Ileal Ureter Utilization in Patients With Previous Urinary Diversions

Abstract

To evaluate a subset of patients who develop strictures requiring Ileal Ureter (IU) in the setting of prior urinary diversion or augmentation (ileal conduits, neobladders, continent urinary diversions). To our knowledge, there are no prior studies on patients with IU substitution into established lower urinary tract reconstructions. A retrospective review of patients(18 years) undergoing IU creation from 1989 to 2021 was performed. 160 patients were identified. 19(12%) patients had IUs into diversions. We examined demographics, stricture cause, diversion type, renal function, and postoperative complications. Nineteen patients were identified. Sixteen were male. Mean age was 57.7(SD 17.0) years. Diversions included continent urinary reservoirs(4), neobladders(5), ileal conduits(7), and bladder augmentations with Monti channels(3). Fifteen had unilateral surgery and four had bilateral "reverse-7"ileal ureter creation. Average length of stay was 7.6 days (SD 2.9). Average follow up was 32.9 months(SD 27). Mean pre-operative creatinine was 1.5(SD 0.4); mean post-operative creatinine at most recent follow up was 1.6(SD 0.7). There was no significant difference between pre- and post-operative creatinine(p=0.18). One patient had a VP Shunt infection resulting VP shunt externalization, 1 had clostridium difficile infection potentially causing an entero-neobladder fistula, 2 with ileus, 1 urine leak and 1 wound infection. None required renal replacement therapy. Patients with urinary diversions and prior bowel reconstructive surgeries with subsequent ureteral strictures are a challenging cohort of patients. In properly selected patients, ureteral reconstruction with ileum is feasible and preserves renal function with minimal long-term complications.