Ureteral Replacement with Reconfigured Colon Substitute

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

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.

Ureteral replacement using the Yang-Monti principle: Long-term follow-up

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.

Laparoscopic Ureteral Reconstruction: Intracorporal Reconfiguration of Ileum and Colon in a Porcine Model

BACKGROUND AND PURPOSE

Long ureteral defects can be reconstructed in humans with reconfigured short colonic or ileal segments. We undertook the present study to evaluate whether laparoscopy with completely intracorporal reconfiguration could replicate open surgery results.

MATERIALS AND METHODS

In eight renoureteral units of six pigs, a ureteral defect of 4.5 to 8.0 cm (mean 6.6 cm) was created. Ileum was used for reconstruction in six renal units and colon in two. A 3-cm-long segment was isolated from the intestinal tract and transversely reconfigured into a long pedicled tubular graft, which was then interposed into the ureteral defect. Reconfiguration and all anastomoses were performed by freehand intracorporal suturing and knot-tying.

RESULTS

Reconstruction was successful in all cases. No significant blood loss or open conversions occurred. The mean total surgical time was 296 minutes (range 234-353 minutes).

CONCLUSIONS

Ureteral repair with intracorporally reconfigured intestinal segments is technically feasible. Clinical application will await survival studies.