Use of Ileum as Ureteral Replacement in Urological Reconstruction

Abstract

Purpose-We reviewed indications and outcomes in patients undergoing ileal ureter replacement for ureteral reconstruction. December 1989 and September 2007, 105 patients underwent ileal ureter replacement, of whom 14 were excluded from study due to incomplete data. The remaining 91 patients (99 renal units) comprised the study cohort. Materials and Methods-BetweenResults-Mean patient age was 46.8 years and mean followup was 36.0 months. Indications for an ileal ureter were stricture following genitourinary surgery in 29 cases (31.9%), radiation induced stricture in 17 (18.7%), nonurological surgery iatrogenic injury in 16 (17.6%) and retroperitoneal fibrosis in 11 (12.1%). Only 4 patients (4.4%) had primary ureteral cancer. Long-term complications included anastomotic stricture in 3 patients (3.3%) and fistula in 6 (6.6%). Serum creatinine decreased or remained stable in 68 patients (74.7%) and hyperchloremic metabolic acidosis developed in 3. No patient complained of excessive urinary mucous production.Conclusions-In 68.1% of patients indications for an ileal ureter included radiation induced stricture or iatrogenic injury. The ileal ureter is a reasonable option for long-term ureteral reconstruction with preserved renal function in carefully selected patients. Keywordsureter; ileum; reconstructive surgical procedures; iatrogenic disease SINCE its first description in 1906 by Shoemaker 1 and later popularization by Goodwin et al in the late 1950s, 2 the use of ileal segments for ureteral substitution has become a valuable procedure in reconstructive urology. Although it was initially described for tubercular obstruction, recent decades have seen the indications for its use broaden. We report a contemporary series representing changes in indications, patient selection and clinical outcomes. PATIENTS AND METHODS Study DesignAfter receiving institutional review board approval we retrospectively analyzed the records of all patients who underwent ileal ureter replacement at

U-shaped Bilateral Ileal Ureter Substitution for Failed Conservative Management of Retroperitoneal Fibrosis: A Case Report

“…Multiple studies have confirmed the utility and reliability of ureteral replacement with small intestine [9,10]. However, we counsel patients preoperatively that the complication rate ranges from about 30 to 50%-minor mostly and major less often.…”

“…Having any of these could lead to worsening renal failure and/or bowel related shortterm and long-term complications. Armatys et al describe a 7-shaped and reverse 7-shaped ileal segment configuration for bilateral ureteral reimplantation [9]. The disadvantage of this is technique is that it can be difficult to position the middle ileal segment to the renal pelvis.…”

Laparoscopic bowel ureteroplasty

“…По данным литературы, после открытой пла-стики мочеточника кишкой в 10% случаев наблю-даются такие отдаленные осложнения, как негер-метичность анастомоза, стриктура и фистула [2][3][4].…”

“…В настоящее время кишечная пластика мо-четочника является методом выбора при протя-женных рецидивных стриктурах верхних мочевых путей (ВМП) [1][2][3][4]. Данная операция до эры эн-довидеохирургии выполнялась открытым досту-пом, который был травматичным и значительно увеличивал сроки пребывания в стационаре и ре-абилитации больных.…”

Oral Mucosa Graft

“…Options for ureteral replacement traditionally include psoas hitch, boari flap, the Monti tube, use of the appendix, reconfigured colon or ileal segment (Brandes et al, 2004;Mathews &Marshal,1997;Ali-El-Dein&Ghoneim,2003;Jeffrey et al,2000;Armatys et al,2009;Pope&Koch,1996). Ureteral defects too long to be treated by excision and spatulated end-toend anastomosis can be treated by use of oral mucosa grafts.…”