Replacement of the damaged or neoplastic ureter by ileum

Use of ileum as ureteral replacement in urological reconstruction

PURPOSE

We reviewed indications and outcomes in patients undergoing ileal ureter replacement for ureteral reconstruction.

MATERIALS AND METHODS

Between 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.

RESULTS

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.

La terapia chirurgica tradizionale della fibrosi retroperitoneale idiopatica: Traditional surgical treatment of idiopathic retroperitoneal fibrosis

Surgical treatment of idiopathic retroperitoneal fibrosis is indicated in the most advanced stages of the disease and aims at resolving the urinary obstruction by freeing the ureters of the compressing and enveloping fibrous plaque. The purpose of this study was to briefly review the traditional surgical techniques, while assessing the results of the main reports in literature.

Versatility of the adult psoas hitch ureteral reimplantation

PURPOSE

The psoas hitch ureteral reimplant has been described in the literature as an excellent method to restore ureterovesical continuity in patients with ureteral defects of various etiologies. However, long-term data on the durability of this procedure are lacking. We retrospectively reviewed patients who underwent ureteral reconstruction using the psoas hitch reimplantation to determine long-term efficacy.

MATERIALS AND METHODS

Ureteral reimplantation in the adult is frequently performed in the setting of ureteral tissue loss secondary to resection or injury. The psoas hitch reimplantation is a simple, versatile technique that avoids the inclusion of intestinal segments and can be used in most patients requiring reimplantation. Indications for surgery and the long-term followup were examined in 20 patients undergoing reimplantation using the psoas hitch.

RESULTS

The indications for ureteral reconstruction included surgical injury in 13 cases, recurrent pyelonephritis with reflux in 1, obstruction secondary to cancer in 2, trauma in 1, retroperitoneal fibrosis in 1 and ureteral stricture in 2. At followup of 1 to 14 years (mean 6) 17 patients have not required further intervention for urological problems and have retained normal renal function. In the 2 patients with cancer ileal conduit was performed later and in 1 flank pain persisted despite negative urological evaluation.

CONCLUSIONS

Psoas hitch ureteral reimplantation can be used successfully for bridging various ureteral defects in difficult clinical situations. Adequate renal and bladder mobilization will allow reconstruction despite long ureteral defects.

Ileal segment replacement of ureter. I. Effects on kidney of refluxing vs nonrefluxing ileovesical anastomosis

Unilateral partial ureteral obstruction was induced in 32 dogs followed by total ileal replacement of the obstructed ureter. The morphologic and functional effects on the kidney using a freely refluxing versus a nonrefluxing ileovesical anastomosis were compared, as well as the effect of total tapering of the reimplanted ileal segment. The tapered ileovesical anastomosis proved more reliable for prevention of reflux than the nontapered technique. Reflux prevention does not appear necessary for maintaining renal morphology and function when bladder function is normal and the observation period short. Total tapering of the ileal segment did not prove to be advantageous in protecting against hyperchloremic acidosis in this short-term canine study.

Ileal segment replacement of ureter. II. Dynamic characteristics of refluxing, nonrefluxing, and totally tapered ileal ureter

The pressure characteristics and cinefluoroscopic appearances of a refluxing, nonrefluxing, and totally tapered ileal " neoureter " were compared in 22 dogs with normal bladder function. The totally tapered ileal segment with a reflux preventing ileovesicostomy simulates normal ureteral peristalsis most closely on cinefluoroscopic evaluation. Pressure gradients across the ileovesical junction though were similar in refluxing and nonrefluxing ileovesicostomies , as well as in totally tapered ureters.

Renal autotransplantation for retroperitoneal fibrosis

Idiopathic retroperitoneal fibrosis is a disease of unknown etiology characterized by a dense rubbery retroperitoneal plaque that encases 1 or both ureters, causing hydronephrosis and impairing renal function. Primary or recurrent disease may result in extensive ureteral damage, leaving the urologist with limited surgical options. We herein report the fourth case managed successfully by renal autotransplantation.

Ileal loop replacement and restoration of kidney function in extensive bilharziasis of the ureter

Ileal loop replacement is often the only possible treatment of extensive bilharziasis of the ureter. Experience with 5 such cases is presented and the special problems arising from the nature and extent of the lesion are discussed. In bilateral cases, attempts should be made to preserve as much renal tissue as possible. Non-functioning kidneys in 3 cases were not removed and a degree of function was restored following the relief of obstruction by also connecting these kidneys to the ileal loop.

Total replacement of the ureter with a segment of ileum. A follow-up study

Total replacement of the ureter with a segment of ileum was performed on seven patients. Five of them were followed up for a mean of 20 months. The results of the operation were good. Serum electrolyte imbalance occurred postoperatively in one case.