Replacement of the ureter by small intestine: clinical application and results of the ileal ureter

Study on use of isolated segment of ileum in urological plastic operation

Studies were done on 33 cases of plastic reconstruction of the urinary tract with an isolated ileal segment. We found that electrolytes and other components in the urine can be absorbed or excreted by the isolated ileal mucosa. Although electrolyte balance was preserved in most cases the tendency for hyperchloremic acidosis and high blood urea nitrogen was observed in some patients with poor renal function. The degree and the incidence of these changes were influenced by the length of ileal segment used and the volume of urine excreted. These 2 factors were related to infection, which gave deleterious effects on renal function. Among the tests used for prognosis the excretory urogram was found to be the most simple and provided the best information.

A case against incorporation of bowel segments into the closed urinary system

Five patients in whom isolated ileal or ileocecal segments had been incorporated into the urinary tract suffered complications that ended in excision of the bowel segment. A bowel segment functions if it does not meet resistance or increased intraluminal pressures. In a closed system these 2 evils are working constantly against the loop of bowel, subjecting it to growing distension, dilatation and redundancy and, inevitably, residual urine, urinary tract infection, stone formation, electrolyte imbalance and progressive deterioration of the upper urinary tract ensue. What was initially meant to save kidney function causes instead renal damage and eventually total loss of function.

Urinary tract refunctionalization after prior diversion in children

Thirty-two children who had undergone previous urinary diversion were operated upon to refunctionalize the bladder. In 24 the diversion had been considered permanent, and in eight, temporary. Success in these procedures suggests that many young patients deserve a second look for possible "undiversion."