Use of the Appendix as Ureteral Substitute in a Patient with a Single Kidney Affected by Relapsing Upper Urinary Tract Carcinoma

Abstract

The treatment of upper urinary tract transitional cell carcinoma (UT-TCC) in single-kidney patients requires the radical removal of cancer, but also, when feasible, the preservation of the continuity of the urinary tract by various surgical techniques. In case of wide resections during ureteral surgery, a ureteral replacement could be advocated. In the literature, the cecal appendix has rarely been used as a ureteral substitute, moreover in benign pathological conditions, showing encouraging early results. The positive functional and oncological outcomes obtained after a lengthy follow-up in a single-kidney patient with UT-TCC treated by ureteral resection and appendix interposition confirm the viability of this surgical option.

Extended Ureteral Stricture Corrected With Appendiceal Replacement in a Kidney Transplant Recipient

“…The reported complications mirror those of any reconstructive procedure involving urinary anastomosis, i.e. ischemia, stenosis, and urinary leak amongst others (6). Some concerns have been expressed over the risk of luminal obstruction due to excessive production of mucus from the appendiceal mucosa, and the use of intra-vesical instillation of Acetylcysteine has been suggested to obviate this …”

“…The small calibre, limited tendency to dilate over time and intrinsic peristalsis all contribute to minimizing the risk of urinary stasis and reflux (13). Finally the limited mucosal surface area prevents significant urine absorption, thus minimizing the risk of metabolic acidosis (6,14).…”

Appendix vermiformis as a left pyelo-ureteral substitute in a 6-month-old girl with solitary kidney

“…Restricted availability after appendectomy, post-inflammatory changes and fibrosis, missing length and a short mesoappendix may limit the use of the appendix. [8][9][10][11][12][13] General concerns using bowel in reconstructive urology, like recurrent urinary tract infection, tumor formation, In general, vascularity of the AV is excellent, the length of the mesoappendix is rarely a limitation and mobilization of the appendix to the left side is easily performed. It can also satisfactorily used for other substitutions such as an appendicovesicostomy [14] or hepaticoportoappendicostomy [15] and in the majority of cases with satisfactory results.…”

“…[2,8] Successful ureteral substitution with AV in adults and children involving the right, mid to distal ureter, right proximal ureter, pyeloureterostomy and for bridging the right renal pelvis to the left ureter has been reported. [5,[8][9][10][11][12] Replacement of the left ureter bears the special problem of a long distance from the caecum to the left peritoneum depending on the length of the appendix and the mesoappendix.…”

Intestinal interposition for complex ureteral reconstruction: A comprehensive review

“…Some case reports and case series reports (as shown in Table 2) of appendiceal interposition were reported during the past century, as some technical issues might limit the use of the appendix. [49][50][51][52][53] The appendix could be unavailable or unsuitable for ureteral reconstruction when it is absent because of previous appendectomy, or it became scarred or narrow as a result of previous inflammation. The length of the appendix is finite, replacing approximately 3-cm ureteral defects on average, and usually it fails to bridge long-segment strictures or a defect is left-sided.…”