aged 4 to 15 years (average age - 8.3±1.5 years). Enzymological activity of the morning portion of urine in patients was determined by the colorimetric method. Statistical processing of data was performed after analyzing the conformity of their distribution to normality. Results. It was established that the total activity of NAG and the activity of NAG B in the urine of all patients with congenital MU with the I degree of suppression of urodynamics of the UUT, regardless of age, probably exceeded the average data of similar indicators in the control group (p<0.05-0.001). In children with congenital MU with II degree suppression of urodynamics of the UUT, regardless of age, a similar trend of changes in the activity levels of all the studied enzymes was determined, compared to patients of the 1st group (р<0.02-0.001). The total activity of NAG, the activity of NAG B and β-Gal in the urine of patients with III degree of suppression of urodynamics of the UUT probably exceeded similar indicators compared to patients of the 2nd group regardless of the age (p<0.001). The results of the study showed that in patients with the I degree of suppression of urodynamics of the UUT between age groups there was no statistical probability of changes in the activity levels of the studied enzymes. In children under 3 years of age with III degree of inhibition of urodynamics of the UUT the levels of enzyme activity probably exceeded similar indicators in the group of patients of 3 years old and over (р<0.05-0.001). Enzyme activity levels of NAG and NAG B in the urine of patients under 3 years old with II degree of suppression of urodynamics of the UUT also statistically significantly exceeded the similar indicators of sick children over 3 years old (p<0.01). Conclusions. The intensity of the increase in the urinary activity of NAG, its thermostable isoenzyme NAG B and β-Gal in patients under 3 years old compared to the group of patients over the age of 3 years growths with an increase in the degree of suppression of the urodynamics of the UUT, which should be taken into account during treatment. [ABSTRACT FROM AUTHOR]

Background: Anatomical variations are defined as atypical morphologic and positional presentations of anatomical entities. Pelvic anatomical variations encountered during abdominal hysterectomy can be of clinical interest, given that misidentification of certain structures can lead to iatrogenic injuries and postoperative sequelae. The aim of the present study was to detect and highlight the anatomical structures of interest and their variations to the surgeon performing abdominal hysterectomy for benign conditions. Materials and methods: A narrative review of the literature was performed including reports of anatomical variations encountered in cadavers, by surgeons during abdominal hysterectomy and radiologists on computed tomography angiography, searching within a 10-year span on PubMed database. Studies regarding the treatment of malignant conditions requiring lymphadenectomy and different modes of surgical approach were reviewed with regards to the aspects relevant to benign conditions. The search was extended to the reference lists of all retrieved articles. Results: Ureters and the uterine arteries, due to anatomical variations, are the anatomical structures most vulnerable during abdominal hysterectomy. Specifically, the ureters can present multiplications, retroiliac positionings and ureteric diverticula, whereas, the uterine arteries can present notable variability in their origins. Such variations can be detected preoperatively or intraoperatively. Conclusions: Although rare, the presence of anatomical variations of the uterine arteries and ureters can increase the possibility of complications should they escape detection. Intraoperative misidentification could lead to improper dissection or ligation of the affected structures. Knowledge of these variations, coupled with extensive preoperative investigation and intraoperative vigilance can minimise the risk of complications. [ABSTRACT FROM AUTHOR]

The patient was 66 years old, had three pregnancies and two deliveries, and was menopausal at the age of 51. She had irregular bleeding and was found to have a chicken-egg-sized uterus and a thickened endometrium (23 mm). She underwent laparoscopic surgery for uterine endometrial cancer (endometrioid carcinoma G1, stage IB). Laparoscopic simple hysterectomy, bilateral adnexectomy, pelvic lymph node dissection, para-aortic lymph node dissection, and partial omentectomy were performed using the transperitoneal approach (TPA). The patient was obese, with a height of 148 cm, a weight of 68 kg, and a body mass index of 31 kg/m2. She had a large amount of visceral fat, which made it difficult to expand the surgical field during para-aortic lymph node dissection. A laparoscopic fan retractor (EndoRetract II, Medtronic) was used to lift the intestinal tracts and expand the field of view. It broke the fat around the left kidney, and the exposed left ureter was heat-damaged using a vessel sealing device (LigaSure, Medtronic). Postoperatively, a left ureteral stent was placed, and continuous urine draining into the retroperitoneum was performed. To prevent injury to the left ureter, the left ovarian vein branching from the left renal vein should be exposed as a landmark before the left ureter running parallel to it is isolated. It is essential that the fat around the left kidney is not broken during this operation. The left iliopsoas muscle should be exposed, and using this as a base, the left ovarian vein, left ureter, and left perirenal fat should be compressed and moved to the left side using a fan retractor to ensure a safe operation. [ABSTRACT FROM AUTHOR]

Objective: We describe and analyze outcomes of a novel extra-anatomical paracolic gutter routing technique for surgical repair of aorto-iliac infections. Methods: A double-center, observational, cohort study of all consecutive patients with aorto-iliac infections treated using extra-anatomical paracolic gutter technique. Between May 2015 and December 2022, six patients with aorto-iliac infections were treated with the paracolic gutter routing technique. Cases were identified retrospectively in an institutional database, and data were retrieved from surgical records, imaging studies, and follow-up records. Results: Aorto-bifemoral vascular reconstructions were performed using this technique in six patients. During mean follow-up of 52 ± 44 months, there was one case of graft thrombosis (17%) with subsequent successful thrombectomy. Primary and secondary graft patency rates were 83% and 100%, respectively. There was one mortality (17%) due to candida sepsis. All graft prostheses were patent at last follow-up. Conclusions: The paracolic gutter technique is a useful technique in patients with extensive aorto-iliac infections, arteriovenous and iliac-ureteric fistulas, or at a high risk of vascular graft infection and is associated with favorable reinfection and patency rates. [ABSTRACT FROM AUTHOR]

Mesonephric remnants persist as an appendix of epididymis and paradidymis in efferent ductules in males and skene's glands and Gartner's ducts in females. The mesonephric remnant in the renal parenchyma is extremely rare and only a few cases have been reported in the literature. We present a case with a non-functioning atrophic left kidney. Histopathology showed variable-sized ducts filled with colloid-like material surrounded by collagenized stroma. The ureter showed hypertrophied muscle and a few ducts lined by flattened and a few by columnar epithelium resembling epididymis suggestive of mesonephric remnants. IHC for CD10, PAX 8, and GATA3 was positive. A diagnosis of congenital unilateral hypoplasia of kidneys and ureter with mesonephric remnants was given. [ABSTRACT FROM AUTHOR]

Objective: Ureteral endometriosis has an incidence of 0.1% to 1%. The type of surgery required is either conservative (ureterolysis) or radical treatment, depending on the degree of ureter infiltration. The incidence of intraoperative and postoperative complications is heterogeneous. Thus, the aim of the current study was to propose a classification of ureterolysis based on the anatomical structure of the ureter and differing complication rates with procedures. Methods: A total of 139 ureterolysis procedures were included in the study. Patients were divided into three groups according to the depth of ureterolysis required. Differences were recorded across the three types of ureterolysis in terms of intraoperative and postoperative complications. Results: The incidence of ureteral fistula was reported in 0.7% of cases, with postoperative ureteral stenosis in 2% of type 2 ureterolysis. In the case of type 3 ureterolysis, after conservative procedures, 52.9% of patients required an ureteroneocystostomy to solve the ureteral stenosis. Conclusion: The risk of ureteral injury and ureteroneocystostomy after conservative procedures appears to be associated with type 3 ureterolysis, probably due to excessive devascularization, secondary to the incision of adventitia. Obviously, these data should be confirmed through a prospective study of a larger number, but our proposed classification can provide the basis for making data from future studies more comparable. Synopsis: The proposed classification of ureterolysis for deep endometriosis differentiates the procedure in terms of rate of complications and need for more radical procedures. [ABSTRACT FROM AUTHOR]

Background: Intraoperative ureteral injury, a serious complication of abdominopelvic surgeries, can be avoided through ureter visualization. Near-infrared fluorescence imaging offers real-time anatomical visualization of ureters during surgery. Pudexacianinium (ASP5354) chloride is an indocyanine green derivative under investigation for intraoperative ureter visualization during colorectal or gynecologic surgery in adult and pediatric patients. Methods: In this phase 2 study (NCT04238481), adults undergoing laparoscopic colorectal surgery were randomized to receive one intravenous dose of pudexacianinium 0.3 mg, 1.0 mg, or 3.0 mg. The primary endpoint was successful intraoperative ureter visualization, defined as observation of ureter fluorescence 30 min after pudexacianinium administration and at end of surgery. Safety and pharmacokinetics were also assessed. Results: Participants received pudexacianinium 0.3 mg (n = 3), 1.0 mg (n = 6), or 3.0 mg (n = 3). Most participants were female (n = 10; 83.3%); median age was 54 years (range 24–69) and median BMI was 29.3 kg/m2 (range 18.7–38.1). Successful intraoperative ureter visualization occurred in 2/3, 5/6, and 3/3 participants who received pudexacianinium 0.3 mg, 1.0 mg, or 3.0 mg, respectively. Median intensity values per surgeon assessment were 1 (mild) with the 0.3-mg dose, 2 (moderate) with the 1.0-mg dose, and 3 (strong) with the 3.0-mg dose. A correlation was observed between qualitative (surgeon's recognition/identification of the ureter during surgery) and quantitative (video recordings of the surgeries after study completion) assessment of fluorescence intensity. Two participants experienced serious adverse events, none of which were drug-related toxicities. One adverse event (grade 1 proteinuria) was related to pudexacianinium. Plasma pudexacianinium concentrations were dose-dependent and the mean (± SD) percent excreted into urine during surgery was 22.3% ± 8.0% (0.3-mg dose), 15.6% ± 10.0% (1.0-mg dose), and 39.5% ± 12.4% (3.0-mg dose). Conclusions: In this study, 1.0 and 3.0 mg pudexacianinium provided ureteral visualization for the duration of minimally invasive, laparoscopic colorectal procedures and was safe and well tolerated. [ABSTRACT FROM AUTHOR]

Background: Intraoperative near-infrared fluorescence imaging (NIRF) with preoperative optical dye administration is a promising technique for quick and easy intraoperative visualization of the ureter and for an improved, real-time assessment of intestinal perfusion. During colorectal surgery, there is a need for simultaneous non-invasive ureteral imaging and bowel perfusion assessment, using one single camera system. The purpose of this study is to investigate the feasibility of simultaneous intestinal perfusion and ureteral imaging using a single commercially available NIRF imaging system. Methods: Six Landrace pigs underwent laparotomy under general anesthesia in this experiment. An intravenous (IV) dose of 0.2 mg/kg indocyanine green (ICG) was given to assess bowel perfusion. Two pairs received a methylene blue (MB) iv injection of 0.75, 0.50 or 0.25 mg/kg respectively to investigate ureteral visualization. Quest Spectrum Fluorescence Camera (Quest Medical Imaging, Middenmeer, The Netherlands) was used for NIRF imaging. Results: Ureter visualization and bowel perfusion under NIRF imaging was achieved in all animals. All ureters were visible after five to ten minutes and remained clearly visible until the end of every experiment (120–420 min). A mixed model analysis did not show any significant differences neither between the three groups nor over time. Importantly, we demonstrated that bowel perfusion could be visualized with methylene blue (MB) as well. We observed no interference between ICG and MB and a faster washout of MB. Conclusion: We successfully demonstrated simultaneous fluorescence angiography with ICG and ureteral imaging with MB in the same surgical procedure, with the same commercially available NIRF imaging equipment. More importantly, we showed that the use MB is adequate for bowel perfusion assessment and ureter visualization with this NIRF imaging system. Besides, MB showed an earlier washout time, which can be clinical beneficial as a repeated dye injection may be necessary during a surgical procedure. [ABSTRACT FROM AUTHOR]

This study aimed to demonstrate the feasibility of ureteral navigation using intraoperative indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging during complex laparoscopic or robot-assisted gynecologic surgery (LRAGS). Twenty-six patients at high risk of ureteral injury with complex pelvic pathology (CPP) due to pelvic organ prolapse (POP), multiple myomas, large intraligamentary or cervical myoma, severe pelvic adhesions, or cervical atresia underwent LRAGS. All patients underwent cystoscopic intraureteral ICG instillation before LRAGS and ureteral navigation under NIRF imaging intraoperatively. Both ureteral pathways were identified from the pelvic brim downwards through NIRF imaging in all patients, even though some were not visualized under the white light mode. The fluorescent ureters were visualized immediately after the beginning of surgery and typically lasted for >5 h during surgery. There were no cases of iatrogenic ureteral injury. The hemoglobin decrement was 1.47 ± 1.13 g/dL, and no transfusion was required. In our study, both ureters in all patients were identified with ICG-NIRF imaging during LRAGS, and these techniques made surgeries easier and safer. Despite the CPP, there was no ureteral injury or transfusion following surgery. Further prospective studies are needed to introduce intraoperative ureteral guidelines for ICG-NIRF imaging during LRAGS with CPP. [ABSTRACT FROM AUTHOR]

A 12-y-old Shetland Pony was presented with a mucus-secreting fistula in the right paralumbar fossa. Surgery was performed to unravel the origin of the fistula. The horse died under anesthesia and was forwarded to autopsy. The right kidney was markedly atrophic and fibrotic, consistent with unilateral end-stage kidney. The right ureter was markedly thickened, but with luminal continuity leading into the urinary bladder where a partial obstruction caused by nodular para-ureteral fat necrosis was evident. The lumen of the cutaneous fistula was continuous with the right ureter; therefore, we diagnosed the lesion as a ureterocutaneous fistula. Anomalies of the ureter are uncommon, and ureterocutaneous fistula formation in equids has not been reported previously to our knowledge. [ABSTRACT FROM AUTHOR]

Retrocaval ureter is a rare congenital vascular anomaly described as the passage of the ureter behind the inferior vena cava (IVC) and then turning around the IVC to attain the final lateral position. The condition is usually associated with obstruction in the ipsilateral kidney, causing different degrees of hydronephrosis and complications associated with urinary stasis, such as stone formation. Imaging has a crucial role in the diagnosis and management of retrocaval ureter. CT urography may be the procedure of choice to confirm the diagnosis and avoid retrograde ureteropyelography. Indications for treatment include flank pain, recurrent infection, hydronephrosis, and stone formation due to obstruction. Surgical management is standard and can be done through either an open, laparoscopic, or robotic approach. In this case series, we are going to see two cases of retrocaval ureter in a 56-year-old male and a 14-year-old male child who presented with a right flank of less than a couple of months duration. The first case has an associated horseshoe kidney and a solitary secondary stone. Both cases were surgically managed with open ureteral division, relocation, and ureteroureterostomy. Both have uneventful post-operative follow-ups. [ABSTRACT FROM AUTHOR]

A 5‐month‐old, female, entire golden retriever presented for investigation of urinary incontinence and recent urinary tract infection. While under general anaesthesia, a urinary catheter was placed to fill the bladder, aid accurate visualisation of the ureteral vesicular junction and facilitate a retrograde contrast study. The preliminary computed tomography was deemed unremarkable, and a computed tomography intravenous urethrogram was performed, followed by retrograde of contrast in an attempted vaginourethrogram. The post‐contrast retrograde study highlighted an unusually straight distal right ureter and contrast escaping into the right retroperitoneal space. Contrast‐enhanced ultrasonography supported haemorrhage into the perirenal space, and on retrospective analysis of preliminary pre‐contrast computed tomography sequences, the urinary catheter was identified in the right renal pelvis. Accidental catheterisation of the right intramural ectopic ureter and iatrogenic renal perforation was ultimately concluded. The dog made a full recovery with conservative management and to date has no chronic repercussions of the injury. [ABSTRACT FROM AUTHOR]

Background: Upper tract urothelial carcinoma (UTUC) is the most common urothelial malignancy in the renal pelvis or ureter. Renal pelvic carcinoma accounts for 90% of all tumours in the renal pelvis, so the mass in the renal pelvis is usually considered a UTUC. Renal cell carcinoma (RCC) in the renal pelvis, calyces and upper ureter is extremely rare, especially MiT family translocation RCC, which makes this case even more uncommon. Case presentation: We report the case of a 54-year-old man had intermittent painless gross haematuria with occasional blood clots and urodynia for 2 years. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) scan showed an enlarged left kidney, and a soft tissue mass was seen in the renal pelvis, calyces and upper ureter. The patient’s urine-based cytology was positive three times. Due to the severity of the upper ureteral lumen stenosis, we did not perform pathological biopsy during ureteroscopy. In the current case, clinical symptoms, imaging examinations, urine-based cytology, and ureteroscopy were combined to obtain a preoperative diagnosis of UTUC. Therefore, robot-assisted laparoscopic left radical nephroureterectomy and retroperitoneal lymphadenectomy were performed. Unexpectedly, the patient was pathologically diagnosed with MiT family translocation RCC after surgery. The surgery was uneventful. There was no intestinal tube injury or other complications perioperatively. The postoperative follow-up was satisfactory. Conclusion: MiT family translocation RCC in the renal pelvis, calyces and upper ureter is extremely rare, and can be easily confused with UTUC, resulting in the expansion of surgical scope. Preoperative ureteroscopy and biopsy or tumour punch biopsy should be used to obtain accurate pathology as far as possible, and the selection of correct surgical method is conducive to a good prognosis for patients. [ABSTRACT FROM AUTHOR]

In the present study, we aimed to report our single-center experience in encrusted ureteral stent management and to compare the utility of two different scoring systems in patient management. This is a retrospective study of patients who underwent various surgical procedures to remove encrusted ureteral stent. Encrusted stent grading was performed using KUB and FECal grading sytems. FECal grading system scored from Grade 1 to Grade 5 according to stone size, location, and degree of stent incrustation and the KUB score is the sum of the stone burden scores of three different parts of an encrusted stent within the kidney, ureter, and bladder determined using a scale from 1 to 5 according to the maximal diameter of encrustation. We compared these two classifications for the prediction of perioperative outcomes. Fifty patients were included in the study (52% female, mean age 48 years). The mean time from ureteral stent insertion until diagnosis of encrustation was 11.4 ± 13.6 months. High-grade incrustations (FECal Grade 3, 4, and 5) accounted for 62% of cases. The mean KUB score was 9.8 ± 2.7. The average number of procedures required to remove the stent was 1.71 ± 1.38. Multimodal surgery was required to remove 42% of the stents. Both, a total KUB score ≥ 9 and high-grade FECal classification were found to be significant predictors of longer operative time (> 100 min), need for multiple surgeries, and need for invasive surgery. While high-grade FECal classification showed a significant association with need for multimodal surgery (OR 6.92, p = 0.008), a total KUB score ≥ 9 showed no association (OR 2.91, p = 0.086). These two scores seem to be good indicators in predicting difficulties for surgical management of encrusted ureteral stent with a clear advantage of the FECal score in terms of prediction of multimodal surgery. [ABSTRACT FROM AUTHOR]

Objective. To identify surgical manipulations that caused ureter injury during total laparoscopic hysterectomy (TLH) and evaluate the surgical manipulations to identify ways to prevent such injury. Patients and Methods. This single-center, cross-sectional study included 1135 cases of TLH performed for benign diseases from January 2009 to December 2021. Seven cases (0.6%) that needed ureteral stent placement intra- or postoperatively for ureter injury were included. We identified the surgical manipulations that caused ureter injury from surgical videos. Results. Two cases had adhesions around the bladder pillar, and the ureter sustained a thermal injury during the cardinal ligament transection. One case had severe endometriosis, and the ureter was bluntly damaged when the adhesion was released. In one case, the ureter was thermally damaged during bipolar hemostasis for uterine artery bleeding. In two cases, the obliterated umbilical artery was mistaken for the ureter, and the real ureter was injured. In one case, ureteral peristalsis was inhibited by a pelvic abscess caused by postoperative infection. Conclusion. To prevent ureter injury during TLH, the ureter should be isolated in case of severe adhesion. Moreover, the following could be considered: (1) expand Okabayashi's pararectal space lateral to the uterosacral ligament, (2) perform dissection sharply using a monopolar or scissors forceps when releasing adhesion, (3) clarify the anatomy around the ureter for cases needing hemostasis, (4) repeatedly confirm the ureter with its peristalsis even after its isolation, (5) for severe adhesion cases, reduce infection risk by drain placement and administering antibiotics, and (6) use a delineator cup. [ABSTRACT FROM AUTHOR]

Objectives: To describe outcomes of oral mucosal graft ureteroplasty (OMGU) and ileal ureter replacement (IUR) and determine the relative merits of both procedures. Methods: Databases (including PubMed, Embase and Cochrane) were interrogated for eligible trials that assessed outcomes of OMGU or IUR from 2000 to 30 July 2022. The variables analysed were reconstruction success rates, stricture length, hospital stays, perioperative complications and long‐term complications. Results: A total of 23 single‐arm studies were included. The pooled reconstruction success rates for OMGU and IUR were 94.9% (95% confidence interval [CI] 91.0%–97.7%) and 85.8% (95% CI 81.0%–90.0%), respectively. Stricture length of patients in the OMGU and IUR groups were 3.73 (95% CI 3.17–4.28) and 11.55 (95% CI 9.82–13.29) cm, respectively. The maximal stricture length repaired by OMGU was 8 cm. The hospital stays were 5.85 (95% CI 3.88–7.82) and 11.55 (95% CI 6.93–16.17) days in the OMGU and IUR groups, respectively. The incidences of low‐grade postoperative complications were 13.6% (95% CI 6.9%–20.3%) and 27.3% (95% CI 19.5%–35.1%), high‐grade postoperative complications were 4.6% (95% CI 1.8I–8.5%) and 13.0% (95% CI 9.4%–17.1%), and long‐term complications (occurred at > 3months) were 9.0% (95% CI 1.7%–20.0%) and 35.4% (95% CI 25.8%–45.6%) in the OMGU and IUR groups, respectively. Conclusion: An OMGU is an effective, minimally invasive, and safe alternative to IUR for the management of long ureteric strictures. OMGU was the preferred treatment for long ureteric strictures, especially obstructed ureter segments of ≤8 cm. [ABSTRACT FROM AUTHOR]

Pain sensation induced by kidney stone (renal calculi) in ureter, a kind of visceral ducts connecting the kidneys and bladder, critically depends upon the relative size of stone to ureter. To quantify such pain sensation, we draw a parallel analogy between the mechanisms underlying skin pain (which can be quantified with a holistic pain model consisting of a modified Hodgkin-Huxley model and gate control theory) and mechanism of ureteral pain to extend the holistic pain model to the stone-blocked ureter. We then perform finite element simulations to obtain key mechanical stresses on the ureter wall exerted by a kidney stone having varying sizes. These stresses are subsequently adopted to calculate the voltage potential of neuron membrane in the holistic pain model and eventually a theoretical framework to quantify the dependence of ureteral pain sensation on stone size is established, for the first time. We demonstrate that ureter pain sensation increases sharply when the diameter of the kidney stone becomes 7.5% to 20% larger than the inner diameter of ureter, peaking at -20% larger; however, increasing further the stone diameter leads only to marginally exacerbated pain sensation. Other related effects on ureter pain sensation, such as ureter wall thickness, ureter stiffness, and intra-abdominal pressure (IAP), are evaluated. The results of the present study provide insightful information for urologists to diagnose and treat patients with renal calculi in a more personalized way. [ABSTRACT FROM AUTHOR]

In the case of transurethral lithotripsy performed with a rigid ureteroscope, the saline used in reflux may remain in the bladder, causing poor reflux and changing the angle of the ureter. Additionally, it often necessitates surgery, which may be difficult. Conventionally, a thin catheter is introduced from the side of a rigid ureteroscope, or the outer tube of a rigid cystoscope is inserted and operated through a rigid ureteroscope as a countermeasure during surgery for lower ureteral stones. However, there can be problems such as difficulty in operating the borescope when using a catheter, urethral injury due to insertion of the rigid cystoscope's outer cylinder, and insertion limitations due to the outer cylinder length. In order to improve these problems, we considered using a three-tip-hole catheter. With this method, shortening the surgical time by smoothly approach and keeping the good view by drainage of dust. It is possible to reduce pressure on the kidneys and bladder. Another advantage is that it can be performed safely regardless of the surgeon's skill. We herein report our experience using TUL for low)er ureteral stones, with the intention of addressing these problems and managing decompression, while allowing access to the ureter seamlessly. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic retroperitoneal fibrosis is a known cause of obstructive uropathy. Ureterolysis is done when medical management fails or the presentation is at an advanced stage. Conventionally ureterolysis without omental wrap has been considered incomplete. Our Institute has experience of laparoscopic or robotic ureterolysis with intraperitonealization of the ureter alone and no other adjunctive procedure. This study retrospectively assesses the result of the procedure with patients presenting with varying severity of disease. Methods: From 2008, all patients who underwent laparoscopic or robotic ureterolysis were analyzed retrospectively for pre-operative management, operative findings, and post operative outcomes. Results: We operated and released nine renal units in seven patients. Two of the nine cases were performed robotically completely and the rest was performed by laparoscopic approach. Median follow up was 60 months. All patients documented resolution of symptoms. The mean post-operative creatinine at 1 year was significantly decreased to 1.47 ± 0.49 mg/dl in comparison to preoperative creatinine (p < 0.05). The postoperative mean ESR decreased significantly from a preoperative value of 58.2 ± 19.41 mm to 15.8 ± 17.23. The nuclear scan revealed unobstructed drainage and radiological imaging revealed resolution of hydronephrosis and fibrosis in all. The mean GFR on the nuclear scan after 3 and 12 months of surgery was 36.3 ± 4.33 and 40 ± 3.77, respectively. Thus, there was significant increase noted in GFR at 3 and 12 months in comparison to preoperative GFR (p < 0.05). Conclusion: Laparoscopic/robotic ureterolysis with intraperitonealization alone is secure and durable procedure for idiopathic retroperitoneal fibrosis needing surgical release. [ABSTRACT FROM AUTHOR]

Ureteral strictures, which can be caused by ureteral injury, radiation therapy, ureterolithiasis, urinary tract infections, and ureteral endometriosis, typically require ureteral reconstruction. Although tissue engineering, autologous alternative tissue transplantation, and surgical techniques applying various flaps have been carried out for ureteral regeneration, all with some success, each method has its advantages and disadvantages. As an alternative, we created the first artificial ureter structures using only live cells and grafted them into healthy rat ureters. Spheroids were created using normal human dermal fibroblasts and human umbilical vein endothelial cells and subsequently laminated using a bio-three-dimensional printer. After molding the laminated spheroids into tubular structures, the artificial ureters were transplanted into live rats. After 2–12 weeks, the animals were sacrificed and their gross and pathological features were examined. In the artificial ureteral lumen of rats with Grade 0-1 hydronephrosis, regeneration of the ureteral epithelium was observed, the thickness of which increased over the course of the experiment. Regeneration of the muscular layer was also observed, extending from the normal ureteral side toward the artificial ureter structure over time. However, complete regeneration was not observed at the end of 12 weeks. Although ureteral peristalsis was noted in all cases, it was weaker than expected. Therefore, we achieved short-segment ureteral regeneration using a cell-only structure. This finding suggests that by applying alternative strategies to this method, such as changing the cell type and composition, regeneration over the entire length of the ureter may be possible in the future. Until now, ureteral regeneration techniques have been dominated by the use of high-molecular-weight compounds and autologous tissues, and there have been no reports of regeneration using structures made entirely of cells. This is the first report of ureteral regeneration using a tubular structure made from stacked spheroids. Although this study only attained short-segment ureteral regeneration, regeneration of the ureter over a much longer proportion of its length can be achieved in the future by applying other strategies, such as changing the cell type. This study provides a foundation to achieve the future goal of complete regeneration. [Display omitted] [ABSTRACT FROM AUTHOR]

Summary. A 7-month-old female Jack Russell Terrier weighing 4.6 kg was referred to a veterinary hospital for persistent urinary incontinence. Blood test results and vital signs were within the normal range. Computed tomography allowed the diagnosis of extramural ectopic ureter and unilateral renal agenesis. After the first neoureterocystostomy surgery, the dog had severe complications, such as hydroureter and hydronephrosis, so a second surgery was performed. A commercial ureteral stent was not an option, and it was decided to fabricate a homemade stent to avoid euthanasia. The stent used was a soft, DEHP-free PVC tube with a lumen of 3 × 4.1 mm and a length of approximately 40 mm that connected the ureter to the urinary bladder. Two years after surgery, the dog is in good general condition, and the results of regularly performed blood and urine tests are within the normal range for dogs. [ABSTRACT FROM AUTHOR]

Delayed surgical reconstruction of iatrogenic ureteral injuries is often a challenging procedure because spreading scar tissue impedes accurate identification and dissection of the injured ureter. We report a novel real‐time navigation system using a ureteral near‐infrared ray catheter (NIRC) and indocyanine green (ICG) via nephrostomy in delayed robot‐assisted ureteral reconstruction. A female patient presented with complete obstruction of the right upper ureter after gynecological surgery with extensive lymphadenectomy. A nephrostomy tube was urgently placed, and surgical repair was performed. A straight NIRC was placed in the right ureter up to the obstruction point. ICG was administered via nephrostomy. Near‐infrared light could clearly visualize the ureter and renal pelvis encased in scar tissue. The ureter and renal pelvis were dissected and successfully anastomosed. We found that near‐infrared navigation using ureteral NIRC and ICG via nephrostomy was valuable for delayed laparoscopic reconstruction of the injured ureter. [ABSTRACT FROM AUTHOR]

Introduction: Electromotive drug administration (EMDA) delivers a drug deeply into targeted tissues, such as the bladder. EMDA has never been applied to the ureter. Methods: In four in vivo porcine ureters, a unique EMDA catheter containing a silver conducting wire was advanced for the infusion of methylene blue. In two ureters, a pulsed current was delivered through an EMDA machine, whereas the other two ureters served as a control. After 20 minutes of infusion, the ureters were harvested. Results: In the EMDA ureter, there was diffuse staining of the urothelium; penetration of methylene blue occurred in the lamina propria and muscularis propria. In the control ureter, there was only patchy staining of the urothelium. Conclusion: In this first report of ureteral EMDA, a charged molecule penetrated beyond the urothelium into the lamina propria and muscularis propria of the porcine ureter. [ABSTRACT FROM AUTHOR]

Our results were obtained by studying 128 CT urographies. We found the total length of the ureter to be between 17.34-25.73 cm, with the lumbar ureter between 7.92-12.64 cm, the iliac ureter between 5.61-8.62 cm, and the pelvic ureter between 3.0-11.28 cm. The external diameter of the ureter was found to be between 1.50-7.20 mm. At its origin, the ureter was between 2.40-7.20 mm in diameter, at the iliac level 2.90-4.60 mm, at the supravesical level 1.70-5.0 mm, at the retrovesical level 2.10-2.90 mm and the vesical level 1.50-1.80 mm. We measured the distance between the two ureters, right and left, on a total of 31 cases. At the pyelo-ureteral junction, we found a distance between the two ureters of 7.2-12.53 cm, in the male sex this distance was 7.2-12.53 cm and in the female sex, the distance was 7.16-12.08 cm. At the level of the iliac ureters, this distance was between 2.26-7.36 cm, for males it was 2.26-7.36 cm, and for females 3.34-6.45 cm. At the supravesical level, the distance between the two ureters was 3.04-6.84 cm, with 3.04-6.84 cm for the male sex and 34.6-6.73 cm for the female sex. At the urinary bladder level, the distance between the two ureters was 2.13-4.5 cm, 2.13-4.5 cm for the male sex, and 2.2-3.47 cm for the female sex. At the retrovesical level, the distance between the two ureters was between 3.04-5.71 cm. [ABSTRACT FROM AUTHOR]

Introduction: The intraoperative anatomical findings (IOAF) of all ureteropelvic junction obstruction (UPJO) cases are not identical. Moreover, there is also controversy in the literature regarding histopathological (HP) findings in cases of UPJO. In the present study, we evaluated different IOAF and assessed their association with specific HP parameters. Materials and Methods: This was a cross-sectional study set-up, which was carried out in a tertiary care centre. Children with UPJO who underwent surgery between 2017 and 2020 were enrolled. The following IOAF were noted: Type of pelvis (extrarenal or intrarenal), insertion of the ureter (high or normal), presence of lower pole crossing vessel (CV), negotiation of UPJ segment with double J stent (3 Fr) and length of internal narrowing (LIN) at UPJ. The resected segment of UPJ was assessed at three levels (pelvis, UPJ and ureter) for various HP parameters including fibrosis, oedema, inflammation and smooth muscle hypertrophy (SMH). Results: Thirty-nine children were included in the study with a mean age of 31 months. The summary statistics of IOAF were intrarenal pelvis in 5 cases, high insertion of the ureter (HIU) in 9, CV in 6, negotiable UPJ in 23, and 16 cases showed LIN >1 cm. All cases showed SMH at the pelvis region and SMH with fibrosis at the UPJ region. At the pelvis region, there was an association between (1) HIU with oedema and chronic inflammation (CIF), (2) CV with CIF and (3) LIN with CIF and SMH. At the UPJ region, there was an association between (1) CV and negotiable UPJ with less fibrosis and (2) LIN with SMH. At the ureteric end, CV showed an association with less fibrosis and more CIF. Conclusion: All UPJO cases have some common HP findings. Although, some particular IOAF, i.e., presence of CV, negotiable UPJ, HIU and LIN showed association with specific HP parameters. [ABSTRACT FROM AUTHOR]

To evaluate a subset of patients who develop strictures requiring Ileal Ureter (IU) in the setting of prior urinary diversion or augmentation (ileal conduits, neobladders, continent urinary diversions). To our knowledge, there are no prior studies on patients with IU substitution into established lower urinary tract reconstructions. A retrospective review of patients (18 years) undergoing IU creation from 1989 to 2021 was performed. A total of 160 patients were identified. In total, 19 (12%) patients had IUs into diversions. We examined demographics, stricture cause, diversion type, renal function, and postoperative complications. Nineteen patients were identified. Sixteen were male. Mean age was 57.7(SD 17.0) years. Diversions included continent urinary reservoirs (4), neobladders (5), ileal conduits (7), and bladder augmentations with Monti channels (3). Fifteen had unilateral surgery, and 4 had bilateral "reverse 7" IU creation. Average length of stay was 7.6 days (SD 2.9). Average follow-up was 32.9 months (SD 27). Mean preoperative creatinine was 1.5 (SD 0.4); mean postoperative creatinine at most recent follow-up was 1.6 (SD 0.7). There was no significant difference between pre- and postoperative creatinine (P =.18). One patient had a ventriculoperitoneal Shunt infection resulting ventriculoperitoneal shunt externalization, 1 had Clostridium difficile infection potentially causing an entero-neobladder fistula, 2 with ileus, 1 urine leak, and 1 wound infection. None required renal replacement therapy. Patients with urinary diversions and prior bowel reconstructive surgeries with subsequent ureteral strictures are a challenging cohort of patients. In properly selected patients, ureteral reconstruction with ileum is feasible and preserves renal function with minimal long-term complications. [ABSTRACT FROM AUTHOR]

In ureteroscopy a flexible ureteroscope is used to inspect the kidneys and the ureters. In this context, we investigate robotic solutions that leverage recent developments from Simultaneous Localization and Mapping (SLAM) to provide a 3D map of the organ to be explored and the ureteroscope's pose. With this aid, the surgeoncan navigate through the organ more precisely. Additionally, for the final organ inspection, the risk of missing certain regions of the organ is minimized. In this paper, we propose a visual, monocular SLAM system based on ORB-SLAM3 that is able to estimate the pose of the ureteroscope's tip. In order to fulfill this task, we introduce two pre-processing steps. The first one aims at increasing the contrast of the image and the second one helps to avoid detecting features in non-desired regions (e.g. reflections). Additionally, we extend ORB-SLAM3 with A-KAZE and SuperPoint features and compare their performances to ORB features. The proposed method is evaluated in two experiments. The first experiment shows that we are able to estimate the trajectory of the ureteroscope and the map of a synthetic kidney with low errors. The second experiment shows that the method also gives promising results in cystoscopy. [ABSTRACT FROM AUTHOR]

Introduction. Inguinal herniation of the ureter is a rare entity that occurs either as a complication of renal transplantation or spontaneously. Patients may suffer from obstructive uropathy or groin pain due to the unusual ectopic course of the ureter. This case report highlights the importance of recognizing a ureteroinguinal hernia. Methods. In this case report, we present a 75-year-old man with a surgical history of a right inguinal hernia repair who was referred to our center with burning left inguinal pain that persisted for two weeks. The patient's history and physical examination were consistent with an inguinal hernia. The suspected indirect inguinal hernia was found on preoperative imaging to be a tubular structure distinct from the intestine or adjacent organs. An open exploration of the inguinal canal was performed to prevent further hernia development. Results. The unusual structure in the inguinal canal turned out to be an ectopic ureter originating from the left upper pole moiety of the left duplex kidney (i.e., with duplicated ureters) and containing concentrated urine, as confirmed on a postoperative computerized tomography urogram. Conclusion. It is crucial to perform a thorough clinical examination and utilize adequate imaging modalities before surgical procedures when encountering unidentified structures. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the age, gender, survival, and etiology of cases diagnosed with urothelial carcinoma (UC) in the genitourinary system simultaneously or later in a different localization (lower tract and/or upper tract). Materials and Methods: Sixty-four patients diagnosed with concurrent or subsequent lower and/or upper tract UC in the Department of Pathology between 2010 and 2020 were evaluated for age, gender, survival, and etiology. Our study is a retrospective study. Results: Fifty-eight patients were male and six were female. The ages of the patients ranged between 27 and 87 years. The patients were evaluated for noncoagulable and painless hematuria. While 52 of the patients were smokers, 12 of them were non-smokers. Ten of our patients were initially diagnosed with UC in the renal pelvis and/or ureter and three months to eight years later with UC in the bladder, whereas 14 patients were initially diagnosed with UC in the bladder and four months to 10 years later with UC in the renal pelvis and/or ureter. Of the remaining 40 patients, 14 were diagnosed with UC simultaneously in the bladder and ureter, nine in the renal pelvis and ureter, seven in the renal pelvis and bladder, and 10 in the renal pelvis, ureter, and bladder. The mean duration of symptoms before diagnosis was seven months (range; 7 days to 1.5 years). Conclusion: Because UC can affect multifocal organs, close surveillance of patients diagnosed with upper or lower urinary tract disease UC and who are smokers is recommended at the time of diagnosis or especially during the first three years after diagnosis to prevent the formation of primary tumors in other regions. [ABSTRACT FROM AUTHOR]

To present our initial experience and evaluate perioperative, and follow-up outcomes following the novel technique of robot-assisted laparoscopic bilateral ileal ureter replacement (IUR) with extracorporeal ileal segment preparation for bilateral extensive ureteral strictures (BEUS). We prospectively enrolled 4 consecutive patients with BEUS undergoing robot-assisted laparoscopic bilateral IUR with extracorporeal ileal segment preparation between June 2021 and October 2021. A 4-arm technique was used. The demographic characteristics, perioperative data, and follow-up outcomes as well as the description of surgical technique were reported. All the patients had BEUS, and the length of strictures was over 10.ßcm in both sides. All procedures were performed effectively with a median operative time of 312.5.ßminutes (range 227-433) and a median estimated blood loss of 75.ßmL (range 50-200). In one patient, additional partial small bowel resection procedure was performed. No case was converted to open surgery. The median length of the ileal graft was 29.ßcm (range 15-32). The median postoperative hospitalization was 10 days (range 6-13). Two patients developed metabolic acidosis, and no major complications during the perioperative and follow-up period were reported. All patients presented symptom-free, with no signs of restenosis and improved/stabilized hydronephrosis, during the median follow-up of 12 months (range 12-15). We present the details and initial experience of robot-assisted laparoscopic bilateral IUR with extracorporeal ileal segment preparation. According to the median follow-up of 12 months, this minimally invasive procedure is a safe, feasible, and effective approach in the management of BEUS. [ABSTRACT FROM AUTHOR]

Urolithiasis is an uncommon disorder reported in horses. Calculi located in the kidneys and ureters are often underdiagnosed. Associated clinical signs include weight loss, anorexia, haematuria, dysuria, colic and polyuria/polydipsia. A 26‐year‐old Thoroughbred gelding was referred for evaluation of an acute colic episode of 5‐hour duration. Haematologic analysis revealed increased serum creatine kinase and creatinine concentrations. Abdominocentesis yielded serosanguineous, mildly cloudy fluid with a lactate of 9.6 mmol/L (<2 mmol/L). Exploratory laparotomy was recommended. Surgical intervention was declined, and the horse was humanely euthanased. Limited postmortem evaluation was performed. A 3.633 kg nephrolith measuring 23.6 × 16.2 × 8.9 cm was completely effacing the left kidney. Crystallography and infrared spectroscopy (attenuated total reflection and Fourier transform infrared) revealed a 100% calcium carbonate nephrolith. Carbonate calcium calculi are the most common subtype in horses. Nephrolithiasis should be considered as a differential diagnosis for colic and haematologic evidence of azotaemia in horses. [ABSTRACT FROM AUTHOR]

Computed Tomography Urography (CTU) is a multiphase CT examination optimized for imaging kidneys, ureters, and bladder, complemented by post-contrast excretory phase imaging. Different protocols are available for contrast administration and image acquisition and timing, with different strengths and limits, mainly related to kidney enhancement, ureters distension and opacification, and radiation exposure. The availability of new reconstruction algorithms, such as iterative and deep-learning-based reconstruction has dramatically improved the image quality and reducing radiation exposure at the same time. Dual-Energy Computed Tomography also has an important role in this type of examination, with the possibility of renal stone characterization, the availability of synthetic unenhanced phases to reduce radiation dose, and the availability of iodine maps for a better interpretation of renal masses. We also describe the new artificial intelligence applications for CTU, focusing on radiomics to predict tumor grading and patients' outcome for a personalized therapeutic approach. In this narrative review, we provide a comprehensive overview of CTU from the traditional to the newest acquisition techniques and reconstruction algorithms, and the possibility of advanced imaging interpretation to provide an up-to-date guide for radiologists who want to better comprehend this technique. [ABSTRACT FROM AUTHOR]

Ectopic ureter is a rare congenital anomaly that predominantly affects females and typically manifests as urinary incontinence due to atypical ureteral openings in structures such as the vagina or cervix. This condition is estimated to occur in approximately 1 in 4000-10,000 female births. An exceptional variant, the intrasphincteric ectopic ureter, poses significant diagnostic challenges due to its atypical presentation, as it may cause dynamic obstruction and reflux phenomena without resulting in incontinence. A 28-year-old female presented with severe left flank pain, fever, and chills persisting for 10 days. Her medical history included intermittent dull, aching left flank pain over 7 years, exacerbated during voiding, but no urinary incontinence. Physical examination revealed marked tenderness in the left flank, and laboratory investigations showed elevated leukocyte count and normal serum creatinine levels. Computed tomography urography revealed a left duplex moiety with upper moiety infected hydronephrosis, necessitating percutaneous nephrostomy placement. Subsequent nephrostogram and micturating cystourethrogram identified a grossly dilated and tortuous upper moiety ureter with intrasphincteric ectopic ureteral opening, confirming the diagnosis of obstructed and refluxing megaureter. Following infection resolution, the patient underwent laparoscopic extravesical non-refluxing reimplantation of the upper moiety ectopic ureter with DJ stenting. The postoperative course was uneventful, and the patient reported no flank pain or fever upon stent removal. Periodic evaluations showed no increase in hydronephrosis, indicating a successful intervention. This case underscores the diagnostic complexity of intrasphincteric ectopic ureter, a rare anomaly presenting with obstructed and refluxing megaureter without incontinence. Heightened clinical vigilance and comprehensive radiological evaluation are imperative for timely diagnosis and intervention. Preservation of continence further complicates the clinical picture, necessitating early intervention to prevent renal function deterioration and improve long-term outcomes. [ABSTRACT FROM AUTHOR]

Rarely, hydronephrosis can be caused by the retrocaval ureter. Its rarity and vague appearance make a proper diagnosis difficult for surgeons and radiologists to make. For successful surgical care, it is crucial to distinguish different causes of urinary tract obstruction, particularly urolithiasis, which is more prevalent. In the current standard of care, intravenous urography (IVU) is quickly being replaced with computed tomography urography (CTU) when evaluating patients who have hydronephrosis due to suspected urolithiasis, particularly ureterolithiasis. A retrocaval ureter, being the rarest cause of hydronephrosis in adults, can be accurately diagnosed using CTU, which shows its typical appearance. We reported a case of a 41‑year‑old man who presented with left flank pain for which his surgeon suspected obstructive renal calculi. On investigations, however, we found a retreocaval ureter on the right side with resultant moderate hydroureteronephrosis. We therefore demonstrate the value of CTU in determining rare causes of hydronephrosis as it exemplifies this circumstance. Retrocaval ureter is a rare cause of hydronephrosis and may be one of the challenging cases for urologists that need careful investigations, especially when asymptomatic. [ABSTRACT FROM AUTHOR]

The bilateral duplex system is extremely uncommon, and only a few cases have been documented in the literature. It may manifest as a bifid renal pelvis and partial or complete ureteric duplication, with or without ectopic insertion of the ureter. An ectopic ureter is more problematic when there is significant vesicoureteral reflux, incontinence, and/or blockage. The optimal course of treatment is considered to be ureteral reimplantation rather than heminephrectomy. We describe the management strategy for a case of bilateral duplex kidneys with bilateral ectopic ureters in a growing female child. [ABSTRACT FROM AUTHOR]

The use and application of robotic systems with a high-definition, three-dimensional vision system and advanced EndoWrist technology have become widespread. We sought to share our clinical experience with ureter identification and preventive uterine artery ligation in robotic hysterectomy. The records of patients undergoing robotic hysterectomy between May 2014 and December 2015, including patient preoperative characteristics, operative time, and postoperative outcomes, were analyzed. We evaluated the feasibility and safety of using early ureteral identification and preventive uterine artery ligation in robotic hysterectomy in patients with benign gynecological conditions. Overall, 49 patients diagnosed with benign gynecological conditions were evaluated. The mean age of the patients and mean uterine weight were 46.2 ± 5.3 years and 348.7 ± 311.8 g, respectively. Robotic hysterectomy achieved satisfactory results, including a short postoperative hospital stay (2.7 ± 0.8 days), low conversion rate (n = 0), and low complication rate (n = 1; 2%). The average estimated blood loss was 109 ± 107.2 mL. Our results suggest that robotic hysterectomy using early ureteral identification and preventive uterine artery ligation is feasible and safe in patients with benign gynecological conditions. [ABSTRACT FROM AUTHOR]