IntroductionThe transformation from normal to malignant urothelium is induced by certain chemical agents, pathogens, and physical stimuli. Tumor-inciting stimuli can affect the entire urinary tract from the renal calyces to the urethra, although 95% of primary urothelial tumors occur within the bladder. Patients who develop bladder cancer are considered to have a "field change" disease, suggesting that the entire urothelium is at risk for tumor formation. Recurrences in various sites and particularly within the bladder are therefore characteristic, and patients must undergo lifelong surveillance.
As with other types of urinary diversion, left ureteral obstruction is a common complication of bilateral cutaneous ureterostomies. Long-term stenting for greater than 3 months and the applied surgical modifications improved the clinical outcome of this type of urinary diversion.
Long ureteral defects require tissue replacement when bladder flaps do not suffice. Ureteral replacement can be achieved by reconfigured intestinal segments, which are readily mobilized and secured as interposed segments or as an onlay flap on the preserved ureter. A relatively short segment can be used to repair a lengthy defect along any segment of ureter, also allowing for nonrefluxing reimplantation.
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