PMC10164996_01
(A) The patient's preoperative urine cytologic testing results, suggesting urothelial carcinoma. (B, C) Preoperative CTU of the patient.
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A urine culture revealed Streptococcus agalactiae, and the results of urine cytologic testing suggested that the transitional cell carcinoma was arranged in a papillary structure with mild-moderate heterogeneity of cells, and urothelial carcinoma was considered ( Figure 1A ). CTU showed a filling defect in the lower right ureter with right hydronephrosis ( Figures 1B, C , arrow).
Schematic diagram of total intracorporeal laparoscopic kidney autotransplantation. (A) The tumor was located in the distal right ureter. (B) The right middle ureter was clamped using a hem-o-lock clip. (C) Bladder cuff excision. (D, E) The right renal artery and vein were fully clamped and disconnected, respectively, and the right vena cava was sutured. (F, G) Reconstruction of the vascular system after right kidney transplantation. (H) Reconstruction of the urinary tract system. (I) Kidney after transplantation.
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The right middle ureter was clamped using a hem-o-lock clip ( Figures 2A, B ), the right ureter-bladder was cuffed and resected, and the cystotomy incision was sutured ( Figure 2C ). The right renal artery and vein were fully clamped and disconnected, respectively, and the right vena cava was sutured ( Figures 2D, E ). The right kidney and right ureter were quickly removed through an incision of approximately 7 cm in length in the right iliac fossa. The right internal iliac vein was clamped at both ends by bulldog clips, and the right vein was reconstructed end-to-end with the right internal iliac vein ( Figure 2F ). Similarly, the right artery was reconstructed end-to-end with the right internal iliac artery ( Figure 2G ). Then, the right ureter was reconstructed end-to-end with the right posterior wall of the bladder ( Figure 2H ), and finally, the right internal iliac vein and arterial hobgoblin were released to restore blood flow to the right kidney, which was rich in vitality ( Figure 2I ).
(A, B) CTU at the 1-year postoperative follow-up examination. (C) Postoperative cosmetic results.
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Surveillance cystoscopy and CTU examination showed no evidence of disease recurrence ( Figures 3A, B ). The postoperative cosmetic results were satisfactory ( Figure 3C ), and the patient is still undergoing close follow-up ( Figure 4 ).
Patient timeline. CTU, computed tomography urography; LS, Lynch syndrome; BCG, Bacillus Calmette-Guerin.
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The postoperative cosmetic results were satisfactory ( Figure 3C ), and the patient is still undergoing close follow-up ( Figure 4 ).