Background: Ureteral polyps are rare benign ureteral tumor. No guideline recommends that open or minimally invasive surgery is best for treating ureteral polyps. This article aims to provide a comprehensive review of the minimally invasive techniques currently available for treating ureteral polyps. Materials and Methods: We performed a comprehensive search of articles published in PubMed, using the keywords \"ureteral\" and \"polyp,\" or \"polyps.\" Results: A total of 275 studies were obtained from the literature search but 96 articles were excluded. Conclusions: Several minimally invasive approaches were developed with the advancement of medical technology, including endoscopic, laparoscopic, and robotic approaches; however, the best surgical technique was yet to be decided. Due to the advantages and disadvantages of these approaches, the best surgical approach should be tailored to each patient\'s needs and the surgeon\'s preferences and experience.

OBJECTIVE: To present our initial experience in the management of multiple ureteral polyps with robotic or laparoscopic ileal ureter replacement (IUR).
METHODS: Eight consecutive patients diagnosed with multiple ureteral polyps underwent robotic or laparoscopic IUR between July 2019 and November 2022. Unilateral IUR was performed in 5 patients with polyps in the left (n = 3) or right (n = 2) side, and 3 patients with bilateral multiple polyps underwent bilateral IUR. Demographic characteristics, perioperative data and follow-up outcomes were prospectively collected.
RESULTS: A cohort of 5 male and 3 female patients (11 ureters) with a mean age of 32.8 ± 11.3 years were included. Among these patients, 5 presented with recurrent flank pain, 1 had hematuria, and 2 were asymptomatic. Four patients experienced prior failed surgical interventions. The mean length of diseased ureter was 11.9 ± 4.7 cm, with more than 10 cm in eight sides. All procedures were performed successfully. The mean operation time was 319 ± 87.6 min with 3 patients who simultaneously underwent intraoperative ureteroscopy. The mean length of ileal graft was 23.8 ± 5.8 cm. During the mean follow-up of 20.4 ± 12.8 months, one major complication, specifically incision infection, and four minor complications, including urinary infection (n = 3) and metabolic acidosis (n = 1), were observed. All patients presented symptom-free, with improved/stabilized hydronephrosis and no signs of restenosis.
CONCLUSIONS: Robotic or laparoscopic IUR is a feasible, safe, and effective surgical option for patients with long ureteral defects caused by multiple polyps.

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OBJECTIVE: To explore the impacts of delayed ureteral stent removal on the quality of life (QoL) and mental health of urinary calculi postoperative patients due to the corona virus disease 2019(COVID-19) pandemic.
METHODS: The demographic and clinical data of patients with ureteral stent placement after urinary endoscopic lithotripsy and returned to Peking University People\'s Hospital for stent removal from December 2019 to June 2020 were collected. Ureteral stent symptoms questionnaire (USSQ) score and the outcome 20-item self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were collected to estimate the QoL and mental status. The USSQ consisted of 44 questions in 6 domains (including urinary symptom, physical pain, general health, work performance, sexual function, and ureteral stent related infection). For most questions in each domain, its score was a five-point Likert-type scale from 1 to 5, and a small proportion of questions was quantified by 1 to 4 or 1 to 7 scale. SAS and SDS both contained 20 questions used to assess a patient\'s level of anxiety and depression. Its scoring for each item was on a four-point Likert-type scale from 1 to 4. A total score (ranging from 20 to 80) was the main statistical indicator. The level of clinical anxiety and depression was quantified by using standard scores (total score multiplied by 1.25 to produce integers). And the multi-group structural equation model was constructed by analysis of moment structure (AMOS) analysis.
RESULTS: Overall, 71 patients were enrolled for analysis. It was found that the median duration of ureteral stent time differed significantly between the control and delayed groups for 32 (30, 33) d and 94.5 (88, 103) d, respectively. The delayed group resulted in higher scores in the USSQ multidimensional, which included urinary symptoms, general health, work performance and ureteral stent related infections. Anxiety and depression were also significantly serious in the delayed group than in the control group. A longer indwelling time of a ureteral stent could exacerbate the effects of urinary symptoms and physical pain on work performance (P=0.029 < 0.05). Among them, the patients with severe urinary symptoms leading to poor work performance were most significantly affected by prolonged ureteral stent duration time (CR=2.619>1.96).
CONCLUSIONS: Patients with delayed ureteral stent removal due to the COVID-19 had resulted in worse QoL and mental status. Stents related symptoms are more severe in patients with higher anxiety and depression degree during COVID-19. To improve the QoL and mental health of patients after urinary calculi surgery during COVID-19, it is still not recommended to prolong the stent duration time or corresponding intervention measures should be taken.

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BACKGROUND Endometriosis is a disease characterized by endometrial tissue appearing outside the uterus, mainly involving the peritoneum and pelvic organs. Ureteral endometriosis (UE) is rare, typified by deep infiltrating endometriosis involving the ureter and can result in ureteral obstruction, proximal hydroureter, hydronephrosis, and impairment of renal function. Symptoms may be insidious and nonspecific and may lead to a prolonged disease course. We describe a patient with UE complicated by hydronephrosis. CASE REPORT A 42-year-old woman was admitted to the Urology Department with the incidental discovery of right hydronephrosis. After a thorough examination, she underwent right ureteral mass resection and right ureteral stump anastomosis. The pathology report indicated endometriosis. The patient was given 6 doses of gonadotropin-releasing hormone agonist immediately after surgery, followed by an intrauterine levonorgestrel-releasing system. Postoperative follow-up showed that no recurrence was observed in this year. Here, we briefly summarize the epidemiology, pathogenesis, clinical presentation, imaging, treatment, and prognosis of the disease. CONCLUSIONS UE should be listed as one of the differential diagnoses of unexplained hydronephrosis in women of childbearing age, and those with dysmenorrhea should be cognizant of this disease. Active surgical treatment and long-term management should be carried out to obtain better prognosis.

BACKGROUND: Arterioureteral fistula (AUF) is a rare, life-threatening condition wherein communication occurs between a ureter and the common, internal, or external iliac artery. The sensitivity of common clinical imaging examination for AUF is low, which leads to a delayed diagnosis and increased mortality. In addition, the increased use of ureteral stents contributes to the growing frequency of AUF.
METHODS: Our two patients were 74 and 65 years old males respectively. They both had a medical history of bladder cancer and underwent radical cystectomy with ureterocutaneostomy. The patients underwent routine catheter exchange during over 1 year postradical cystectomy and subsequently experienced intermittent gross pulsatile haematuria. After a series of imaging examinations failed to identify the cause, the patients were ultimately diagnosed with AUF and treated with interventional radiotherapy, followed by broad-spectrum antibiotics. Positive effects were found.
CONCLUSIONS: The incidence of AUF is increased with the prolongation of survival in patients with related risk factors. This case report aims to highlight early diagnosis and management of AUF to lower the mortality.

BACKGROUND: The purpose of this study was to characterize the pathophysiological changes of hydronephrosis caused by ureteral calculi obstruction in a new rabbit ureteral calculi model by implanting flowable resin.
METHODS: Forty New Zealand rabbits were randomly divided into two groups: the calculi group and the sham control group. In the calculi group (n = 20), rabbits were operated at left lower abdomen and the left ureter was exposed. Then flowable resin (flowable restorative dental materials) was injected into the left ureter using a 0.45 mm diameter intravenous infusion needle. Then light-cured for 40 s by means of a dental curing light to form calculi. In the sham control group, normal saline was injected into the ureter. Rabbits underwent X-ray and routine blood and urine tests preoperatively, as well as X-ray, CT, dissection, HE staining and routine blood and urine tests on 1, 3, 5 and 7 days postoperatively. Stone formation was assessed by X-ray and unenhanced CT scan after surgery. The pathophysiological changes were evaluated through dissection, HE staining and routine blood and urine tests.
RESULTS: Ureteral calculi models were successfully constructed in 17 rabbits. In calculi group, high-density shadows were observed in the left lower abdomen on postoperative day 1st, 3rd, 5th and 7th by X-ray and CT scan. Dissection found obstruction formation of the left ureters, dilatation of the renal pelvis and upper ureter during 7 days after surgery. The renal long-diameters of the left ureters increased only on the 1st postoperative day. HE staining found ureteral and kidney damage after surgery. In calculi group and sham group,the serum creatinine, urea nitrogen, white blood cells and urine red blood cells were raised at day 1 after surgery. However, the indicators returned to normal at day 3, 5, and 7.
CONCLUSIONS: This is a stable, less complicated operation and cost-effective ureteral calculi model by implanting flowable resin. And this novel model may allow us to further understand the pathophysiology changes caused by ureteral calculi obstruction.

BACKGROUND: The timing of surgical repair for ureterovaginal fistula (UVF) is under debate, here we introduce our experience to compare the safety and efficacy between early and delayed ureteral reimplantation for UVF.
METHODS: Between January 2012 and January 2020, 22 patients who were diagnosed with UVF had received ureteral reimplantation. Baseline characteristics, history of previous abdominal surgery, operative profile, and follow-up data were collected and analyzed.
RESULTS: Among 22 patients diagnosed with UVF, 12 patients received early ureteral reimplantation and others received delayed ureteral reimplantation. Both groups were comparable in baseline characteristics and detailed history of previous operations. The mean operative time of the early surgery group was 140.83 ± 35.28 min, while that of the delayed surgery group was 181.00 ± 43.83 min (p = 0.027). Patients of the early surgery group (183.33 ± 107.31 mL) had less blood loss compared with that of the delayed surgery group (285.00 ± 94.43 mL) (p = 0.030). After an overall mean follow-up of 34.55 months, the ureteral stricture rate of two groups was not statistically significantly different (16.67% in early repair vs. 40.00% in delayed repair, p = 0.348).
CONCLUSIONS: With similar long-term outcomes, the early ureteral reimplantation had a shorter operative time and less blood loss. Moreover, the stress during the waiting period could be minimized. High-quality clinical studies with larger sample size are needed to confirm the superior nature of early surgery.

Renal arteriovenous malformation (RAVM) is a rare pathology. It may present with heamturia, hypertension, and congestive heart failure. Digital subtraction angiography (DSA) is the standard diagnostic choice, and endovascular embolization is a preferred procedure of management in most cases. The feeding branches of RAVM are reported to originate from renal arteries. In this report, a 43-year-old female with recurrent massive hematuria and left flank pain was described. Renal angiography revealed double renal arteries supplying the left kidney and multiple renal arteriovenous fistula formation around the renal pelvis. Embolization with coils and gelfoam was performed after which her hematuria subsided. One month later, the patient was readmitted to our hospital due to the relapse of massive hematuria following heavy physical activities. DSA found another feeding artery of the RAVM originating from the aorta around the 4th lumbar vertebra. After embolization of this arterial feeder, hematuria settled. There was no recurrence during a 10-month follow-up. To our knowledge, this is the first case of RAVM with an extrarenal feeding artery, and omission of this scenario can lead to treatment failure.