Change of Ureteral Submucosal Anti-reflux Implantation into an Intussuscepted Ileal Nipple Valve as Reflux Protection in Ureterosigmoidostomy

Abstract

After submucosal implantation of the ureters in ureterosigmoidostomy failed for different reasons, urologists are confronted with the task of creating a new form of urinary diversion. Therefore, the implantation site of the ureters must be removed because of the risk of secondary malignancy with the consequences of a large colonic defect. Here we describe a technique for reimplantation of both ureters with an intussuscepted ileal nipple in ureterosigmoidostomy with three advantages for the patient in situations in which classical submucosal implantation failed after several years. We were able to avoid conversion into another form of incontinent or continent urinary diversion. To prevent the development of colonic tumors at the implantation site where urothelial meets colonic epithelium, we interposed an ileal segment which avoids this epithelial contact. We were also able to cover a large colonic defect which was mandatory to receive a negative surgical margin when the tumor was resected. This technique of using an ileal nipple as reflux protection in ureterosigmoidostomy allows the patient to keep the form of urinary diversion he is used to live with, for many decades.