Management of Complete Ureteral Replacement: Experiences and Review of the Literature

Abstract

The common treatment for patients with extensive damage to the ureter is complete ureteral replacement, combining Boari flap-psoas bladder hitch and downward mobilization of the involved kidney, with complete ideal replacement of the ureter, renal autotransplantation, of elective nephrectomy. Three case reports serve to describe two options of reconstructive treatment for complete ureteral replacement. The operative techniques, their limits, their postoperative results, and the treatment alternatives are discussed with due regard to recent literature. In the case of ileal replacement we have used a very short ileal segment to reduce the absorption surface of the ileal mucosa. Reflux prevention of the ileal segment was performed by creating an invaginated distal ileum nipple which was additionally fixed at the Boari flap by a third stapler row (auto suture TASS) to prevent potential nipple-gliding.

Ureteral reconstruction for retroperitoneal tumors in children

“…Good long-term success rates have been achieved with minimal complications [7]. A combination of the Boari flap with the psoas hitch has been used to provide additional length for long defects [8][9][10]. This combined procedure does not affect the ipsilateral or contralateral kidneys and can be used safely in patients with diminished renal function [10] with only minor complications and good long-term patency rates [4,11].…”

Comparison between ureteral replacements using a transverse tubularized colonic tube or ileal ureter: experimental study in dogs

“…When the native ureter is significantly shortened such that it can no longer be repaired using conventional surgical techniques, traditionally, an ileal ureter or renal autotransplantation has been the procedure of choice [1,2]. However, there are times when the use of small bowel is suboptimal such as in patients with short gut syndrome, renal insufficiency, and small bowel disease or radiation enteritis.…”

“…Autologous tissues such as small bowel, appendix, fallopian tube, stomach, and colon have been used as substitute for a damaged ureter [2][3][4][5][6][7][8][9][10]. Synthetic materials have been developed and failed to gain wide acceptance [5].…”

“…In the majority of situations, ileum is readily available and can be used to provide the appropriate length necessary to replace large segments of the ureter. However, in situations in which the use of small bowel is undesirable, renal autotransplantation is usually performed, requiring complete renal mobilization and 2 vascular anastomoses in addition to the ureteral reimplantation [2].…”

“…To handle the problems posed by the shortened ureter, a variety of techniques have evolved. The conventional alternatives include the Psoas hitch, Boari flap, transureteroureterostomy, and ureterocalycostomy with or without renal mobilization [1,2]. There are situations, however, when these conventional techniques simply do not provide enough ureteral length, and complete ureteral substitution or renal auto-transplantation is necessary.…”