The following is a summary of “Total intracorporeal laparoscopic ileal ureter replacement in a Single Position for Ureteral Stricture Based on Membrane Anatomy,” published in the March 2024 issue of Surgery by Wu et al.
The primary objective of this study was to share our initial experience and validate the viability of total intracorporeal laparoscopic ileal ureter replacement (TILIUR) performed in a single position for managing ureteral strictures grounded on membrane anatomy. From January 2021 to April 2023, six patients underwent TILIUR for ureteral strictures originating from diverse etiologies. These patients had a complex medical history, having undergone radical hysterectomy with bilateral pelvic lymph node dissection and subsequently developed extensive ureteral strictures due to radiotherapy.
The procedure, conducted entirely via laparoscopy, involved meticulous dissection guided by membrane anatomy, encompassing the digestive system, ureteral strictures, and renal pelvis. Notably, the surgical intervention was executed within a single position. The outcomes demonstrated the successful execution of TILIUR without necessitating open conversion across all cases. Among the cohort, three patients underwent combined ileal ureter replacement (IUR) with abdominal wall ostomy, two underwent unilateral IUR, and one underwent bilateral IUR. The mean length of the ileal substitution measured 22.83 cm, with an operative duration averaging 458 ± 72.77 minutes and intraoperative blood loss ranging from 50 to 400 mL.
Postoperative hospital stays exhibited a median duration of 15.1 days, with a follow-up period extending up to 29 months, reflecting a 100% success rate. In conclusion, TILIUR performed in a single position emerges as a promising therapeutic avenue for managing ureteral strictures linked to membrane anatomy, particularly in carefully selected patients. Furthermore, this approach yields favorable outcomes for individuals grappling with renal insufficiency and urinary incontinence. Despite the inherent challenges associated with IUR, adept surgeons can navigate these complexities, ensuring safe and efficacious patient outcomes.
Source: bmcsurg.biomedcentral.com/articles/10.1186/s12893-024-02363-w
