OBJECTIVETo report our 16-year experience with ileal ureter interposition for complex ureteral stricture. Ureteral reconstruction continues to evolve to include less invasive techniques to successfully manage ureteral stricture. However, long, complex, obliterative and especially radiated ureteral strictures are not amenable to less invasive techniques and may require Ileal ureter interposition.
MATERIALS AND METHODSRetrospective review of a single institution's ureteral reconstruction database was performed. Demographics, operative details, success rate, complication rate, and length of follow-up were noted. Unilateral replacements utilized ileal ureteral interposition. Success rate was defined as no need for further open intervention.
RESULTSBetween 2003 and 2019, 188 ureteral reconstructions were performed, of which 46 required ileal ureter interposition. Of these 46 patients, 10 required bilateral reconstruction. Average age was 53 years, 26 (57%) were female. The average stricture length was 9.1 cm (2-20 cm). Stricture etiology included iatrogenic causes (n = 24, 52%), radiation causes (n = 12; 26%), vascular disease (n = 3; 7%), and idiopathic retroperitoneal fibrosis (n = 3; 7%). Forty-three surgeries were performed by open abdominal approach; 3 were performed robotically. The average length of operation was 412 minutes, blood loss 417 mL and LOS was 10 days. At mean follow up of 4.4 years (1-16 years), overall success rate was 83%, with 17% (n = 8) patients requiring subsequent major surgery (5 successful ureteral revision, 3 nephrectomy) and 11 (24%) patients experiencing a major complication.
CONCLUSIONIn our long-term follow up of over 4 years, ileal ureteral interposition remains a successful option for complex ureteral strictures in properly selected patients. UROLOGY 157: 257−262, 2021.
follow up of 2.5 months all three patients report improvement in the pain that was the indication for their mesh excision. No patient has recurrence of prolapse.CONCLUSIONS: This video demonstrates the critical steps of robot assisted laparoscopic sacrocolpopexy mesh excision and concomitant uterosacral ligament suspension. Excellent visualization of the mesh and vital structures as well as reduced morbidity over open surgery are advantages of a robotic approach. Concomitant uterosacral ligament suspension is both safe and feasible, and excellent visualization of the ureters may reduce complications with this approach. Uterosacral ligament suspension provides a mesh free option for reducing prolapse recurrence in patients that require surgical intervention for a mesh related complication.
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