Antireflux Technique of Ureteroileal Implantation Used in the Substitution of the Ureter/s/ by Isolated Intestinal Segment

Abstract

Introduction: Gynecological surgery and pelvic radiotherapy often lead to ureteral damage, requiring subsequent reconstruction of the ureter. Our aim was to analyze the long-term functional results after ureteral substitution by isolated ileal segment. Materials and methods: Within the period 2004 - 2016, we treated a total of 21 women (mean age 54.2 years, from 29 to 68 years) with iatrogenic damage of the ureter: 6 on the right, 8 on the left and 7 - bilateral. These complications occurred after hysterectomy performed for malignant gynecological diseases, with or without adjuvant radiotherapy. In all these cases the length of the ureteral lesion exceeded 10 cm, which necessitated partial or total substitution of the ureter by isolated ileal segment. The antireflux ureteroileal anastomosis was performed by the modified by us serous-lined extramural tunnel technique, initially described and applied until now only during construction of orthotopic urinary reservoirs.Results: Most of the surgeries were performed without serious complications. The follow-up ultrasound and roentgenological examinations confirmed that all reconstructive procedures provide effectively nonobstructive unidirectional flow of the urine. In spite of the good functional results, the oncological results in this patient series were quite unsatisfactory: the malignancy progressed in 9 patients (42.8%), 6 of whom died from the disease in spite of the adjuvant treatment applied. Pelvic recurrences with invasion to the bladder required total cystectomy with subsequent conversion to ileum conduit in 4 of the cases.Conclusions: Ureteral substitution by an isolated ileal segment is a good alternative in case of prolonged stenosis of the ureter, which has occurred as a complication after gynecological and/or radiological therapeutic procedures.