Sigmoidoscopy, cystoscopy, and stenting
J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan in An Atlas of Gynecologic Oncology, 2018
The instrumentation and stenting of ureters should only be performed by clinicians such as urologists or gynecologic oncologists, since it is easy to damage the ureteric orifices and ureters. Ureteric catheterization and the placement of double J stents are achieved with the 30° telescope. There is a special port for the introduction of the stents, which can be directed toward the ureteric orifices. A floppy-tipped, Teflon-coated guide wire is first placed into the ureteric orifice and advanced under fluoroscopic control into the renal pelvis. The double J stent is slid over the guidewire through the channel of the cystoscope and into the ureter (Figure 6.9). The stent is radio-opaque and its position is monitored by fluoroscopic control. Excessive force used in insertion of the guidewire or stent should be avoided. The proximal and distal ends curl to form a J shape when they are correctly placed in the renal pelvis and bladder, respectively.
Transplantation
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
After completion of the venous and arterial anastomoses, the vascular clamps are removed and the kidney is allowed to reperfuse with blood. The ureter, which is kept reasonably short to avoid the risk of distal ischaemia, is then anastomosed to the bladder (Figure82.25). This is achieved by direct implantation of the ureter into the dome of the bladder with a mucosa-to-mucosal anastomosis, followed by closure of the muscular wall of the bladder over the ureter to create a short tunnel, the Lich–Gregoir technique. A double-J ureteric stent should be left in situ, to reduce the risk of urine leak or early obstruction, and removed after several weeks by cystoscopy. If the donor ureter is too short to reach the bladder, the native ureter can be divided and the distal segment anastomosed to the ureter or renal pelvis of the donor kidney. The proximal segment of the native ureter can usually be ligated and the native kidney left in situ without causing a problem. Before closing the transplant wound, it is very important to ensure that the kidney is lying in a satisfactory position without kinking or torsion of the renal vessels. In small children receiving an adult donor kidney, the abdomen is opened through a midline incision and the graft is placed intra-abdominally with anastomosis of the renal vessels to the aorta and vena cava.
Upper urinary tract obstructions
Prem Puri in Newborn Surgery, 2017
Recent progress in endoscopic tools (such as miniscopes, balloons, and guide wires) has led to the widespread use of endoscopy for ureteral repair.80,81 Some suggested that a simple insertion of the double-J stent into the obstructive ureter for 6 months may solve the problem.82 Others have advocated balloon dilatation of the obstructed segment with 3.5 Fr dilating balloon, which is inflated to 12–14 atm, or until disappearance of the stenotic obstructive area.83 This technique demonstrated 90% success rate not only in the short-term period but also in the long-term follow-up. Barat et al.85 recently reported preliminary results with endoureterotomy for congenital megaureters. The technique consists of incision of the obstructive segment of the ureter, which is inserted into the ureteral orifice ureteroscope. All of the layers of the ureter are incised in the long axis through the entire obstructive segment to expose the periureteral areolar tissue. A double-J stent is inserted for 3 weeks after the procedure. The risk of secondary reflux, which is a main concern after this type of procedure, has not been systematically checked. The role of endoureterotomy in the treatment of megaureters in children has not been widely established. Recently, some authors have advocated a laser incision on the obstructive segment following balloon dilatation at the same setting.84 Although the initial results in the small group of patients were promising, long-term follow-up into adolescent period is required.
Indwelling ureteric stents: Patterns of use and nomenclature
Published in Arab Journal of Urology, 2020
Joon Yau Leong, James E. Steward, Kelly A. Healy, Scott G. Hubosky, Demetrius H. Bagley
The reason for this occurrence is unclear, although speculations can be made. Branding may have played a role. The term Double J in relation to the ureteric stent can be likened to Kleenex® as it relates to facial tissues. Or perhaps, as the clinically superior ‘pigtails’ supplanted the ‘Double Js’, urologists and stent manufacturers preferred fewer syllables with ‘dou-ble-J’. Additionally, as there was an almost universal adoption of pigtail stents by endourologists, the incorrect use of clinical nomenclature did not carry with it an overall negative clinical outcome during the transition. Nonetheless, continual misuse of the term Double J serves to underappreciate the importance of the ‘double pigtail’ and ignores the ingenuity and innovation that was required to create its superior design.
Donor kidney lithiasis and back-table endoscopy: a successful combination
Published in Acta Chirurgica Belgica, 2023
Michaël M. E. L. Henderickx, Joyce Baard, Pauline C. Wesselman van Helmond, Ilaria Jansen, Guido M. Kamphuis
Pushkar et al. described 14 cases with back-table endoscopic stone treatment. All were living donors with unilateral, asymptomatic nephrolithiasis between four and ten millimeters who underwent standard donor screening and therefore are comparable with this case [4]. They put the donor kidney on the ice during the back-table treatment. The authors first spatulated the ureter and started the procedure with a semi-rigid URS. They only used a flexible URS if necessary. When the kidney stone was found, they relocated it to the pyelum with a basket or forceps and extracted it via a pyelotomy. Only if a pyelotomy was not feasible, they would use a laser to fragment the stone and extract the pieces through the ureter [4]. Mean operation time in their series was 28 min. A double-J stent was placed for four weeks. The stone-free rate was 93% and no major complications (modified Clavien-Dindo classification ≥3) were recorded [4].
Robotic correction of iatrogenic ureteral stricture: preliminary experience from a tertiary referral centre
Published in Scandinavian Journal of Urology, 2019
L. Masieri, S. Sforza, F. Di Maida, Antonio Andrea Grosso, A. Mari, Emma Maria Rosi, R. Tellini, M. Carini, A. Minervini
Patients were treated with three different robot-assisted techniques according to the level of the stenosis as previously described: Anderson-Hynes pyeloplasty for uteropelvic junction obstruction (UPJO), partial ureterectomy with end-to-end anastomosis and ureteral reimplantation for distal ureteral strictures [16–18]. The Da Vinci Si system was used in all the cases (Intuitive Surgical, Sunnyvale, CA, USA) with a transperitoneal approach. The pneumoperitoneum was induced using a standard mini-open access according to Hasson technique and, when feasible, robotic trocars were placed corresponding to previous scars. The ureter was spatulated in all of these surgeries to reduce the risk of restenosis. After these reconstructive procedures, a bladder catheter and drainage were left in place. The double J stent was removed ∼4 weeks after surgery in the outpatient department.
Related Knowledge Centers
- Cystoscopy
- Pyelonephritis
- Urinary Tract Infection
- Urine
- Vesicoureteral Reflux
- Ureter
- Kidney
- Kidney Stone Disease
- Ureteroscopy
- Renal Pelvis