Long-term outcome of ileal ureter replacement with proximal antirefluxing technique

Abstract

Objective To investigate the long-term outcome of ileal ureter replacement with proximal antirefluxing technique. Methods Thirty-four cases with a long uteter stricture or defect （ 15-25 cm） and cancer of middle and lower ureter （ resected ureter ranged from bladder to 5- 8 cm above the tumor） （ male 23 and female 11 ; bilateral 19 and unilateral 15） , were treated by ileal ureter replacement with proxi- mal antirefluxing technique, in which the ureter was replaced with a segment of ileum using an end-to-side anastomosis. The distal part of upper ureter （4 cm） was fixed between the psoas muscle and ileal segm6nt （the ileo-psoas tunnel technique）. The distal ileum was connected to the urinary bladder withpan end-to-side anastomosis. Serum electrolyte, creatinine and blood urea nitrogen （BUN） ; ultrasonography and radiograph- ic investigations of urinary system were recorded during follow up. Results The 34 cases were followed for 12-180 months （mean, 67 months）. The intravenous urography showed that the hydronephrosis improved significantly or diseapeared by a~sessed after 6 month in 25 patients, 9 had improvement. Cystography showed no evidence of ileo-ureteral reflux. Three patients needed oral alkalization because of prevention of hyperchloremie acidosis. Among the 3 patients with ureter cancer, 1 patient died after 3 years because of metastasis and the other 2 patients were well without cancer currence after follow up of 11 and 15 years postop- eratively. Conclusion In our experience, ileal ureteral replacement with the ileo-psoas tunnel anti-refluxing technique is a highly effective procedure for the treatment of long segment ureteral strictures and defect. Key words: Ureter; Ileum; Antireflux; Hydronephrosis