You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery I1 Apr 20128 URETERAL RECONSTRUCTION AND THE DOWNSTREAM EFFECT ON BLADDER FUNCTION Raul Ordorica, Cesar Ercole, David Hernandez, Alejandro Rodriguez, Rafael Carrion, and Jorge Lockhart Raul OrdoricaRaul Ordorica Tampa, FL More articles by this author , Cesar ErcoleCesar Ercole Tampa, FL More articles by this author , David HernandezDavid Hernandez Tampa, FL More articles by this author , Alejandro RodriguezAlejandro Rodriguez Tampa, FL More articles by this author , Rafael CarrionRafael Carrion Tampa, FL More articles by this author , and Jorge LockhartJorge Lockhart Tampa, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.050AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral obstruction can result from a myriad of pathologies along with its occurrence along any extent and location. Such a variety requires a plethora of approaches and techniques to surgically manage with not only varying results in terms of renal drainage but also effect on bladder function depending on amount of bladder incorporated. We sought to determine the effect on renal drainage depending on the method of ureteral repair, along with the effect on lower urinary tract symptoms (LUTS) depending on the amount of bladder tissue used. We retrospectively review our experience involving ureteral repair involving from proximal to distal location with the repair either isolated from the bladder (primary anastomosis [PA], transuretero-ureterostomy [TUU], reconfigured intestinal onlay [RIO]), or involving the bladder (direct reimplant [DI], psoas hitch [PH], or boari flap [BF]). METHODS 56 patients underwent ureteral repair (40 women, 16 men), mean age of 51 (range 21 - 78). Etiology included pelvic surgery (32), radiation (11), nephrolithiasis (7), retroperitoneal fibrosis (3), cystitis cystica (2), trauma (2), and idiopathic (1). Methods of repair included PA (15), TUU (9), RIO (14), DI (7), PH (5), or BF (9). Renal function was followed postoperatively with renal scan performed at 3, 6, and 12 months, and annually thereafter. Bladder function was evaluated by AUA symptoms score along with additional subjective complaints. Cystometrogram was performed preoperatively for those patients with subjective compromise to bladder volume to assess bladder function prior to incorporation of bladder tissue for ureteral repair. RESULTS Successful drainage was noted in 49/56 patients (PA – 15/15, TUU – 7/9, RIO – 12/14, DI – 7/7, PH – 4/5, and BF – 7/9). Significant alteration in bladder function was noted in some of those patients in whom bladder tissue was used to augment ureteral continuity in the absence of other pathology (BF - 4/9, PH – 2/5). In addition, 2/8 patients who underwent direct reimplantation complained of significant pelvic and/or bladder discomfort following repair. CONCLUSIONS Multiple techniques are required for ureteral repair. While many of these methods result in reasonable success in restoring urinary tract continuity, compromise in bladder function may be encountered if the reconstruction demands prove too great for the available supply of bladder tissue. Bladder sensitivity and pain issues may persist even when relatively normal anatomy is restored. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e3 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raul Ordorica Tampa, FL More articles by this author Cesar Ercole Tampa, FL More articles by this author David Hernandez Tampa, FL More articles by this author Alejandro Rodriguez Tampa, FL More articles by this author Rafael Carrion Tampa, FL More articles by this author Jorge Lockhart Tampa, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...