Background: The introduction of a new generation of flexible ureteroscopes significantly advanced the therapeutic and diagnostic efficacy of the instrument, allowing greater access to all aspects of the upper urinary tract and facilitating wireless ureteroscopy. Patients and Methods: Four hundred sixty consecutive upper urinary-tract procedures were performed utilizing the 7.5F actively deflectable, flexible ureteroscope. A prospective database of these procedures was maintained. The indications, access technique, complications, success rate of stone treatment, and access to lowerpole calices were evaluated. The accumulated clinical data were compared with a published database of 1000 consecutive flexible ureteroscopies. Results: A stent was in place or had recently been in place in 108 of the procedures (24%). Of the remaining 352 flexible ureteroscopic procedures, only 11% (52) required any form of ureteral dilation to facilitate ureteral access. Two hundred twenty seven procedures were performed in whi...

Advanced ureteroscopy: wireless and sheathless.

Diagnostic Utility of Selective Upper Tract Urinary Cytology: A Systematic Review and Meta-analysis of the Literature.

Objective: Low-grade urothelial tumors of the distal ureter historically can be managed by open distal ureterectomy and ureteral reimplantation with or without bladder reconstruction. In recent years, the da Vinci® surgical robotic system (DSRS) (Intuitive Surgical Inc., Sunnyvale, CA) has being increasingly used to perform complex urologic cancer surgeries. In this article, we report first on two consecutive patients undergoing robotic distal ureterectomy and Boari flap reconstruction (RDUBF) for distal ureteral cancer. Patients and Methods: Two consecutive patients underwent RDUBF, both with a diagnosis of low-grade papillary neoplasm of a distal ureter at our institution between August 2008 and November 2008. Perioperative parameters were prospectively collected and analyzed following institutional review board approval. Results: Two patients, male and female (age, 70 and 71 years, respectively) were included in the study. In both the patients, RDUBF was completed transperitoneally without the...

Robotic Distal Ureterectomy with Boari Flap Reconstruction for Distal Ureteral Urothelial Cancers: A Single Institutional Pilot Experience

Objective

To report registry data obtained by the British Association of Urological Surgeons (BAUS) for nephroureterectomy (NU) surgery in the UK performed between 1 January and 31 December 2012.



Subjects/Patients and Methods

Registry data entered by each individual surgeon's team (self-reported) on all 6042 nephrectomy surgeries reported to BAUS during 2012 were analysed to identify all NU surgery. Parameters for analysis included demographics, indication, type of surgery, histopathology and complications (Clavien system) of surgery. Data did not include tumour location or multiplicity, preoperative diagnostic evaluation or details of minimally invasive surgery (MIS) undertaken. Before analysis for this report a central process of ‘data-cleansing’ was undertaken by a BAUS group to address any discrepancy between the listed surgery and the preoperative indication.



Results

In all, 863 NU surgeries were included, performed by 220 consultant surgeons in 119 centres, and the median (range) number of NU per surgeon and unit was 3 (1–20) and 6 (1–29), respectively. The most common age group was 71–80 years (40%), most were male (64%), and haematuria was the most common presentation (74%). The dominant pathology was upper tract urothelial cancer (89%, 735), with final stage ≥pT2 in 47% (367), and the grade was 1, 2 or 3 in 6% (38), 36% (228) and 58% (362) respectively. Operative technique included MIS in 85% (720) and total reported operative complication rate (any Clavien) was 15% (128), of which Clavien ≥3 was reported in 4% (36), and perioperative death was reported in nine patients (1%). Advantages in favour of MIS included reduced hospital stay (median 5 vs 8 days), reduced major blood loss (3% vs 14%) and reduced transfusion requirement (6% vs 24%). In all, 76 cases (8%) were excluded from analysis based on benign pathology leading to reassignment to the ‘simple nephrectomy’ category.



Conclusions

NU is currently a low-volume operation (median 3 cases/year) within the remit of the nephrectomy surgeon, but is a safe procedure with a relatively low complication rate. Most NU surgery in the UK is now performed with laparoscopic assistance, with advantages including reduced major blood loss, reduced transfusion requirement and shorter hospital stay.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/bju.12827

Nephroureterectomy surgery in the UK in 2012: British Association of Urological Surgeons (BAUS) Registry data

The role of imaging in the surveillance of urologic malignancies.

Hydronephrosis and renal impairment may persist even after relieving an obstruction, particularly in cases of chronic obstruction. Obstruction can cause fibrotic changes of the ureter, potentially contributing to long-term kidney damage.To characterise pathophysiological changes of obstructed ureters with focus on inflammatory responses triggering fibrosis and potential impairment of ureteral function.Eighty-eight mice were randomly assigned to unilateral ureteral obstruction (UUO) for 2 d, UUO for 7 d, and UUO for 7 d followed by 8 d of recovery, or a control group (no prior surgical intervention).Peristaltic rate was determined over 2 min by direct visualisation with a microscope, while hydronephrosis was assessed by ultrasound. Obstructed and contralateral ureters were harvested, and underwent histopathological evaluation. We quantified 44 cytokines/chemokines, and five matrix metalloproteases using Luminex technology. Cell composition was characterised via immunofluorescence. Statistical significance was assessed using Welch analysis of variance, Kruskal-Wallis test, and Dunnett's T3 multiple comparison test.Obstruction resulted in hydronephrosis and significantly impaired peristalsis. Marked fibrosis was observed in lamina propria, muscle layer, and adventitia. Connective tissue in obstructed ureters showed hyperaemia and leucocyte infiltration. Unsupervised hierarchical clustering demonstrated different cytokine/chemokine patterns between groups. Ureters obstructed for 7 d followed by recovery were notably different from other groups. Inflammatory cytokines, chemoattractants, and matrix metalloproteases increased significantly in obstructed ureters. Contralateral unobstructed ureters showed significantly increased levels of chemokines and matrix metalloproteases. Immunofluorescence confirmed activation of T cells, Th1 and Th2 cells, and M1 macrophages in obstructed and contralateral ureters, and a shift to M2 macrophages following prolonged obstruction.Ureteral obstruction triggers severe inflammation and fibrosis, which may irreversibly impair ureteral functionality. Function of the unobstructed contralateral ureter may be regulated by a systemic immune response as a result of the obstruction.Here, we studied in more detail the way the ureter responds to being blocked. We conclude that a strong immune response is activated by the blockage, leading to changes in the structure of the ureter possibly impacting function, which may not be reversible. This immune response also spreads to the opposite ureter, possibly allowing it to change its function to compensate for the reduced functionality of the blocked ureter. 

Ureteral Obstruction Promotes Ureteral Inflammation and Fibrosis.

Purpose: To determine the current practice patterns in the management of upper-tract transitional-cell carcinoma (TCC) among a large group of urologists. Materials and Methods: A survey was sent to 220 practicing members of the Society of Urologic Oncology (SUO) and the Endourological Society (ES) and members of the American Urological Association who did not belong to either society. The survey consisted of 16 focused questions pertaining to the surveillance and management of upper-tract TCC. The responses were used to create a database, which was then analyzed to determine practice trends. Results: Eighty-four of the urologists responded, for a response rate of 38%. Fourteen responses were excluded because of multiple answers to a given question, so 70 were included in the final analysis. Eighty percent of the respondents were in academic practice. A CT urogram was the favored initial procedure for diagnosis of upper-tract TCC and an intravenous urogram was the next commonest choice (53% and 40%, respec...

Current practice patterns in urologic management of upper-tract transitional-cell carcinoma.

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Ureteral Obstruction Promotes Ureteral Inflammation and Fibrosis.

Current practice patterns in urologic management of upper-tract transitional-cell carcinoma.