A review of complications after ureteral reconstruction

doi:10.1016/j.ajur.2024.02.007

Asian Journal of Urology, 2024, 11 (3): 348-356 doi: 10.1016/j.ajur.2024.02.007

Reviews

Current Issue | Archive | Adv Search

A review of complications after ureteral reconstruction

Jonathan Rosenfeld^a,Devin Boehm^a,Aidan Raikar^a,Devyn Coskey^a,Matthew Lee^b,Emily Ji^a,Ziho Lee^a,*(

)

^aDepartment of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
^bDepartment of Urology, Temple University, Lewis Katz School of Medicine, Philadelphia, PA, USA

Abstract
Related Citation (5)

Download:

HTML

PDF (3296KB)
Export: BibTeX | EndNote (RIS)

Abstract

Objective: This study aimed to provide a comprehensive overview of the complications unique to ureteral reconstruction in adults, emphasizing their presentation, diagnosis, and management in the treatment of ureteral structure disease.

Methods: This review involves an in-depth analysis of existing literature and case studies pertaining to ureteral reconstruction, with a focus on examining the range of complications that can arise post-surgery. Special attention is given to the presentation of each complication, the diagnostic process involved, and the subsequent management strategies.

Results: Ureteral reconstruction can treat ureteral stricture disease with low morbidity; however, complications, although uncommon, can have severe consequences. The most notable complications include urinary extravasation, stricture recurrence, urinary tract infections, compartment syndrome, symptomatic vesicoureteral reflux, and Boari flap necrosis. Each complication presents unique diagnostic challenges and requires specific management approaches.

Conclusion: Ureteral reconstruction is a highly effective treatment for ureteral stricture disease. Having a strong understanding of the potential complications that patients may experience following ureteral reconstruction is not only critical to adequately counsel patients but also facilitate prompt diagnosis and management of complications when they arise.

Key words： Ureteral reconstruction Postoperative complication Urinary extravasation Stricture recurrence Urinary tract infection

Received: 31 July 2023 Available online: 20 July 2024

Corresponding Authors: *E-mail address: Ziho.lee@nm.org (Z. Lee).

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Jonathan Rosenfeld
	Devin Boehm
	Aidan Raikar
	Devyn Coskey
	Matthew Lee
	Emily Ji
	Ziho Lee

TRENDMD:

Cite this article:

Jonathan Rosenfeld,Devin Boehm,Aidan Raikar, et al. A review of complications after ureteral reconstruction[J]. Asian Journal of Urology, 2024, 11(3): 348-356.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2024.02.007 OR http://www.ajurology.com/EN/Y2024/V11/I3/348

Postoperative urinary extravasation noted on postoperative cystogram secondary to Boari flap necrosis.

Endoscopic visualization of stricture recurrence via ureteroscopy after pyeloplasty.

Onlay of a buccal mucosal graft after incision of the ureteral stricture.

Ureteral stricture excision site for application of buccal mucosal graft.

Voiding cystourethrogram showing symptomatic right ureteral reflux during the filling phase after right ureteral reimplantation.

Boari flap perfusion. (A) Difficulty assessing Boari flap perfusion under white light; (B) Boari flap perfusion confirmed after injecting intravenous indocyanine green and visualization under near-infrared fluorescence.

[1]	Braga LH, Pace K, DeMaria J, Lorenzo AJ. Systematic review and meta-analysis of robotic-assisted versus conventional laparoscopic pyeloplasty for patients with ureteropelvic junction obstruction: effect on operative time, length of hospital stay, postoperative complications, and success rate. Eur Urol 2009; 56:848-57.
[2]	Buffi NM, Lughezzani G, Hurle R, Lazzeri M, Taverna G, Bozzini G, et al. Robot-assisted surgery for benign ureteral strictures: experience and outcomes from four tertiary care institutions. Eur Urol 2017; 71:945-51.
[3]	Sukumar S, Sun M, Karakiewicz PI, Friedman AA, Chun FK, Sammon J, et al. National trends and disparities in the use of minimally invasive adult pyeloplasty. J Urol 2012; 188:913-8.
[4]	Nezhat C, Nezhat F, Green B. Laparoscopic treatment of obstructed ureter due to endometriosis by resection and ureteroureterostomy: a case report. J Urol 1992; 148:865-8.
[5]	Gadelmoula M, Abdel-Kader MS, Shalaby M, Abdelrazek M, Moeen AM, Zarzour MA, et al. Laparoscopic versus open pyeloplasty: a multi-institutional prospective study. Cent European J Urol 2018; 71:342-5.
[6]	Klingler HC, Remzi M, Janetschek G, Kratzik C, Marberger MJ. Comparison of open versus laparoscopic pyeloplasty techniques in treatment of uretero-pelvic junction obstruction. Eur Urol 2003; 44:340-5.
[7]	Bird VG, Leveillee RJ, Eldefrawy A, Bracho J, Aziz MS. Comparison of robot-assisted versus conventional laparoscopic transperitoneal pyeloplasty for patients with ureteropelvic junction obstruction: a single-center study. Urology 2011; 77:730-4.
[8]	Yohannes P, Chiou RK, Pelinkovic D. Rapid communication: pure robot-assisted laparoscopic ureteral reimplantation for ureteral stricture disease: case report. J Endourol 2003; 17:891-3.
[9]	Seetharam Bhat KR, Moschovas MC, Patel VR, Ko YH. The robot-assisted ureteral reconstruction in adult: a narrative review on the surgical techniques and contemporary outcomes. Asian J Urol 2021; 8:38-49.
[10]	Etafy M, Pick D, Said S, Hsueh T, Kerbl D, Mucksavage P, et al. Robotic pyeloplasty: the University of California-Irvine experience. J Urol 2011; 185:2196-200.
[11]	Sivaraman A, Leveillee RJ, Patel MB, Chauhan S, Bracho JE 2nd, Moore CR, et al. Robot-assisted laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction: a multi-institutional experience. Urology 2012; 79:351-5.
[12]	Nie Z, Zhang K, Huo W, Li Q, Zhu F, Jin F. Comparison of urological complications with primary ureteroureterostomy versus conventional ureteroneocystostomy. Clin Transplant 2010; 24:615-9.
[13]	Whang M, Geffner S, Baimeedi S, Bonomini L, Mulgaonkar S. Urologic complications in over 1000 kidney transplants performed at the Saint Barnabas healthcare system. Transplant Proc 2003; 35:1375-7.
[14]	Akhavan A, Avery D, Lendvay TS. Robot-assisted extravesical ureteral reimplantation: outcomes and conclusions from 78 ureters. J Pediatr Urol 2014; 10:864-8.
[15]	Wang Q, Lu Y, Hu H, Zhang J, Qin B, Zhu J, et al. Management of recurrent ureteral stricture: a retrospectively comparative study with robot-assisted laparoscopic surgery versus open approach. PeerJ 2019; 7:e8166. https://doi.org/10.7717/peerj.8166 doi: https://doi.org/10.7717/peerj.8166
[16]	White C, Stifelman M. Ureteral reimplantation, psoas hitch, and Boari flap. J Endourol 2020; 34:S25-30. https://doi.org/10.1089/end.2018.0750 doi: https://doi.org/10.1089/end.2018.0750
[17]	Meeks JJ, Zhao LC, Navai N, Perry Jr KT, Nadler RB, Smith ND. Risk factors and management of urine leaks after partial nephrectomy. J Urol 2008; 180:2375-8.
[18]	Kutikov A, Lee M, Lee Z, Uzzo R. Complications of renal surgery. AUA University; 2020. Update Series 39. https://auau.auanet.org/content/update-series-volume-39-2020. [Accessed 1 August 2023].
[19]	Wenske S, Olsson CA, Benson MC. Outcomes of distal ureteral reconstruction through reimplantation with psoas hitch, Boari flap, or ureteroneocystostomy for benign or malignant ureteral obstruction or injury. Urology 2013; 82:231-6.
[20]	Titton RL, Gervais DA, Hahn PF, Harisinghani MG, Arellano RS, Mueller PR. Urine leaks and urinomas: diagnosis and imagingguided intervention. Radiographics 2003; 23:1133-47.
[21]	Stolzenburg JU, Rai BP, Do M, Dietel A, Liatsikos E, Ganzer R, et al. Robot-assisted technique for Boari flap ureteric reimplantation: replicating the techniques of open surgery in robotics. BJU Int 2016; 118:482-4.
[22]	Lee M, Lee Z, Koster H, Jun M, Asghar AM, Lee R, et al. Intermediate-term outcomes after robotic ureteral reconstruction for long-segment (≥4 centimeters) strictures in the proximal ureter: a multi-institutional experience. Investig Clin Urol 2021; 62:65-71.
[23]	Palese MA, Munver R, Phillips CK, Dinlenc C, Stifelman M, DelPizzo JJ. Robot-assisted laparoscopic dismembered pyeloplasty. J Soc Laparoendosc Surg 2005; 9:252-7.
[24]	Lee Z, Llukani E, Reilly CE, Mydlo JH, Lee DI, Eun DD. Single surgeon experience with robot-assisted ureteroureterostomy for pathologies at the proximal, middle, and distal ureter in adults. J Endourol 2013; 27:994-9.
[25]	Selzman AA, Spirnak JP. Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries. J Urol 1996; 155:878-81.
[26]	Rasool S, Singh M, Jain S, Chaddha S, Tyagi V, Pahwa M, et al. Comparison of open, laparoscopic and robot-assisted pyeloplasty for pelviureteric junction obstruction in adult patients. J Robot Surg 2020; 14:325-9.
[27]	Kolontarev K, Kasyan G, Pushkar D. Robot-assisted laparoscopic ureteral reconstruction: a systematic review of literature. Cent European J Urol 2018; 71:221-7.
[28]	Chow AK, Rosenberg BJ, Capoccia EM, Cherullo EE. Risk factors and management options for the adult failed ureteropelvic junction obstruction repair in the era of minimally invasive and robotic approaches: a comprehensive literature review. J Endourol 2020; 34:1112-9.
[29]	Kumar M, Singh SK, Arora S, Mittal V, Patidar N, Sureka SK, et al. Follow-up imaging after pediatric pyeloplasty. Indian J Urol 2016; 32:221-6.
[30]	Lee M, Lee Z, Houston N, Strauss D, Lee R, Asghar AM, et al. Robotic ureteral reconstruction for recurrent strictures after prior failed management. BJUI Compass 2023; 4:298-304.
[31]	Lee M, Lee Z, Strauss D, Jun MS, Koster H, Asghar AM, et al. Multi-institutional experience comparing outcomes of adult patients undergoing secondary versus primary robotic pyeloplasty. Urology 2020; 145:275-80.
[32]	Elbaset MA, Zahran MH, Sharaf MA, Elmeniar AM, Ezzat O, Elgamal M, et al. Long term functional success after pyeloplasty for pelvi-ureteral junction obstruction in unilateral poorly functioning kidney in exclusively adults population. Urology 2019; 131:234-9.
[33]	Mughal S, Soomro S. Pelvi-ureteric junction obstruction in children. J Surg Pakistan (International) 2008; 13:163-6.
[34]	Wagner M, Mayr J, H?cker FM. Improvement of renal split function in hydronephrosis with less than 10% function. Eur J Pediatr Surg 2008; 18:156-9.
[35]	Rogers A, Hasan T. Management of secondary pelviureteric junction obstruction. Indian J Urol 2013; 29:294-302.
[36]	Park J, Kim WS, Hong B, Park T, Park HK. Long-term outcome of secondary endopyelotomy after failed primary intervention for ureteropelvic junction obstruction. Int J Urol 2008; 15:490-4.
[37]	Vannahme M, Mathur S, Davenport K, Timoney AG, Keeley FX Jr. The management of secondary pelvi-ureteric junction obstructionda comparison of pyeloplasty and endopyelotomy. BJU Int 2014; 113:108-12.
[38]	Thomas JC, DeMarco RT, Donohoe JM, Adams MC, Pope JC 4th, Brock JW 3rd. Management of the failed pyeloplasty: a contemporary review. J Urol 2005; 174:2363-6.
[39]	Hammady A, Elbadry MS, Rashed EN, Moussa A, Gamal W, Dawood W, et al. Laparoscopic repyeloplasty after failed open repair of ureteropelvic junction obstruction: a case-matched multi-institutional study. Scand J Urol 2017; 51:402-6.
[40]	Naude JH. Buccal mucosal grafts in the treatment of ureteric lesions. BJU Int 1999; 83:751-4.
[41]	Zhao LC, Yamaguchi Y, Bryk DJ, Adelstein SA, Stifelman MD. Robot-assisted ureteral reconstruction using buccal mucosa. Urology 2015; 86:634-8.
[42]	Lee Z, Keehn AY, Sterling ME, Metro MJ, Eun DD. A review of buccal mucosa graft ureteroplasty. Curr Urol Rep 2018; 19:23. https://doi.org/10.1007/s11934-018-0772-5 doi: https://doi.org/10.1007/s11934-018-0772-5 pmid: 29497854
[43]	Lee Z, Lee M, Koster H, Lee R, Cheng N, Jun M, et al. A multiinstitutional experience with robotic ureteroplasty with buccal mucosa graft: an updated analysis of intermediateterm outcomes. Urology 2021; 147:306-10.
[44]	Lee Z, Waldorf BT, Cho EY, Liu JC, Metro MJ, Eun DD. Robotic ureteroplasty with buccal mucosa graft for the management of complex ureteral strictures. J Urol 2017; 198:1430-5.
[45]	Hanske J, Sanchez A, Schmid M, Meyer CP, Abdollah F, Roghmann F, et al. Comparison of 30-day perioperative outcomes in adults undergoing open versus minimally invasive pyeloplasty for ureteropelvic junction obstruction: analysis of 593 patients in a prospective national database. World J Urol 2015; 33:2107-13.
[46]	Packiam VT, Cohen AJ, Nottingham CU, Pariser JJ, Faris SF, Bales GT. Open vs. minimally invasive adult ureteral reimplantation: analysis of 30-day outcomes in the National Surgical Quality Improvement Program (NSQIP) database. Urology 2016; 94:123-8.
[47]	Lee Z, Lee M, Lee R, Koster H, Cheng N, Siev M, et al. Ureteral rest is associated with improved outcomes in patients undergoing robotic ureteral reconstruction of proximal and middle ureteral strictures. Urology 2021; 152:160-6.
[48]	Kehinde EO, Rotimi VO, Al-Awadi KA, Abdul-Halim H, Boland F, Al-Hunayan A, et al. Factors predisposing to urinary tract infection after J ureteral stent insertion. J Urol 2002; 167:1334-7.
[49]	Kikuchi T, Maeda H. Two cases of compartment syndrome of the lower extremities during surgery for gynecological malignancies. J Anesth 2016; 30:481-5.
[50]	Reisiger KE, Landman J, Kibel A, Clayman RV. Laparoscopic renal surgery and the risk of rhabdomyolysis: diagnosis and treatment. Urology 2005; 66:29-35.
[51]	Pariser JJ, Pearce SM, Patel SG, Anderson BB, Packiam VT, Shalhav AL, et al. Rhabdomyolysis after major urologic surgery: epidemiology, risk factors, and outcomes. Urology 2015; 85:1328-32.
[52]	Stornelli N, Wydra FB, Mitchell JJ, Stahel PF, Fabbri S. The dangers of lithotomy positioning in the operating room:case report of bilateral lower extremity compartment syndrome after a 90-minutes surgical procedure. Patient Saf Surg 2016; 10:18. https://doi.org/10.1186/s13037-016-0106-9 doi: https://doi.org/10.1186/s13037-016-0106-9
[53]	Flierl MA, Stahel PF, Hak DJ, Morgan SJ, Smith WR. Traction table-related complications in orthopaedic surgery. J Am Acad Orthop Surg 2010; 18:668-75.
[54]	Genthon A, Wilcox SR. Crush syndrome: a case report and review of the literature. J Emerg Med 2014; 46:313-9.
[55]	Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJ, de Visser M. Rhabdomyolysis: review of the literature. Neuromuscul Disord 2014; 24:651-9.
[56]	Cervellin G, Comelli I, Lippi G. Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features. Clin Chem Lab Med 2010; 48:749-56.
[57]	Mufarrij PW, Woods M, Shah OD, Palese MA, Berger AD, Thomas R,. et al. Robotic dismembered pyeloplasty: a 6-year, multi-institutional experience. J Urol 2008; 180:1391-6.
[58]	Stefanovic KB, Bukurov NS, Marinkovic JM. Non-antireflux versus antireflux ureteroneocystostomy in adults. Br J Urol 1991; 67:263-6.
[59]	Slawin J, Patel NH, Lee Z, Dy GW, Kim D, Asghar A, et al. Ureteral reimplantation via robotic nontransecting side-toside anastomosis for distal ureteral stricture. J Endourol 2020; 34:836-9.
[60]	Corse TD, Dayan L, Cheng N, Brown A, Krishnan N, Mishra K, et al. A multi-institutional experience utilizing Boari flap in robotic urinary reconstruction. J Endourol 2023; 37:775-80.
[61]	Thompson IM, Ross G Jr. Long-term results of bladder flap repair of ureteral injuries. J Urol 1974; 111:483-7.
[62]	Asghar AM, Lee Z, Lee RA, Slawin J, Cheng N, Koster H, et al. Robotic ureteral reconstruction in patients with radiationinduced ureteral strictures: experience from the collaborative of reconstructive robotic ureteral surgery. J Endourol 2021; 35:144-50.