Korean J Urol.  2007 Jun;48(6):615-619. 10.4111/kju.2007.48.6.615.

Ileoureteral Substitution for Complex Ureteral Reconstruction using Refluxing, Non-tailoring Vesicoileal Anastomosis

• Park YH
• Kim KT
• Kim M
• Jeong BC
• Kim HH

• KMID: 1885543
• DOI: http://doi.org/10.4111/kju.2007.48.6.615

Abstract

PURPOSE: Ileoureteral substitution could be the viable option for the cases with long defects of the ureter that cannot be repaired using intrinsic urinary tract tissues. Yet it is controversial whether anti-refluxing and tailoring vesicoileal anastomosis is necessary. We evaluated the safety and efficacy of ileoureteral substitution using refluxing, non-tailoring technique.
MATERIALS AND METHODS
A total of 6 patients (8 ureters) underwent ileoureteral substitution at our institution between July 2002 and March 2006. We reviewed the follow up data including clinical evaluation, excretory urography or equivalent imaging results, serum creatinine and blood gases of the patients who underwent ileoureteral substitution using refluxing, non-tailoring technique.
RESULTS
Mean follow up duration was 16 months (range: 1-44). Mean operation time was 332.5 minutes (range: 285-480), estimated blood loss was 366.7ml (range: 200-900), time to oral intake was 5 days (range: 3-7) and postoperative hospital stay was 12.7 days (range: 8-27). Most postoperative complications, which occurred in 3 patients (50%), were minor in nature, including mild ileus and wound dehiscence. On the last excretory urography, there was no evidence of obstruction in any patient. None of the patients experienced worsened renal function or metabolic derangements.
CONCLUSIONS
Ileoureteral substitution using refluxing, non-tailoring vesicoileal anastomosis can be used safely without renal deterioration or metabolic derangement for patients suffering with complex and difficult ureteral strictures that are not amenable to more conservative measures. Further studies are needed to determine the long-term safety and efficacy.

Keyword

Ureteral obstruction; Urinary diversion; Ileal substitution

MeSH Terms

Constriction, Pathologic
Creatinine
Follow-Up Studies
Gases
Humans
Ileus
Length of Stay
Postoperative Complications
Ureter*
Ureteral Obstruction
Urinary Diversion
Urinary Tract
Urography
Wounds and Injuries
Creatinine
Gases

Figure

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  Fig. 1 Preoperative and postoperative intravenous urography of a patient with bilateral ureteral stricture. (A) Preoperative intravenous urography demonstrates severe bilateral hydronephrosis secondary to long obliterating stricture, (B) postoperative intravenous urography demonstrates that the contrast materials are drained into the bladder without obstruction. The ileal segment (arrow) is opacified by the contrast materials.

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  Fig. 2 Preoperative and postoperative intravenous urography of a patient with unilateral ureteral stricture. (A) preoperative intravenous urography demonstrates left hydronephrosis secondary to the ureteral stricture, (B) Postoperative intravenous urography demonstrates good drainage of contrast materials through the ileal ureter. The ileal segment (arrow) is opacified by the contrast materials.

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