Purpose-We reviewed indications and outcomes in patients undergoing ileal ureter replacement for ureteral reconstruction. December 1989 and September 2007, 105 patients underwent ileal ureter replacement, of whom 14 were excluded from study due to incomplete data. The remaining 91 patients (99 renal units) comprised the study cohort. Materials and Methods-BetweenResults-Mean patient age was 46.8 years and mean followup was 36.0 months. Indications for an ileal ureter were stricture following genitourinary surgery in 29 cases (31.9%), radiation induced stricture in 17 (18.7%), nonurological surgery iatrogenic injury in 16 (17.6%) and retroperitoneal fibrosis in 11 (12.1%). Only 4 patients (4.4%) had primary ureteral cancer. Long-term complications included anastomotic stricture in 3 patients (3.3%) and fistula in 6 (6.6%). Serum creatinine decreased or remained stable in 68 patients (74.7%) and hyperchloremic metabolic acidosis developed in 3. No patient complained of excessive urinary mucous production.Conclusions-In 68.1% of patients indications for an ileal ureter included radiation induced stricture or iatrogenic injury. The ileal ureter is a reasonable option for long-term ureteral reconstruction with preserved renal function in carefully selected patients. Keywordsureter; ileum; reconstructive surgical procedures; iatrogenic disease SINCE its first description in 1906 by Shoemaker 1 and later popularization by Goodwin et al in the late 1950s, 2 the use of ileal segments for ureteral substitution has become a valuable procedure in reconstructive urology. Although it was initially described for tubercular obstruction, recent decades have seen the indications for its use broaden. We report a contemporary series representing changes in indications, patient selection and clinical outcomes. PATIENTS AND METHODS Study DesignAfter receiving institutional review board approval we retrospectively analyzed the records of all patients who underwent ileal ureter replacement at

RESULTSPatients with cT2 tumours were more likely to have a higher Gleason score ( P = 0.04) and final pathological stage ( P = 0.05) than those with cT1c tumours. There was no significant difference in age ( P = 0.92), preoperative PSA level ( P = 0.17), prostate weight ( P = 0.34), tumour volume ( P = 0.16), surgical margin status ( P = 0.86), multifocality ( P = 0.92), the presence of perineural invasion ( P = 0.09), or high-grade prostatic intraepithelial neoplasia ( P = 0.99) between patients with clinical stage cT1c and those with cT2 tumours. There was no difference in PSA recurrence between patients with clinical stage T1c and those with cT2 tumours ( P = 0.27). CONCLUSIONSPatients with clinical stage cT2 tumours have a higher Gleason score and advanced pathological stage than tumours detected because of a high serum PSA level (cT1c). These results suggest that clinical stage cT1c tumours should be separated from clinical stage cT2 disease, but the PSA recurrence rate for both tumour stages is similar, indicating a need for further evaluation and refinement of the current clinical staging system.

Electrophilic trisubstituted ethylene monomers, ring-substituted methyl 2-cyano-3-phenyl-2-propenoates, RC6H4CH = C(CNC02CH, (where R is 0-C1, m-C1, p-C1, p-Br, and p-F) were prepared and copolymerized in solution with styrene at equimolar monomer feed composition in the presence of a radical initiator, AIBN at 80°C. The order of reactivity (lh,) for the trisubstituted ethylene monomers was p-C1 (3.0) > m-CI (2.9) > p-Br (2.3) > 0-C1 (2.0) > p-F (1.4). High Tg's of the copolymers in comparison with that of polystyrene indicates substantial decrease in chain mobility of the copolymer due to high dipolar character of the trisubstituted monomer units.

Copolymerizations of ring-substituted methyl 2-cyano-3-phenyl-2-propenoates, RC,H,CH=C(CN)CO,CH, (R = CtH5, CH30, C1, Br, F) with styrene (M,) were studied in solution in the presence of a radical initiator. Terminal and penultimate kinetic models were applied for best prediction of the copolymer composition. The Alfrey-Price Q and e parameters calculated for the monomers correlate well with the relative reactivity ( l/rl). The relative reactivity showed a tendency to increase with increasing Hammett constant 6, cyclic voltammetric reduction potential, Ep, caIculated atomic charge, and I3C-NMR chemical shift on the olefinic a-carbon of the ring-substituted monomers. 627 Copyright 0 1997 by Marcel Dekker, Inc.