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Ureteral reconstruction with bowel segments: experience with eight patients in a single institute.

Takeuchi M, Masumori N, Tsukamoto T - Korean J Urol (2014)

Bottom Line: We present our experience and outcome of ureteral reconstruction using bowel segments.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.

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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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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Figure 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.

Mentions: Between 1969 and 2009, the ureters of eight patients consisting of two males and six females (seven unilateral, one bilateral) were replaced with bowel segments owing to tuberculous ureteral stricture in two, urogenital malignancy in two, stricture after nonurological surgery in two, stricture after radiation in one, and an intractable vesicovaginal fistula in one. The median age at surgery was 42 years (range, 36-65 years). The patients' characteristics are shown in Tables 1 and 2, and the details of the surgical procedures are shown in Figs. 1, 2, 3, 4, 5, 6, 7 and 8. The median follow-up period was 60 months (range, 7-260 months). Brief summaries of the patients' clinical courses are provided below.


Ureteral reconstruction with bowel segments: experience with eight patients in a single institute.

Takeuchi M, Masumori N, Tsukamoto T - Korean J Urol (2014)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231152&req=5

Figure 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.
Mentions: Between 1969 and 2009, the ureters of eight patients consisting of two males and six females (seven unilateral, one bilateral) were replaced with bowel segments owing to tuberculous ureteral stricture in two, urogenital malignancy in two, stricture after nonurological surgery in two, stricture after radiation in one, and an intractable vesicovaginal fistula in one. The median age at surgery was 42 years (range, 36-65 years). The patients' characteristics are shown in Tables 1 and 2, and the details of the surgical procedures are shown in Figs. 1, 2, 3, 4, 5, 6, 7 and 8. The median follow-up period was 60 months (range, 7-260 months). Brief summaries of the patients' clinical courses are provided below.

Bottom Line: We present our experience and outcome of ureteral reconstruction using bowel segments.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.

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.

Show MeSH
Related in: MedlinePlus