Optimization of Replacement of the Ureter by Ileum

Shokeir, Ahmed A.; Gaballah, Mohamed; Ashamallah, Albair; Ghoneim, Mohamed A.

doi:10.1016/s0022-5347(17)37777-7

Cited by 36 publications

(16 citation statements)

References 25 publications

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“…Ileal segments continue to produce mucus after incorporation into the urinary tract, which can be troublesome when it interferes with upper tract drainage or emptying the bladder or intestinal reservoir. The risk of mucus obstruction can be reduced by using short ileal segments and providing complete drainage of the lower and upper urinary tract, avoiding residual urine and stasis [16]. While mucus obstruction with no identifiable cause can be managed endoscopically, morphological problems must be solved definitively, e.g.…”

Section: Discussionmentioning

confidence: 99%

Ileal ureteric replacement in complex reconstruction of the urinary tract

2004

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Authors from Wurzburg report their experience over a 10‐year period with the use of ileal segments in partial or total ureteric substitution. They felt it was a safe and reliable procedure, but that it should only be used as a last resort, even in difficult cases. A free graft of fat from the anterior abdominal wall was used by authors from Cairo in 26 female patients having a retropubic repair of genitourinary fistula. They found it to be an easy procedure with a high success rate, and with few postoperative complications. OBJECTIVE To report 10 years’ experience with ileal ureteric replacement as a last resort in complex reconstruction of the urinary tract. PATIENTS AND METHODS From March 1991 to February 2002 ileal segments were used for partial or total substitution of the ureter in 43 patients (mean age 45.6 years) with structural or functional ureteric loss secondary to irradiation, surgical complications or various other pathological conditions. Ileum was either implanted into the native urinary bladder (in 14) or an intestinal reservoir (in 29). In the latter group the technique was used at the time of primary urinary diversion in eight, in a secondary approach for treating early or late complications in nine and in undiversion or conversion procedures in 12. The ileal ureter was implanted into the urinary reservoir using a serous‐lined extramural tunnel or distal intussusception for reflux prevention (in 31). All patients were followed prospectively according to a standardized protocol. RESULTS There were no perioperative deaths; the mean (range) follow‐up was 40.8 (1.5–109.5) months. In 41 patients with dilatation of the upper urinary tract before surgery there was a significant improvement radiographically in 34, no change in five and deterioration in two. The serum creatinine level decreased or remained stable in all. Reflux occurred in the 12 cases without and in three with an antireflux mechanism. Shortening of an elongated kinking ileal ureter became necessary because of recurrent severe metabolic acidosis and mucus obstruction in two; in one case mucus obstruction was treated endoscopically. There was pyelonephritis only in three patients with refluxing implantation into an intestinal reservoir. CONCLUSION Ileal ureteric replacement is a safe and reliable last resort even in difficult cases. Whenever feasible, antirefluxing implantation into intestinal urinary reservoirs is recommended.

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Section: Discussionmentioning

confidence: 99%

Ileal ureteric replacement in complex reconstruction of the urinary tract

2004

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“…Ileal interposition and vesico-psoas hitch and Boari flaps are utilized in such instances. 14,16,17 Our patient with antiphospholipid syndrome developed a hematoma in the early postoperative period, which was managed conservatively. Later, he developed a complete necrosis of the graft ureter and a large urinoma.…”

Section: Discussionmentioning

confidence: 96%

Complete necrosis of graft ureter following renal transplant in a patient with primary antiphospholipid syndrome: A case report

Fernando

Jayarajah

Rubakan

et al. 2018

Clinical Case Reports

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Key Clinical MessageComplete necrosis of the graft ureter is a rare but serious complication following kidney transplant. In a patient with antiphospholipid syndrome, a combination of factors such as arterial thromboembolism, hematoma formation, and surgical collateral damage can cause ischemia of the graft ureter. Preoperative optimization of disease activity and coagulation with meticulous preservation of ureteric perfusion may help in prevention.

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“…Shokeir et al combined this technique with the incorporation of an antireflux nipple valve, and reported good results in the construction of the damaged ureter, confirmed to be superior to the standard procedure through a randomized controlled trial. 19 From another perspective, Ordorica et al incised the diseased areas of ureter forming ureteral plates, and sutured the reconfigured ileal segments that readily mobilized as onlay flaps on the ureteral plate, repairing average 5-cm ureteral strictures. 20 The patients showed minor mucous production without urinary tract infection and stone formation.…”

Section: Ileal Ureteral Replacementmentioning

confidence: 99%

Intestinal interposition for complex ureteral reconstruction: A comprehensive review

Xiong

Zhu

et al. 2020

Int J of Urology

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Long ureteral defects have remained a challenge to urologists for a long time. Bowel interposition, including ileal ureter, appendiceal interposition and reconfigured colon substitution, has gained wide acceptance, even though it is a complicated procedure and associated with some potential complications. Mucus obstruction and metabolic disorders are common complications of intestinal substitution. To circumvent these troubles, modified techniques, such as tapering the bowel graft, intestinal onlay flap and the Yang-Monti procedure, are used. In particular, Yang-Monti ileal ureter replacement is a highly effective option for ureteral reconstruction, and the incidence of complications would be significantly reduced in select patients. After being combined with the Boari flap or psoas hitch technique, the length of intestinal segment used can also be significantly reduced. Most recent long-term results suggest that ileal ureter replacement with antireflux anastomosis seems to be remarkably free of complications, and we highly praise the distal nipple valve technique. Appendiceal interposition is available for patients with normal appendix, and usually this procedure is limited to reconstructing the right ureter. Appendiceal onlay ureteroplasty has emerged as a feasible and effective option to manage patients with complex proximal and midureteral strictures of the right side. The colon is rarely used for ureteral reconstruction because of its large caliber and mucous surface area. However, a reconfigured colon segment is a good substitute to reconstruct long-segment ureteral defects, and longterm follow up confirmed minimal complications and improved renal function. This review provides a comprehensive perspective on complex ureteral reconstruction and replacement using intestinal segments, in particular, ileal ureter replacement.

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Optimization of Replacement of the Ureter by Ileum

Cited by 36 publications

References 25 publications

Ileal ureteric replacement in complex reconstruction of the urinary tract

Ileal ureteric replacement in complex reconstruction of the urinary tract

Complete necrosis of graft ureter following renal transplant in a patient with primary antiphospholipid syndrome: A case report

Intestinal interposition for complex ureteral reconstruction: A comprehensive review

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