Abstract
With an aim to provide an optimal solution for the management of large defects of the distal ureter we developed a novel antireflux technique ofileal ureteral substitution. The new method was applied in 5 female patients (mean age 39.4 years, range 29 - 53 years) with iatrogenic injury to the distal ureter that occurred as a complication after total hysterectomy and pelvic irradiation for gynaecological malignancies. Reconstructive surgery was done, and the damaged ureter was replaced by an isolated ileal segment. The ureteroileal anastomosis was created in an antireflux manner by the implementation of the serous-lined extramural tunnel technique, originally described in orthotopic bladder substitutes. To avoid mucus retention, the distal end of the isolated ileal segment was widely anastomosed with the bladder. Surgery was performed without any major perioperative complications. The follow up ultrasound and radiological studies confirmed that the procedure efficiently provided a nonobstructed unidirectional flow of urine. Optimization of the renal function and restoration of the previous patient quality of life were recorded in all cases treated by the new technique. Ureteral substitution by an isolated ileal segment via antireflux ureteroileal and reflux ileovesical anastomosis could be a viable option when large defects of the distal ureter are encountered.
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