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Grosso AA, DI Maida F, Mari A, Campi R, Crisci A, Vignolini G, Masieri L, Carini M, Minervini A. Totally intracorporeal robotic ileal ureter replacement: focus on surgical technique and outcomes. Minerva Urol Nephrol 2021; 73:532-539. [PMID: 33439579 DOI: 10.23736/s2724-6051.20.04191-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of the present study was to describe our totally intracorporeal robotic ileal ureter replacement technique, reporting perioperative and mid-term results and compare it with previous similar experiences, specifically focusing on technical considerations. METHODS Three patients were submitted to robotic ileal ureter substitution for long ureteral defects in our institution during 2019. The procedures were carried out fully intracorporeally. Two patients received a complete replacement of the urinary tract using an ileal segment, while in one patient the lower ureteral stump was maintained, and an ileal-ureter anastomosis was performed distally. Patients' baseline characteristics, as well as perioperative and mid-term results were collected. A detailed description of the technique is reported and compared with prior similar experiences. RESULTS Median operative time was 270 (range 240-300) min. No Clavien-Dindo complication >2 was collected. All patients experienced a fast return to oral intake and canalization. Antegrade pyelography, performed a 1-month follow-up, revealed full passage of the medium contrast in those patients submitted to complete ileal ureter replacement while, in the third one, stenosis at the level of ileal-ureter anastomoses was found. CONCLUSIONS Robotic ileal ureter replacement can be performed completely intracorporeal with optimal results and limited complication rate, in selected cases. According to our considerations, specific surgical steps are needed to reduce the risks related to this procedure, including avoiding partial ileal substitution.
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Affiliation(s)
- Antonio A Grosso
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy -
| | - Fabrizio DI Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Alfonso Crisci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Masieri
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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Staged ureteral reconstruction using the appendix in a complex pediatric patient. Urol Case Rep 2018; 21:98-100. [PMID: 30263890 PMCID: PMC6157467 DOI: 10.1016/j.eucr.2018.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/11/2018] [Accepted: 08/22/2018] [Indexed: 11/22/2022] Open
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Kumar S, Chandna A, Khanna A, Parmar KM, Narain TA, Sadasukhi N. Robot assisted intra-corporeal ileocalicostomy ureteral substitution for complex uretero-pelvic junction obstruction: a novel and feasible innovation. J Robot Surg 2018; 13:589-593. [DOI: 10.1007/s11701-018-0885-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
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Kranz J, Brandt AS, Anheuser P, Reisch B, Steffens J, Roth S. [Ureteral stricture as a late complication of radiotherapy : Possible treatment options]. Urologe A 2016; 56:322-328. [PMID: 28004123 DOI: 10.1007/s00120-016-0294-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ureteral strictures are uncommon complications of radiotherapy which are often recognized late. Their consequences range from harmless dilatation of the ureter to loss of renal function and potential life-threatening urosepsis.Therapy of radiogenic ureteral stricture is a challenging task for every urologist. Several surgical strategies including minimally invasive procedures, reconstruction and partial or complete replacement of the ureter are available.This article provides an overview of the various options in the treatment of radiogenic stricture of the ureter, focusing on the use of ileum and colon segments for ureteral substitution.
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Affiliation(s)
- J Kranz
- Klinik für Urologie und Kinderurologie, St. Antonius-Hospital Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland.
| | - A S Brandt
- Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Wuppertal, Deutschland
| | - P Anheuser
- Klinik für Urologie, Albertinen-Krankenhaus Hamburg, Hamburg, Deutschland
| | - B Reisch
- Klinik für Urologie und Kinderurologie, St. Antonius-Hospital Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
| | - J Steffens
- Klinik für Urologie und Kinderurologie, St. Antonius-Hospital Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
| | - S Roth
- Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Wuppertal, Deutschland
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Takeuchi M, Masumori N, Tsukamoto T. Ureteral reconstruction with bowel segments: experience with eight patients in a single institute. Korean J Urol 2014; 55:742-9. [PMID: 25405017 PMCID: PMC4231152 DOI: 10.4111/kju.2014.55.11.742] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose Although replacement of the ureter with a bowel segment is indicated for large ureteral defects, it is still a challenging technique for urologists. We present our experience and outcome of ureteral reconstruction using bowel segments. Materials and Methods Ureteral reconstruction with bowel segments was performed in eight patients in our institute between 1969 and 2009. We investigated the position and length of the ureteral defect and methods of reconstruction as well as the patients' backgrounds, postoperative complications, and clinical outcomes. Results Five patients underwent ureteral replacement with isolated ileal segments alone. In one patient, the ureter was reconstructed by using the Yang-Monti procedure with the ileum. A colon segment was used in two patients who required bladder augmentation for tuberculous contracted bladder at the same time. Metabolic acidosis occurred in three patients having a solitary kidney and the ureter had to be replaced by a relatively long intestinal segment. Two patients who received preoperative radiation therapy were required to undergo additional operations. Long-term cancer-free survival was achieved in one patient who underwent ileal substitution for low-grade renal pelvic cancer. Conclusions Although ureteral replacement with a bowel segment is a challenging and useful procedure, attention must be paid to the possibility of metabolic acidosis, which is likely to occur in patients having a solitary kidney with renal insufficiency or in patients requiring a long intestinal segment for reconstruction. In addition, preoperative radiation therapy for the pelvic organs may cause postoperative complications.
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Affiliation(s)
- Motoi Takeuchi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Taiji Tsukamoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Li Y, Li C, Yang S, Song C, Liao W, Xiong Y. Reconstructing full-length ureteral defects using a spiral bladder muscle flap with vascular pedicles. Urology 2014; 83:1199-204. [PMID: 24767531 DOI: 10.1016/j.urology.2014.01.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 12/31/2013] [Accepted: 01/27/2014] [Indexed: 12/18/2022]
Abstract
INTRODUCTION This study investigates the efficacy of ureteral reconstruction using a spiral bladder muscle flap with vascular pedicles (ie, the superior vesical arteries) to repair full-length ureteral defects and explores a surgical approach for repairing long ureteral defects (>20 cm) using a bladder muscle flap. TECHNICAL CONSIDERATIONS The characteristics of the ureteral reconstruction surgery include the following: (1) Surgeons fully expose the bladder in the retroperitoneal space. (2) While dissecting the superior vesical arteries, the integrities of the blood vessel trunk and the primary branches are maintained as much as possible. (3) While preparing the bladder muscle flap, the surgeons make an S-shaped cut along the route of the superior vesical arteries along the bladder. In general, the basal width of the muscle flap is approximately 2-3 cm in length, and the total length is approximately 1-2 cm longer than the defective ureter. (4) During the surgery, kidney descent and fixation and psoas hitch are performed to reduce end-to-end anastomotic tension. (5) The addition of a submucosal tunnel to prevent postoperative ureteral reflux is unnecessary. (6) A pedicled greater omentum graft is transferred to cover the reconstructed ureter to enhance blood supply when necessary. CONCLUSION Ureteroplasty using a spiral bladder muscle flap with vascular pedicles (ie, the superior vesical arteries) is an ideal treatment to repair full-length ureteral defects. Moreover, this technique is particularly useful for ureteral defects longer than 20 cm. This procedure should be strongly promoted.
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Affiliation(s)
- Yongwei Li
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chenglong Li
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Sixing Yang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Chao Song
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenbiao Liao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yunhe Xiong
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
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Park YH, Kim KT, Kim M, Jeong BC, Kim HH. Ileoureteral Substitution for Complex Ureteral Reconstruction using Refluxing, Non-tailoring Vesicoileal Anastomosis. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.6.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yong Hyun Park
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Kwang Taek Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Myong Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Seoul Municipal Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Patel VR, Gosalbez R, Castellan M. Comparison between ureteral replacements using a transverse tubularized colonic tube or ileal ureter: experimental study in dogs. J Pediatr Surg 2006; 41:799-803. [PMID: 16567196 DOI: 10.1016/j.jpedsurg.2005.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We report the comparison between ureteral replacements using a transverse tubularized colonic tube or ileal ureter in dogs. MATERIALS AND METHODS Ten canines were studied. Four underwent ureteral substitution with an ileal ureter; 5 with a single transverse tubularized colonic tube and 1 with a double colonic transverse tubularized tube. The animals were observed for a predetermined interval of 30 days. At 30 days, the animals underwent an intravenous pyelogram, cystogram, urine analysis, and serum electrolyte sampling, and the kidney, ureteral conduit, and bladder were examined grossly and histologically. RESULTS The pyelograms of both the ileal ureter and the transverse tubularized colonic tube showed prompt bilateral renal excretion. Grade 1 hydronephrosis was seen in 3 of 4 animals that received the ileal ureter and with 1 of 5 animals that received the colonic tube. Histological exam of the kidneys showed small focal areas of pyelonephritis in both groups without significant injury to the collecting tubules or glomeruli. DISCUSSION The transverse tubularized colonic tube is an effective form of ureteral replacement in the animal model. The advantages of using the colon include its proximity to the ureters, the minimal mobilization needed, position outside the radiation portals, and the short colonic segment necessary.
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Affiliation(s)
- Vip R Patel
- Department of Urology, Jackson Memorial Hospital, University of Miami, Miami, FL 33136, USA
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Castellan M, Gosalbez R. Ureteral replacement using the Yang-Monti principle: Long-term follow-up. Urology 2006; 67:476-9. [PMID: 16527561 DOI: 10.1016/j.urology.2005.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Revised: 08/11/2005] [Accepted: 09/08/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To present the long-term results for 2 patients with ureteral replacement using reconfigured transversely tubularized bowel segments according to the Yang-Monti principle. METHODS Between May 1999 and November 2001, 2 patients underwent ureteral replacement at our institution using a reconfigured ileal segment in one and colon in the other. The first patient was a 33-year-old man who had lost 6 cm of the proximal left ureter after two attempts to repair a ureteral stricture. A reconfigured small bowel tube was interposed between the proximal and distal ureteral stumps after excision of the left ureteral stricture. The second patient was a 66-year-old woman with a poorly functioning right kidney and total bilateral ureteral strictures resulting from radiotherapy for metastatic cervical cancer. She underwent complete left ureteral substitution with a double Monti sigmoid tube in association with a Boari flap. RESULTS With a follow-up of 5.75 and 3.25 years, both patients were clinically doing well with a stable split renal function on mercaptotriglycylglycine renal scan and no evidence of obstruction. The man had required exploratory laparotomy 4 weeks postoperatively to correct a small bowel obstruction secondary to a bowel kink. CONCLUSIONS The transverse tubularized bowel tube is an effective technique for partial and complete ureteral replacement with sustained, good, long-term results. Reconfigured tubes of small or large bowel seem to promote an equally efficient urine transport mechanism that persists unaltered for long periods.
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Affiliation(s)
- M Castellan
- Division of Pediatric Urology, Miami Children's Hospital, Miami, Florida 33155, USA.
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Rodríguez Alonso A, González Blanco A, Suárez Pascual G, Bonelli Martín C, Lorenzo Franco J, Cuerpo Pérez MA. Sustitución parcial del uréter por un segmento de íleon tratado según el procedimiento de Monti. Actas Urol Esp 2005; 29:607-10. [PMID: 16092688 DOI: 10.1016/s0210-4806(05)73306-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The partial substitution of the ureter using a pediculated segment of the ileum is a technique used to re-establish ureteral transit and preserve the renal unit, following the resection of extensive ureteral lesions. Standard surgical procedure for an ileoureteroplasty consists of isolating an ileal duct of equal or greater length than the ureteral defect and interposing it in the urinary tract in an isoperistaltic direction. Monti described a surgical technique that allows for the creation of catheterizable stomas in continent urinary diversions, using the Mitrofanoff principle. These passageways were created from one or several 2.5 cm long ileal sections by means of their detubulization and transverse retubulization. The clinical case study presented here corresponds to a 57 year-old male with a history of ureteral lithiasis, with a 9 cm stenosis of the sacroiliac ureter. He was treated surgically by means of a resection of the stenotic ureter and the interposition of a duct made up of 2.5 ileal sections, treated in accordance with the Monti procedure. Since this operation, the patient's metabolic state has been completely normal. Morphological and functional results have also proved totally satisfactory, as the use of image techniques have shown.
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Bonfig R, Gerharz EW, Riedmiller H. Ileal ureteric replacement in complex reconstruction of the urinary tract. BJU Int 2004; 93:575-80. [PMID: 15008733 DOI: 10.1111/j.1464-410x.2003.04672.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report 10 years' experience with ileal ureteric replacement as a last resort in complex reconstruction of the urinary tract. PATIENTS AND METHODS From March 1991 to February 2002 ileal segments were used for partial or total substitution of the ureter in 43 patients (mean age 45.6 years) with structural or functional ureteric loss secondary to irradiation, surgical complications or various other pathological conditions. Ileum was either implanted into the native urinary bladder (in 14) or an intestinal reservoir (in 29). In the latter group the technique was used at the time of primary urinary diversion in eight, in a secondary approach for treating early or late complications in nine and in undiversion or conversion procedures in 12. The ileal ureter was implanted into the urinary reservoir using a serous-lined extramural tunnel or distal intussusception for reflux prevention (in 31). All patients were followed prospectively according to a standardized protocol. RESULTS There were no perioperative deaths; the mean (range) follow-up was 40.8 (1.5-109.5) months. In 41 patients with dilatation of the upper urinary tract before surgery there was a significant improvement radiographically in 34, no change in five and deterioration in two. The serum creatinine level decreased or remained stable in all. Reflux occurred in the 12 cases without and in three with an antireflux mechanism. Shortening of an elongated kinking ileal ureter became necessary because of recurrent severe metabolic acidosis and mucus obstruction in two; in one case mucus obstruction was treated endoscopically. There was pyelonephritis only in three patients with refluxing implantation into an intestinal reservoir. CONCLUSION Ileal ureteric replacement is a safe and reliable last resort even in difficult cases. Whenever feasible, antirefluxing implantation into intestinal urinary reservoirs is recommended.
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Affiliation(s)
- R Bonfig
- Department of Urology, Julius Maximilians University Medical School, Würzburg, Germany.
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Verduyckt FJH, Heesakkers JPFA, Debruyne FMJ. Long-term results of ileum interposition for ureteral obstruction. Eur Urol 2002; 42:181-7. [PMID: 12160591 DOI: 10.1016/s0302-2838(02)00266-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To present the long-term results of ileum interposition in the ureter for uni- or bilateral ureteral obstruction. PATIENTS AND METHODS Between 1981 and 2000, a total of 22 patients received an ileal segment interposition as a substitution for the ureter, of whom 18 were available for analysis. The mean age was 54 years (range 29-73). Patients were followed for a mean period of 65 months (range 2-196). Assessment included clinical examination, serum creatinine levels, renal ultrasonography, intravenous pyelography and isotopic renography. In eight patients, the ileal-ureteral substitution was the first reconstructive procedure. The other patients underwent up to four previous reconstructions of different types. Fourteen patients were treated for unilateral ureteral obstruction, four of whom had a functional or anatomical solitary kidney, the other four patients had bilateral obstruction. RESULTS In 16 patients renal function improved after ileal-ureteral substitution. One patient underwent a nephrectomy because of a decreased renal function due to an obstruction at the level of the uretero-ileal anastomosis. One patient had a nephrectomy because of recurrent macroscopic hematuria caused by multiple arterio-venous malformations. Overall, 15 patients (83%) had a good functioning kidney after a mean period of 65 months. In three patients an early reintervention was necessary because of bleeding, small bowel obstruction and urinary leakage from a pyelo-ileal anastomosis. Six patients required a reintervention in the long-term: two had a nephrectomy, three had a re-anastomosis between the renal pelvis and the proximal ileal segment, while the sixth patient underwent a PNL for a kidney stone. Recurrent urinary tract infections were seen in six patients, of whom three had to undergo a reintervention. Metabolic acidosis was detected in two patients and was treated with sodium bicarbonate substitution. CONCLUSION Ileal-ureteral substitution is a valuable procedure with good long-term results and an acceptable rate of secondary interventions in patients for whom other alternatives are not feasible.
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Affiliation(s)
- Frank J H Verduyckt
- Department of Urology, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Manolitsas TP, Copeland LJ, Cohn DE, Eaton LA, Fowler JM. Ureteroileoneocystostomy: the use of an ileal segment for ureteral substitution in gynecologic oncology. Gynecol Oncol 2002; 84:110-4. [PMID: 11748985 DOI: 10.1006/gyno.2001.6453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to assess the results of the use of an ileal segment to restore the functional integrity of the renal tract where lower ureteric resection is necessary in gynecologic oncology surgery. METHODS All patients in whom ureteroileoneocystostomy (UINC) was performed between March 1988 and December 2000 were identified and a retrospective review of their case notes was conducted. RESULTS A total of 12 UINC procedures were performed on eight patients. The primary diagnoses were ovarian cancer in six cases, endometrial stromal sarcoma in one case, and vaginal carcinoma in one case. The average age of the patients at the time of their first UINC procedure was 56 years. Bilateral UINC was performed at a single episode in one patient and unilateral UINC in seven patients. Subsequent obstruction necessitated repeat or revision of the original procedure in two cases and contralateral UINC in one case. Complications included one death at 38 days from aspiration pneumonia not directly related to UINC, one pelvic abscess causing ureteric obstruction, and three cases of recurrent urinary tract infection. Follow-up ranged from 38 days to 77 months following the initial UINC procedure, with a mean of 34 months. Aside from the single postoperative death, the procedure was successful in 82% (9/11) of anastamoses on the first occasion and 100% (2/2) of anastamoses at repeat or revision surgery. There were no cases of renal failure secondary to a failed UINC. CONCLUSIONS Ureteroileoneocystostomy is a safe and effective procedure that should be considered in cases where lower ureteric resection is necessary.
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Affiliation(s)
- Tom P Manolitsas
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The James Cancer Hospital and Solove Research Institute, The Ohio State University College Of Medicine, M-210 Starling Loving, Columbus, Ohio 43210-1228, USA
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Abstract
Ureteral replacement has always been a challenge. Two approaches have been explored: in situ augmentation or replacement and extra-anatomic passage of a conduit. An in-situ prosthetic ureter is basically a simple al. loplastic tube connected to the urinary tract by end-to-end sutures or by intubation and closure. Antireflux devices and peristaltic mechanisms are not necessary. Among the in-situ designs, only those composed of silicone and silicone rubber have performed at all well. Tissue engineering and acellular matrix grafts have produced impressive early results. Subcutaneous ureteral replacement with alloplasts, including a coaxial assembly of an inner silicone and outer expanded polytetrafluoroethylene tube, has produced good results. In the future, we are likely to see bioengineered neotissue combined with highly porous and infection-resistant alloplasts to create better and more functional neo-organs.
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