Korean J Urol.  2014 Nov;55(11):742-749. 10.4111/kju.2014.55.11.742.

Ureteral Reconstruction With Bowel Segments: Experience With Eight Patients in a Single Institute

• Takeuchi M
• Masumori N
• Tsukamoto

• KMID: 2069917
• DOI: http://doi.org/10.4111/kju.2014.55.11.742

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.

Keyword

Colon; Ileum; Reconstructive surgical procedures; Ureter

MeSH Terms

Adult
Aged
Anastomosis, Surgical
Colon/*surgery
Female
Follow-Up Studies
Humans
Ileum/*surgery
Male
Middle Aged
Reconstructive Surgical Procedures/*methods
Retrospective Studies
Time Factors
Treatment Outcome
Ureter/*surgery
Ureteral Obstruction/*surgery
Urologic Surgical Procedures/*methods

Figure

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  FIG. 1 Case 1: A 20-cm ileal segment was isolated for bladder augmentation and replacement of the lower part of the left ureter.

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  FIG. 2 Case 2: Almost the entire ureter was replaced by the ileum, and the bladder was augmented with the cecum and ascending colon. The ureter was anastomosed to the ileum without an anti-reflux procedure.

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  FIG. 3 Case 3: Almost the entire ureter was replaced by the proximal segment of the descending colon and the bladder was augmented. An antireflux procedure was used in anastomosis of the ureter to the descending colon.

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  FIG. 4 Case 4: The mid and lower ureter were replaced by an isolated 15-cm ileal segment that was anastomosed to the distal end of the upper ureter without an anti-reflux procedure. No antireflux procedure was used in anastomosis between the distal end of the ileum and the bladder.

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  FIG. 5 Case 5: Almost the entire ureter was replaced by an isolated 27-cm ileal segment. An antireflux procedure was done for the anastomosis between the distal end of the ileum and the bladder.

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  FIG. 6 Case 6: The right renal pelvis and ureter were replaced by an isolated 10-cm ileal segment. The proximal end of the ileum was anastomosed to the renal pelvis and the distal end to the proximal end of the afferent limb of the ileal neobladder.

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  FIG. 7 Case 7: (A) Two 2.5-cm ileal segments were isolated and their antimesenteric borders were opened and reconfigured as a tube around a 14-Fr Nélaton catheter. This provided ileal segments with a total length of 13 cm, which were interposed in the lower left ureter. (B) The interposed ileum is shown in excretory urography (arrow).

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  FIG. 8 Case 8: (A) The bilateral mid and lower ureters were replaced with an isolated 20-cm ileal segment. The distal ends of both ureters and the proximal end of the ileum were anastomosed with Le Duc's antireflux method. No antireflux procedure was done for the anastomosis between the distal end of the ileum and the bladder. (B) The interposed ileum is shown in excretory urography under clamping of bilateral percutaneous nephrostomy tubes (arrow).

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