Complex Ureteral Reconstruction Research Articles

Minimally invasive ureteroplasty with lingual mucosal graft for complex ureteral stricture: analysis of surgical and patient-reported outcomes.

To evaluate objective treatment efficacy and safety, and subjective patient-reported outcomes in patients with complex ureteral strictures (US) undergoing minimally invasive lingual mucosal graft ureteroplasty (LMGU). We prospectively enrolled patients underwent robotic or laparoscopic LMGU between May 2020 and July 2022. Clinical success was defined as symptom-free and no radiographic evidence of re-obstruction. Patient-reported outcomes, including health-related quality of life (HRQoL), mental health status and oral health-related quality of life (OHRQoL), were longitudinally evaluated before surgery, 6 and 12 months postoperatively. Overall, 41 consecutive patients were included. All procedures were performed successfully with 32 patients in robotic approach and 9 in laparoscopic. Forty (97.56%) patients achieved clinical success during the median follow-up of 29 (range 15-41) months. Although patients with complex US experienced poor baseline HRQoL, there was a remarkable improvement following LMGU. Specifically, the 6-month and 12-month postoperative scores were significantly improved compared to the baseline (p < 0.05) in most domains. Twenty-eight (68.3%) and 31 (75.6%) patients had anxiety and depression symptoms before surgery, respectively. However, no significant decrease in the incidence of these symptoms was observed postoperatively. Moreover, there was no significant deterioration of OHRQoL at 6 months and 12 months postoperatively when compared to the baseline. LMGU is a safe and efficient procedure for complex ureteral reconstruction that significantly improves patient-reported HRQoL without compromising OHRQoL. Assessing patients' quality of life enables us to monitor postoperative recovery and progress, which should be considered as one of the criteria for surgical success.

The Whitaker Test in the Follow-up of Complex Upper Urinary Tract Reconstruction: Is It Clinical Useful or Not.

To evaluate the feasibility and guiding significance in postoperative management of the Whitaker test after complex reconstruction of the upper urinary tract. Patients who underwent complex ureteral reconstruction and received the Whitaker test after surgery between December 2018 and December 2019 were included. We judged it abnormal that the renal pelvis pressure was higher than 22 cmH2O or the pressure difference was greater than 15 cmH2O. The results were used as a reference for removing the nephrostomy tube. Based on whether the renal pelvic pressure was higher than 22 cmH2O, the patients were divided into the elevated pelvis pressure group and the normal group. Follow ups at 1 month and every 3 months were collected. A total of 19 patients were included. Fifteen patients did not present obvious abnormalities. One patient suffered from contrast infiltrating into the renal parenchyma, and the pressure was higher than 15 cmH2O. Ureteral stent implantation was performed. The other 3 patients had either elevated pelvis pressure or insufficient image, 2 of which prolonged the duration of nephrostomy tubes. The median follow-up time was 12.6 months. CTU/MRU after removing nephrostomy tubes indicated improved/stable hydronephrosis in all patients. The creatinine in the elevated pelvis pressure group was higher than that in the normal group (91.4 ± 27.6 vs 86.7 ± 16.5 μmol/L, P = .782), and the eGFR was lower (76.0 ± 14.0 vs 81.8 ± 24.1 mL/min/1.73m2, P = .695), but without significant difference. The change in creatinine during follow-up in the elevated renal pelvic pressure group was significantly different from that in the normal group (-13.6 ± 1.0 vs -0.2 ± 10.6 umol/L, P = .047). Postoperative Whitaker test can help judge whether nephrostomy could be removed. Elevated pressure in upper urinary tract after reconstruction suggests the need to prolong the time of the nephrostomy tube or even re-intervene. Proper management for patients with elevated renal pelvis pressure can help restore the renal function.

Complex Ureteral Reconstruction in Kidney Transplantation.

Despite advances in surgical techniques and organ preservation, transplant ureteric strictures remain a common complication in kidney transplantation. A variety of endourological and surgical techniques have been utilized; however, there is a lack of consensus on the optimal modality in dealing with these complex cases. We present challenging ureteral reconstruction cases after failed attempts at ureteral dilatation, failed conventional open repairs, and/or with bladder dysfunction. All renal allografts were salvaged by successful use of bladder Boari flap and intestinal segment interpositions/diversions. Operative repair remains the most durable and successful approach, and minimally invasive options should be reserved for nonsurgical candidates, with consideration of a single attempt in patients with early, distal, short (<2 cm), nonischemic strictures.

V05-08 MANAGEMENT OF MULTIPLE URETERAL STRICTURES IN A PARTIALLY DUPLICATED COLLECTING SYSTEM

You have accessJournal of UrologyUpper-Tract Reconstruction (V05)1 Apr 2020V05-08 MANAGEMENT OF MULTIPLE URETERAL STRICTURES IN A PARTIALLY DUPLICATED COLLECTING SYSTEM Aeen Asghar*, Ziho Lee, Michael Metro, and Daniel Eun Aeen Asghar*Aeen Asghar* More articles by this author , Ziho LeeZiho Lee More articles by this author , Michael MetroMichael Metro More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000874.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Duplication of the collecting system can be found in nearly 1% of the general population. It can present as partial or complete duplication with or without obstruction and reflux. Herein, we present a patient with idiopathic high-grade ureteral strictures in both ureters of her partially duplicated system. METHODS: We present a 36-year-old female who was initially diagnosed with sepsis secondary to a distal left ureteral stone requiring percutaneous nephrostomy tube placement. After resolution of infection and spontaneous passage of stone, she was found to have a partially duplicated collecting system with dense strictures in both lower and upper proximal ureters on antegrade and retrograde pyelograms. A MAG-3 renal scan revealed functioning moieties with no drainage from the lower moiety and delayed drainage from the upper pole. Given her young age and desire for definitive surgery, we proceeded with Robot-Assisted Laparoscopic (RAL) ureteral reconstruction. Intraoperatively, we encountered severe peri-ureteral inflammation with an obliterated long segment lower pole proximal ureter and a dense 2.8 cm upper pole ureteral stricture, we decided to perform a ureteropyelostomy and an augmented anastomotic buccal mucosal graft ureteroplasty. This was done by creating an ureteropyelostomy anastomosis between the lower moiety pelvis to the upper moiety proximal ureter, followed by reconstruction of the 2.8 cm stricture in the upper ureter to create a new common ureteral drainage pathway. A ureteral stent was placed with the proximal curl in the lower moiety pelvis. We also placed a Foley catheter in the bladder and a Jackson-Pratt (JP) drain. RESULTS: Our console time was 303 minutes with 100 mL of blood loss. The foley catheter was removed on post-operative day (POD) 1, along with the JP drain, given its low output. Patient was discharged on POD 1 and had no 30-day post-operative complications. Her stent was removed 6 weeks post-operatively and her MAG-3 renal scan results are pending. CONCLUSIONS: Duplicated collecting systems are a rare congenital anomaly, often asymptomatic in those with bifid ureters. Patients in this population suffering from ureteral strictures may benefit from minimal invasive ureteral reconstruction. Complex ureteral reconstruction even in multi-level dense ureteral strictures in both limbs of a bifid ureter can be feasible by experienced teams if advanced surgical options such as RAL ureteropyelostomy and buccal mucosal graft ureteroplasty are utilized. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e472-e472 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aeen Asghar* More articles by this author Ziho Lee More articles by this author Michael Metro More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...

Intestinal interposition for complex ureteral reconstruction: A comprehensive review.

Long ureteral defects have remained a challenge to urologists for a long time. Bowel interposition, including ileal ureter, appendiceal interposition and reconfigured colon substitution, has gained wide acceptance, even though it is a complicated procedure and associated with some potential complications. Mucus obstruction and metabolic disorders are common complications of intestinal substitution. To circumvent these troubles, modified techniques, such as tapering the bowel graft, intestinal onlay flap and the Yang-Monti procedure, are used. In particular, Yang-Monti ileal ureter replacement is a highly effective option for ureteral reconstruction, and the incidence of complications would be significantly reduced in select patients. After being combined with the Boari flap or psoas hitch technique, the length of intestinal segment used can also be significantly reduced. Most recent long-term results suggest that ileal ureter replacement with antireflux anastomosis seems to be remarkably free of complications, and we highly praise the distal nipple valve technique. Appendiceal interposition is available for patients with normal appendix, and usually this procedure is limited to reconstructing the right ureter. Appendiceal onlay ureteroplasty has emerged as a feasible and effective option to manage patients with complex proximal and mid-ureteral strictures of the right side. The colon is rarely used for ureteral reconstruction because of its large caliber and mucous surface area. However, a reconfigured colon segment is a good substitute to reconstruct long-segment ureteral defects, and long-term follow up confirmed minimal complications and improved renal function. This review provides a comprehensive perspective on complex ureteral reconstruction and replacement using intestinal segments, in particular, ileal ureter replacement.

Clinical reappraisal and state of the art of nephropexy.

The diffusion of minimally invasive techniques for renal surgery has prompted a renewed interest in nephropexy which is indicated to prevent nephroptosis in symptomatic patients and to mobilize the upper ureter downward in order to bridge a ureteral defect. Recent publications have been reviewed to present the state of the art of the diagnosis and management of these two challenging conditions and to try to foresee the next steps. The evaluation of patients with mobile kidney can be made relying on diagnostic criteria such as ultrasound with color Doppler and measurement of resistive index, conventional upright X-ray frames after a supine uro-computerized tomography scan and both static and dynamic nuclear medicine scans, always with evaluation in the sitting or erect position. Laparoscopic nephropexy emerges as the current treatment option combining both objectively controlled repositioning of the kidney and resolution of symptoms with minimal invasiveness, low morbidity, and short hospital stay. The use of robotics is presently limited by its higher cost, but may increase in the future. Downward renal mobilization and nephropexy is a safe and versatile technique which has been adopted as a unique strategy or more often in combination with other surgical maneuvers in order to cope with complex ureteral reconstruction.

Robotic-assisted laparoscopic repair of ureteral injury: an evidence-based review of techniques and outcomes.

Iatrogenic ureteral injuries represent a common surgical problem encountered by practicing urologists. With the rapidly expanding applications of robotic-assisted laparoscopic surgery, ureteral reconstruction has been an important field of recent advancement. This collaborative review sought to provide an evidence-based analysis of the latest surgical techniques and outcomes for robotic-assisted repair of ureteral injury. A systematic review of the literature up to December 2017 using PubMed/Medline was performed to identify relevant articles. Those studies included in the systematic review were selected according to Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. Additionally, expert opinions were included from study authors in order to critique outcomes and elaborate on surgical techniques. A cumulative outcome analysis was conducted analyzing comparative studies on robotic versus open ureteral repair. Thirteen case series have demonstrated the feasibility, safety, and success of robotic ureteral reconstruction. The surgical planning, timing of intervention, and various robotic reconstructive techniques need to be tailored to the specific case, depending on the location and length of the injury. Fluorescence imaging can represent a useful tool in this setting. Recently, three studies have shown the feasibility and technical success of robotic buccal mucosa grafting for ureteral repair. Soon, additional novel and experimental robotic reconstructive approaches might become available. The cumulative analysis of the three available comparative studies on robotic versus open ureteral repair showed no difference in operative time or complication rate, with a decreased blood loss and hospital length of stay favoring the robotic approach. Current evidence suggests that the robotic surgical platform facilitates complex ureteral reconstruction in a minimally invasive fashion. High success rates of ureteral repair using the robotic approach mirror those of open surgery, with the additional advantage of faster recovery. Novel techniques in development and surgical adjuncts show promise as the role of robotic surgery evolves.

Clinical Utility of Upper Urinary Tract Reconstruction by Ileal-Ureter Substitution

We retrospectively reviewed the indications and outcomes of ileal-ureter substitution cases for complex ureteral reconstruction. We analyzed the patient clinical characteristics, outcomes, and complications of eight patients who had ileal ureter substitution surgery at Kyoto University Hospital between 2009 and 2016. The median patient age was 55.5 years (36-79), and the median follow up period was 25.5 months (7-85). Seven patients had unilateral ureteral obstruction (right:left=4:3), and one had bilateral ureteral obstruction. The etiologies of the ureteral defects were ureteral stricture due to non-urologic malignant tumorinvasion (n=2), benign ureteral stricture (n=2), anastomotic stricture after cystectomy (n=2), and iatrogenic ureteral injury (n=2). The mean length of operation time was 384.7 minutes (median 323 minutes, 242-397), and the mean hospital stay was 32.9 days (median 31 days, 19-41). Simple anastomosis of an untailored ileal segment to ureter and bladder was performed in 5 cases, bilateral ureteral anastomosis to a single ileal segment in one case, and in the remaining two cases, the ileal ureter was anastomosed to ileal conduit or neobladder. A nipple valve was used as the antireflux mechanism, in 2 cases but not in the remaining 6 cases. The outcome was favourable in all cases with no stricture and no requirement for further intervention. There was no significant deterioration of renal function in any patient, and no metabolic abnormality was detected. The ileal-ureter substitution appears to be a reasonable option, allowing nephron sparing in complex ureteral reconstruction cases.

MP51-10 URETERAL STRICTURES AFTER URETEROSCOPY FOR NEPHROLITHIASIS: MULTI-INSTITUTIONAL OUTCOMES

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2016MP51-10 URETERAL STRICTURES AFTER URETEROSCOPY FOR NEPHROLITHIASIS: MULTI-INSTITUTIONAL OUTCOMES Philip May, Ryan Hsi, Henry Tran, Marshall Stoller, Ben Chew, Thomas Chi, Manint Usawachintachit, Brian Duty, John Gore, and Jonathan Harper Philip MayPhilip May More articles by this author , Ryan HsiRyan Hsi More articles by this author , Henry TranHenry Tran More articles by this author , Marshall StollerMarshall Stoller More articles by this author , Ben ChewBen Chew More articles by this author , Thomas ChiThomas Chi More articles by this author , Manint UsawachintachitManint Usawachintachit More articles by this author , Brian DutyBrian Duty More articles by this author , John GoreJohn Gore More articles by this author , and Jonathan HarperJonathan Harper More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.465AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteroscopy (URS) is a common surgical intervention for the management of nephrolithiasis. While ureteral stricture after URS is a relatively rare complication (<1%), it is associated with significant morbidity. Our objective was to evaluate the procedural burden and outcomes for ureteral strictures related to URS performed for nephrolithiasis. METHODS Records for patients managed at 4 academic tertiary care centers between December 2006 and October 2015 with the diagnosis of ureteral stricture following URS for nephrolithiasis were reviewed. Ureteral stricture was defined as the presence of hydronephrosis, evidence of luminal narrowing, and elevated t1/2 on renal scintigraphy. Patients were excluded if their stricture could not be determined to have occurred after URS as verified by three independent physician reviewers. Type of stricture treatment and clinical outcomes were examined as primary endpoints. RESULTS Among 38 patients with 40 ureteral strictures identified, 55% were female and mean BMI was 31.3 kg/m2. Overall, 73% of strictures were left sided; 50% were proximal ureteral, 42.5% distal ureteral, 5% pan-ureteral, and 2.5% mid-ureteral. The mean number of known URS procedures prior to stricture diagnosis was 2.5 ± 2.5 (range 1-10). At least 35% of cases had hydronephrosis or stone impaction at the time of URS, and 20% had known ureteral perforation. After stricture diagnosis, the mean number of procedures performed for stricture treatment was 3.3 ± 1.8 (range 1-10) with a mean follow-up time of 17.2 months. 30% of strictures were successfully managed with endoscopic techniques alone. 35% were successfully managed with complex open, laparoscopic, or robotic-assisted reconstruction (e.g. ureteroureterostomy, ureteroneocystostomy, ileal ureter, or autotransplant), 10% were managed with chronic ureteral stenting or nephrostomy drainage, and 25% with nephrectomy. CONCLUSIONS Ureteral strictures that occurred following URS for nephrolithiasis were associated with high morbidity. Less than one-third of patients in this series could be managed with endoscopic techniques alone, and the majority of patients required complex ureteral reconstruction or nephrectomy. Strategies for stricture prevention should be emphasized in future studies. © 2016FiguresReferencesRelatedDetailsCited byAhn J, Holt S, May P and Harper J (2018) National Imaging Trends after Ureteroscopic or Shock Wave Lithotripsy for NephrolithiasisJournal of Urology, VOL. 199, NO. 2, (500-507), Online publication date: 1-Feb-2018. Volume 195Issue 4SApril 2016Page: e684 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Philip May More articles by this author Ryan Hsi More articles by this author Henry Tran More articles by this author Marshall Stoller More articles by this author Ben Chew More articles by this author Thomas Chi More articles by this author Manint Usawachintachit More articles by this author Brian Duty More articles by this author John Gore More articles by this author Jonathan Harper More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Robot-assisted Tapered Ureteral Reimplantation for Congenital Megaureter

To discuss the clinical implications of primary obstructed congenital megaureter in the adult and illustrate a minimally-invasive approach for surgical intervention. We present the case of a 51-year-old man with a longstanding history of symptomatic congenital megaureter, illustrating an approach for robot-assisted tapered ureteral reimplantation. Ureteral dissection, tapering, and nonrefluxing ureteroneocystostomy were all completed using a robot-assisted laparoscopic technique. The total operative time was 262 minutes, with an estimated blood loss of 150 mL. The patient's hospital course was uneventful, with discharge on postoperative day 4 without a Foley catheter or drain. A diuretic renal scan was performed at 5 months that showed good preservation of renal function with rapid clearance of tracer on the reconstructed side. The patient was pain free at his last follow-up visit without any symptoms. We have demonstrated a technique for robot-assisted tapered nonrefluxing ureteral reimplantation for congenital megaureter. Robotic assistance provided a safe and effective approach for complex ureteral reconstruction while minimizing morbidity.

V1543 ROBOT-ASSISTED TAPERED URETERAL REIMPLANTATION FOR CONGENITAL MEGAURETER

You have accessJournal of UrologyReconstruction1 Apr 2010V1543 ROBOT-ASSISTED TAPERED URETERAL REIMPLANTATION FOR CONGENITAL MEGAURETER Alvin Goh and Richard Link Alvin GohAlvin Goh More articles by this author and Richard LinkRichard Link More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1295AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Primary obstructed congenital megaureter is a rare condition in the adult that may require surgical intervention, especially when symptomatic or associated with complications. METHODS We present a case of a 51-year-old man with a longstanding history of symptomatic congenital megaureter illustrating an approach for robot-assisted tapered ureteral reimplantation. Ureteral dissection, tapering, and non-refluxing ureteroneocystostomy were all completed using a robot-assisted laparoscopic technique. RESULTS Total operative time was 262 minutes with an estimated blood loss of 150ml. The patient's hospital course was uneventful with discharge on post-operative day 4 without a foley or drain. A diuretic renal scan was performed at 5 months showing good preservation of renal function with rapid clearance of tracer on the reconstructed side. The patient is currently pain-free without any symptoms. CONCLUSIONS We demonstrate a technique for robot-assisted tapered non-refluxing ureteral reimplantation for congenital megaureter. Robotic assistance provides a safe and effective approach for complex ureteral reconstruction while minimizing morbidity. Houston, TX© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e595 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alvin Goh More articles by this author Richard Link More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Laparoscopic Assisted Ileal Ureter: Technique, Outcomes and Comparison to the Open Procedure

Ureteral replacement with interposition of a bowel segment has traditionally required a large incision with substantial associated morbidity and prolonged time to convalescence. During the last 7 years a technique for laparoscopic assisted ileal interposition has evolved that mimics our open approach. We present a comparative analysis of functional and perioperative outcomes between patients undergoing laparoscopic or open ileal ureter replacement at our institution. A search of all procedures from 1980 to the present revealed 7 patients undergoing laparoscopic and 7 undergoing open ileal interposition. Functional and perioperative data from these patients are compared, and a detailed description of technique for the laparoscopic procedure is presented. Narcotic analgesic use in morphine equivalents (median 38.9 vs 322.2 mg, p = 0.035) and time to convalescence (median 4 vs 5.5 weeks, p = 0.03) were significantly less in the laparoscopic group. A trend toward shorter hospital stay (median 5 vs 8 days, p = 0.101) was also noted in patients in the laparoscopic group. There was no evidence of anastomotic stricture for patients in either group at last followup. Despite the small number of subjects involved a significant advantage was noted for postoperative recovery after laparoscopic compared to open ileal interposition. A detailed understanding of this complicated procedure can help prevent inherent pitfalls.

Laparoscopic Ureteroplasty Using On-Lay Appendix Graft

Complex ureteral reconstruction has been performed with ileum, appendix, or other intestinal segments for the treatment of long ureteral strictures. In the past decade, challenging ureteral reconstruction has been approached using laparoscopic urology. We report the case of a 6-cm iatrogenic stricture after treatment of stone disease. The stricture was treated using a laparoscopic on-lay appendix graft. This laparoscopic technique used the on-lay concept, which, in addition to minimizing postoperative pain and the length of hospitalization, allowed a tension-free watertight anastomosis and preserved the ureteral vascular supply. This approach should be considered a viable minimally invasive alternative for ureteral reconstruction when endoscopic treatment has failed.

The Use of Bowel for Ureteral Replacement for Complex Ureteral Reconstruction

The Use of Bowel for Ureteral Replacement for Complex Ureteral Reconstruction

The Use of Bowel for Ureteral Replacement for Complex Ureteral Reconstruction: Long-term Results

The Use of Bowel for Ureteral Replacement for Complex Ureteral Reconstruction: Long-term Results

The Use of Bowel for Ureteral Replacement for Complex Ureteral Reconstruction: Long-Term Results

Ileal and intestinal ureteral replacement remains a useful procedure for complex ureteral reconstruction. We examined the long-term safety and efficacy of this procedure, especially in regard to maintaining preoperative renal function and the avoidance of major complications. A total of 56 patients underwent intestinal ureteral substitution at our institution between 1979 and 2003, including 52 with an ileal ureteral replacement, 2 with colonic replacement alone and 2 with bilateral ureteral replacement, necessitating ileum and colon for 1 ureter each. The factors reviewed were indications for surgery, type of ureteral replacement, and the presence and type of complications. Followup data included excretory urogram or equivalent imaging results, and measurement of serum chloride, bicarbonate and creatinine before and after the procedure. Overall the complication rate remained low. Mean followup was 6.04 years (median 3.2). Most postoperative complications, which occurred in 10 patients (17.9%), were minor in nature, including pyelonephritis, fever of unknown origin, neuroma, hernia, recurrent urolithiasis and deep venous thrombosis. Major complications occurred in 6 patients (10.5%), including anastomotic stricture, ileal graft obstruction, wound dehiscence and chronic renal failure. Overall patients did not experience worsening renal function after the procedure with equivalent median creatinine before and after the procedure (1.0 mg/dl). During long-term followup major complications are rare and renal function remains preserved. Ileal and intestinal ureteral substitution remains a safe and efficacious procedure in patients with complex and difficult ureteral issues not amenable to more conservative measures.

248: Ureteral Replacement with Intestine: A Viable and Safe Option for Complex Ureteral Reconstruction

248: Ureteral Replacement with Intestine: A Viable and Safe Option for Complex Ureteral Reconstruction

Replacement of the Ureter by Small Intestine: Clinical Application and Results of the “ileal Ureter”

Replacement of the Ureter by Small Intestine: Clinical Application and Results of the “ileal Ureter”