Ileal ureter replacement is an alternative treatment for various length ureter defects. We present our experience and outcome of ileal ureter replacement in China. We retrospectively collected data of patients who underwent ileal ureter replacement between January 2010 and January 2015. We reviewed the medical history, indications for surgery, operative data, perioperative data, and outcomes. Besides, follow-up data included symptom, urine routine test, serum creatinine, serum electrolyte status, and radiographic test. There were 23 patients who underwent ileal ureter replacement by the same surgeon. Twenty patients were performed unilateral ileal ureter replacement, two patients underwent a combination of ileal ureter replacement and Boari flap-psoas hitch, and one received bilateral ileal ureter replacement. Among these patients, the main cause leading to surgical treatment was iatrogenic injuries (n = 15), especially urinary surgery procedure (n = 11). The median follow-up time was 45 months. There were 6 early complications and 6 late complications after operation. Only one patient suffered from small bowel-related complication and was cured by conservative treatment. Only the patient who underwent bilateral ileal ureter replacement had metabolic acidosis. And 22 patients (95.7%) had a good renal function. Ileal ureter replacement is an efficacious and safe procedure for the therapy of long ureteral defects. With appropriate technical considerations, the complication rate may decrease.

Purpose: To evaluate the onlay technique using the appendix for ureteral reconstruction and describe the initial experience of nine operations performed by one surgeon. Methods: Nine patients with complex ureteral strictures who underwent appendiceal onlay flap ureteroplasty since May 2019 were recruited from our RECUTTER database. There were seven men and two women, with a mean age of 38.9 years; four patients underwent robot-assisted laparoscopic surgery, and five patients underwent traditional laparoscopic surgery. All patients had iatrogenic injuries of the ureter after treatment of stone disease. Seven patients had proximal ureteral strictures, and two had midureteral strictures. The mean stricture length of the nine patients was 3.9 (range 3–4.5) cm. Nephrostomy was performed in seven patients before they presented to our center, and the other two patients had indwelling Double-J ureteral stents. Results: All nine operations were effectively completed without open conversion. The mean operation time was 182 (range 135–220) minutes, the mean estimated blood loss was 71 (range 20–100) mL, and the mean length of postoperative hospital stay was 9 (range 6–12) days. No postoperative complications of high grade (Clavien–Dindo III and IV) occurred within 30 days of surgery. All the patients had their Double-J ureteral stents and nephrostomy tubes removed after complete ureteroscopy and upper urinary tract urodynamic examination or CTU, which showed that the anastomosis healed well and that the urinary tract was unobstructed, respectively. The objective success rate was 100% (all the patients had endoscopic and radiographic resolution of their ureteral strictures). The subjective success rate was 88.9% (one patient developed recurrent back discomfort and a 0.5 cm calculus was found in her renal pelvis). Conclusions: Appendiceal onlay flap ureteroplasty is a viable and effective technique for treating complex proximal and middle ureteral strictures at the right side.

Previous reports about laparoscopic total pelvic exenteration (LTPE) are still limited. In the present study, we described our single-center experience of the initial 11 cases. Between April 2011 and September 2015, eight males and three females diagnosed as pelvic malignancies underwent LTPE by the same operation team. We retrospectively collected all cases’ parameters about surgical technique. Thirty-seven patients who received open surgery were also retrospectively collected. A comparison between LTPE and open surgery was performed to evaluate the feasibility and safety of LTPE. Eleven cases successfully underwent the LTPE without any intraoperative complication. No open conversion was required. Eight patients underwent Bricker’s procedure. Three patients were performed with the cutaneous ureterostomy. Anus preservation operation was performed in three patients. Compared with open surgery, LTPE had longer mean operative time (565.2 vs 468.2 min, p = 0.004) but less mean blood loss (547.3 vs 1033.0 ml, p < 0.001) and shorter postoperative hospitalization time (15.3 vs 22.4 days, p = 0.004). One patient died of pulmonary embolism in the 7th month of follow-up time. One patient died of recurrence in the 12th month of follow-up time. Nine patients are still alive without recurrence and metastasis. The mean follow-up time was 11.1 months. The technique of LTPE seems to be feasible and safe in the treatment of carefully selected patients of pelvic malignancies. LTPE can also decrease the blood loss, the recovery time, and the hospital stay. But the oncological safety and long-term outcome of LTPE still need to be explored.

Objective: To share our experience in robot-assisted pyeloplasty (RAP) with the Kangduo (KD) surgical robot vs. the da Vinci Si (DV) robotic system (KD-RAP vs. DV-RAP, respectively). Methods: From August 2019 to February 2021, 16 patients with ureteropelvic junction obstruction (UPJO) underwent KD-RAP and other 16 patients with UPJO accepted DV-RAP. All procedures were performed by the same surgeon. The perioperative results and follow-up data were prospectively collected and compared. Results: There was no conversion to open or laparoscopic surgery. The mean operation time was significantly longer in the KD-RAP group than the DV-RAP group (141 ± 28 vs. 118 ± 31 min, respectively, p = 0.04). The time per stitch was significantly longer in the KD-RAP group than the DV-RAP group (1.7 ± 0.5 vs. 1.4 ± 0.3 min, respectively, p = 0.05). No significant difference was noted in the estimated blood loss and the postoperative length of hospitalization. At a median follow-up of 19 (range, 17–21) and 19.5 (range, 14–33) months for the KD-RAP and DV-RAP groups respectively, no difference was noted in the success rates between the KD-RAP and DV-RAP groups (93.75% and 100%, respectively; p = 0.31). Complications were comparable between the two groups (p = 0.54). One (6.3%) patient developed urinary infection which responded well to oral antibiotics in KD-RAP group and 2 (12.5%) patients suffered from irritation symptoms of bladder which improved after removal of D-J stent in DV-RAP group. Conclusion: The RAP with the use of the KD system was feasible, safe and effective. The DV-RAP group showed advantage in the operation time and the time per stitch.

To analyze the characteristics of ureteral stricture after ureteroscopic holmium laser lithotripsy and summarize our experience with the reconstructive strategies. This study retrospectively reviewed 42 patients with ureteral stricture after ureteroscopic holmium laser lithotripsy between December 2009 and December 2019. Patient demographics, laboratory data, imaging studies, perioperative variables, complications, and follow-up data were recorded. Surgical success was defined as relief of symptoms, improved/stabilized hydronephrosis, and stable renal function. The upper, middle, and lower thirds of the ureter were affected in 27, 6, and 7 cases, respectively. Multiple ureteral strictures were found in 2 patients. The median length of the stricture was 3.5 cm (range 1-30 cm). In the upper ureteral strictures, lingual mucosal ureteroplasty (8/27, 29.6%) is the most commonly used treatment method for stricture longer than 3 cm but shorter than 6 cm, followed by appendiceal onlay ureteroplasty (5/27, 18.5%). Four lower ureteral strictures ranging from 3 to 8 cm were repaired with Boari flap. Reconstructive strategies of the middle ureteral strictures included Boari flap, appendiceal onlay ureteroplasty and ureteroureterostomy. Patients with the length of the stricture longer than 8 cm or multiple strictures underwent ileal ureter replacement. The median follow-up was 27.3 ± 17.2 months. The overall success rate was 97.6%. Upper ureter is more vulnerable in ureteroscopic holmium laser lithotripsy. Sufficient follow-up and appropriate examination are necessary for diagnosis. Different treatment strategies need to be flexibly selected according to the location and length of the injury.