Long-term outcomes of total ureterectomy with ileal-ureteral substitution treatment for ureteral cancer: a single-center experience

Abstract

BackgroundTo explore the feasibility and long-term outcomes of renal preservation in a retrospective cohort of patients with ureteral urothelial carcinoma undergoing total ureterectomy with ileal-ureteral substitution.MethodsA retrospective review of the data from patients treated with total ureterectomy with ileal-ureteral substitution from 1988 to 2016 was performed. The pre-operative oncological status, long-term oncological outcome, long-term renal functional outcome, early and late complications were analyzed.ResultsA total of eight patients with a median age of 70 years were included. The median follow-up time was 109 months. Six patients had multi-focal tumor involvement over the target ureter, and six patients had bilateral upper tract involvement. Only one patient encountered the upper-tract recurrence. The 2 and 5-year cancer-specific survival rates were 87.5 and 75.0%, respectively. The renal function was well-preserved in most patients, with only one patient needed life-long postoperative hemodialysis. Five patients experienced early complications and four patients experienced late complications. No perioperative mortality happened.ConclusionsA total ureterectomy with an ileal-ureteral substitution is feasible for treating ureteral urothelial carcinoma when a renal-sparing procedure is indicated. It provides good long-term oncological outcomes over the upper tract, and it also preserves the renal function.

Nephron-sparing management of upper tract urothelial carcinoma

“…Last, ileal substitution is an option for those with more extensive ureteral involvement. A more recent single center retrospective review from Ou et al [ 52 ] identified 80 patients that underwent ileal ureter creation for UTUC and 2- and 5-year CSS were 87.55% and 75.0%, respectively.…”

Intestinal interposition for complex ureteral reconstruction: A comprehensive review

“…Furthermore, ureteral urothelial carcinoma is usually treated by a long-segment or even total ureterectomy under the circumstances where ureteric substitution with intestine could be desirable. 13 In addition, some rare congenital ureteral abnormalities, such as ureteral ectopia, ureteral agenesis or absence, or long congenital ureteral stenosis, that are unsuitable for more conservative reconstructive techniques, might require ureteral substitution to salvage renal function. Additional indications might include renal transplantation with ureteral necrosis or rejection.…”

“…Other indications might include recurrent intractable renal lithiasis, in that the wider caliber of intestinal ureter can facilitate the passage of calculi so as to alleviate the secondary symptoms of ureteral obstruction. Furthermore, ureteral urothelial carcinoma is usually treated by a long‐segment or even total ureterectomy under the circumstances where ureteric substitution with intestine could be desirable . In addition, some rare congenital ureteral abnormalities, such as ureteral ectopia, ureteral agenesis or absence, or long congenital ureteral stenosis, that are unsuitable for more conservative reconstructive techniques, might require ureteral substitution to salvage renal function.…”

“…Ou et al . classified their selected patients into different stages of CKD by GFR to evaluate renal function preoperatively and postoperatively . All of their patients had a preoperative baseline CKD stage ≥II; in particular, one with CKD stage V. Six patients (75%) had stable or improved renal function during the long‐term follow up (mean 109 months) after ileal ureter replacement.…”

Conservative Treatment of Upper Urinary Tract Urothelial Carcinoma: Con

“…Distal SU with ureterocystoneostomy has lower recurrence rates compared to SU of the proximal ureter with ureteroureterostomy [1] , [3] . Complete resection of the ureter and substitution (eg, with ileum) is technically feasible but should be reserved for low-risk tumors in highly selected cases as it is only supported by low-level evidence [4] .…”