Ureteral Replacement Research Articles

Complete ureteral replacement by boari bladder flap after cadaveric renal transplant

Boari bladder flaps are generally used to bridge a loss of distal ureter in ureteric reconstruction, especially after ureteric injury during pelvic surgery. Herein is reported a case of total ureteral replacement in a cadaveric renal allograft fifteen days after initial implant, for total ischemic loss of the donor ureter.

Segmental replacement of the left ureter using a pedicled and tapered gastric flap in dogs : M. Pul, N.Y. Pul, and N. Gurses. Pediatr Surt Int 7:121–123, (March), 1992

Segmental replacement of the left ureter using a pedicled and tapered gastric flap in dogs : M. Pul, N.Y. Pul, and N. Gurses. Pediatr Surt Int 7:121–123, (March), 1992

Segmental replacement of the left ureter using a pedicted and tapered gastric flap in dogs

Segmental replacement of the left ureter was done using a pedicted and tapered gastric flap in ten dogs. All were followed up for 12 weeks. The results of the operation were good. Serum electrolyte imbalance was not observed in any dog. Intravenous pyelograms were normal except in one animal that had mild calyceal dilatation. Postoperative values of blood urea nitrogen (BUN) and creatinine were normal when compared with preoperative values. Pathologic examinations of the left kidney, left ureter, and gastric ureter of the dogs were normal. We believe that incorporating a pedicled and tapered gastric flap into the urinary tract to bridge a ureteral defect is a new, safe, and effective clinical alternative.

Reconstructive surgery of the ureter

Described here an 20 years of experience with reconstructive surgery of the ureter. Indications during this period have changed. Previously tuberculosis, iatrogenic obstructions (gynecological and urological) and retroperitoneal fibrosis were seen quite often. In recent times, however, partial ureter excision for tumors and fibrosis due to vascular surgery has been more prominent. Congenital anomalies are treated more conservatively today. Urologists should use a variety of techniques, depending on the indication. Extensive experience has proven that ureter replacement by ileal segments and an antireflux nipple of the ileum in the bladder yields better long-term results than direct anastomosis.

Anterior Pelvic Reconstruction with Ileum after Cancer Treatment

Ileum has been used to reconstruct the lower urinary tract in 15 patients (10 women, five men) after treatment for bladder or gynaecological cancer. Seven patients had previously received radical pelvic irradiation. Four methods were used: group 1 (five patients): bladder patch after partial cystectomy or bladder augmentation after clam cystotomy for bladder contracture; group 2 (four patients): bladder replacement after subtotal (supratrigonal) cystectomy; group 3 (two patients): ureteric replacement for lower ureteric obstruction or fistula, and group 4 (four patients): complete replacement of bladder and lower ureters after anterior pelvic exenteration, with creation of neovagina from caecum in the two female patients. Review of the results indicates that ileum provides a versatile and safe material for anterior pelvic reconstruction in cancer patients even after previous pelvic irradiation.

Diffuse stenosis of the ileum after ureteroileal interposition: radiologic-pathologic correlation in two cases.

The small intestine has been effectively used for partial or complete replacement of a diseased ureter since 1906 [1 , 2]. Indications include primary ureteral lesions, such as strictures and neoplasms; extrinsic processes involving the ureter, such as retroperitoneal neoplasms or fibrosis; and penetrating or surgical trauma. In recurrent nephrolithiasis, ileoureteral interposition is an attractive alternative because the large caliber of the intestine allows painless passage of stones. When success is defined as a pain-free state and stable or improved renal function, a successful outcome for ureteroileal interposition can be expected in more than 80% of cases [2]. Focal strictures or dilatation with decompensation of the intestinal ureter have been reported [3, 4]. We present the imaging studies with pathologic correlation in two cases of ureterointestinal interposition complicated by narrowing of the entire intestinal segment, which occurred 3 months and 3 years after surgery.

Nonrefluxing Ileal Ureteral Replacement Using the Intussuscepted Ileal Nipple: Laboratory Studies

A new technique for nonrefluxing ureteral replacement using ileum has been developed. Five adult mongrel dogs were operated using this nonrefluxing ileal ureteral technique. Subsequent reoperation showed in every case the preservation of renal function, a nonrefluxing system and no evidence of pyelonephritis or hydronephrosis. Based on the intussuscepted ileal nipple used in the Kock continent ileostomy, this technique has application in candidates for urinary undiversion, situations of ureteral loss due to trauma and fibrosis, and in patients with tuberculous strictured ureters. (J. Urol., 144: 1041–1043, 1990)

The Role of Renal Autotransplantation in Complex Urological Reconstruction

From 1972 to 1988, 108 patients underwent renal autotransplantation for renal artery disease (67), ureteral replacement (27), or renal cell carcinoma present bilaterally or in a solitary kidney (14). The most common indication for renal autotransplantation was to allow extracorporeal repair of complex branch renal artery lesions. Of the 54 patients in this group technically satisfactory branch renal arterial reconstruction and a successful clinical outcome were achieved in 52 (96%). Renal autotransplantation is the treatment of choice in these patients and also in selected children with main renal artery disease.Renal autotransplantation provided excellent results in 25 of 27 patients (92%) who required replacement of all or a major portion of the ureter. Over-all renal function was well preserved in these patients and only 1 has experienced chronic bacteriuria. Renal autotransplantation is a useful alternative to ileal interposition in this setting.Extracorporeal partial nephrectomy and renal autotransplantation were successful in 12 of 14 patients (85%) undergoing a nephron-sparing operation for renal cell carcinoma. In situ techniques are associated with less morbidity and currently are preferred in this group.

Preliminary Nephrostomy and Total Ileal Replacement of both Ureters in Advanced Bilharzial Obstructive Uropathy

Total substitution of both ureters in 5 patients with advanced obstructive uropathy due to extensive ureteric bilharziasis is described. It is recommended that ureteric replacement in the presence of marked obstructive uropathy should not be undertaken without preliminary renal drainage. An open through-and-through nephrostomy is recommended for this purpose. It is suggested that this approach will help to minimise the incidence of nephrectomy in areas of endemic urinary bilharziasis.

Ureteral Replacement Using Ileum in Compromised Renal Function

Ureteral replacement by ileum is an accepted technique in a highly selective patient population. Two major contraindications in using an ileal ureter are compromised renal function (serum creatinine > 2) and a functionally abnormal bladder. We used ileum to bridge a ureteral defect in animals with half of a solitary kidney and low grade azotemia to see if the antirefluxing mechanism of the lower ureter prevented further deterioration in renal function. Twelve female mongrel dogs underwent a right nephrectomy, followed by a left partial nephrectomy six weeks later. Group I (six dogs) had a six cm. segment of ileum interposed between the upper and lower ureteral segments (nonrefluxing). Group II (five dogs) had a ten cm. segment of ileum placed from the upper third of the ureter to the bladder (refluxing). Cystograms, intravenous pyelograms, serum electrolytes, BUN and creatinine were obtained preoperatively, six weeks after the right nephrectomy, one month after left partial nephrectomy and six months after ileal replacement prior to sacrifice. The BUN and creatinine deteriorated in Group II compared to Group I, p = .02 and p = 0.4 respectively (Mann-Whitney test). The BUN and creatinine also deteriorated between one month after left partial nephrectomy and six months after ileal replacement within Group II, p = .07 and p = .14, respectively (Wilcoxon matched-pairs test) but not in Group I. These data suggest that the antirefluxing mechanism of the lower ureter might prevent further deterioration in renal function. We feel that ileum can be used with caution, as an interposition in compromised renal function.

530 - Ureteral Replacement Using Ileum in Compromised Renal Function

530 - Ureteral Replacement Using Ileum in Compromised Renal Function

1121 - Nonrefluxing Ileal Ureteral Replacement Using the Intussuscepted Ileal Nipple: Laboratory Studies and Clinical Applications

1121 - Nonrefluxing Ileal Ureteral Replacement Using the Intussuscepted Ileal Nipple: Laboratory Studies and Clinical Applications

285 - Complications of Endopyelotomy

No AccessJournal of Urology1 Jun 1987Complications of Endopyelotomy Jerry Weinberg and M.D. Gopal H. BadlaniM.D. Jerry WeinbergJerry Weinberg More articles by this author and Gopal H. BadlaniGopal H. Badlani More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)75435-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Complications of Endopyelotomy." The Journal of Urology, 137(6), p. 175A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySutherland R, Pfister R and Koyle M (2018) Endopyelotomy Associated Ureteral Necrosis: Complete Ureteral Replacement Using the Boari FlapJournal of Urology, VOL. 148, NO. 5 Part 1, (1490-1492), Online publication date: 1-Nov-1992. Volume 137Issue 6June 1987Page: 175A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Jerry Weinberg More articles by this author Gopal H. Badlani More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-Term Results with Renal Autotransplantation for Ureteral Replacement

From 1970 to 1984 renal autotransplantation was performed on 23 patients to replace all or a major portion of the ureter. The conditions necessitating ureteral replacement were postoperative ureteral injury in 16 cases, recurrent renal colic in 4, urinary undiversion in 2 and an atonic ureter in 1. Six patients presented with a solitary kidney and 1 underwent staged bilateral autotransplantation. After autotransplantation urinary continuity was restored by ureteroneocystostomy in 11 patients, pyelovesicostomy in 7, ureteroureterostomy in 2, pyeloureterostomy in 2 and ureterosigmoidostomy in 1.Postoperatively, there was no mortality and all but 1 of the autotransplanted kidneys functioned immediately. Two kidneys required removal postoperatively owing to bleeding. Currently, 20 patients are alive with functioning renal autotransplants at intervals of 1.5 to 14 years. The current serum creatinine level in these patients ranges from 1.1 to 2.2mg. per dl., which in each case is improved or stable compared to the preoperative determination. Only 1 patient has experienced chronic bacteriuria. We conclude that renal autotransplantation provides excellent long-term treatment for patients who require ureteral replacement.

An active artificial ureter with autonomous energy supply.

For long-term ureteral replacement an artificial ureter has to be able to pump against the outflow resistance into the bladder at any physiological flow rate (0.2-2.0 ml/min). This demand is satisfied only by active prostheses. The active prosthesis described in this paper is driven by the intra-abdominal pressure fluctuations caused by the respiratory movements. The comparison of in vitro results with the parameters of physiological peristalsis proves the applicability of the prosthesis at physiological conditions. Compared to active prostheses with foreign energy supply, this concept promises less burden for patients.

Nonrefluxing Ureteroileal Cystoplasty for Bladder Augmentation or Replacement of Ureters: Long-term Results of Own Technique

AbstractThe technique of a nonrefluxing end-to-end ureteroileal anastomosis is described. The conjoined ends of both ureters are formed into a 4 to 5cm. long ureteral tube that is placed loosely into the bowel lumen. Increased intraluminal pressure during micturition closes the valve by compressing the ureter wall from outside, thus, preventing reflux.

Ureteral Replacement Using Collagen Sponge Tube Grafts

The use of a collagen sponge tube graft as a material for segmental ureteral replacement was investigated. The structural design of the collagen sponge graft was achieved by cell culture on the matrix. MGH-U1 cells, derived from bladder cell carcinoma, were grown in vitro on the collagen sponge matrix with excellent biocompatibility and without evidence of cytotoxicity. The collagen sponge demonstrated biodegradability when implanted subcutaneously in dogs. However, a urine exposure test of collagen sponge in rat bladders revealed extensive salt deposits on its surface in some rats, as observed by crystallographic examination. Segmental ureteral replacements by collagen sponge tube grafts, accompanied by ureteral splint catheters, were performed in dogs. There was extensive uro-epithelial cell regeneration on the inner surface of the collagen grafts, without evidence of severe hydronephrosis, 5 to 12 weeks following the procedure. The results indicate the potential for ureteral replacement by collagen sponge tube grafts, which would act as non-toxic, biodegradable scaffolds inducing the regenerative activity of the ureter.

Ileal segment replacement of ureter I. Effects on kidney of refluxing vs nonrefluxing ileovesical anastomosis

Unilateral partial ureteral obstruction was induced in 32 dogs followed by total ileal replacement of the obstructed ureter. The morphologic and functional effects on the kidney using a freely refluxing versus a nonrefluxing ileovesical anastomosis were compared, as well as the effect of total tapering of the reimplanted ileal segment. The tapered ileovesical anastomosis proved more reliable for prevention of reflux than the nontapered technique. Reflux prevention does not appear necessary for maintaining renal morphology and function when bladder function is normal and the observation period short. Total tapering of the ileal segment did not prove to be advantageous in protecting against hyperchloremic acidosis in this short-term canine study.

Ileal segment replacement of ureter II. Dynamic characteristics of refluxing, nonrefluxing, and totally tapered ileal ureter

The pressure characteristics and cinefluoroscopic appearances of a refluxing, nonrefluxing, and totally tapered ileal “neoureter” were compared in 22 dogs with normal bladder function. The totally tapered ileal segment with a reflux preventing ileovesicostomy simulates normal ureteral peristalsis most closely on cinefluoroscopic evaluation. Pressure gradients across the ileovesical junction though were similar in refluxing and nonrefluxing ileovesicostomies, as well as in totally tapered ureters.

Segmental ureteric replacement: an animal study using a free non-pedicled graft.

An animal study has been carried out on 3 baboons to assess the feasibility of replacing a damaged segment of ureter with a free, non-pedicled, full thickness graft. A 3 cm segment was excised from the middle third of one ureter from each baboon and the free graft (buccal mucosa) fashioned into a tube and interposed between the cut ends in order to replace the excised segment. The grafts were left in situ for up to 10 weeks and their subsequent fate studied radiologically, histologically and by gross specimen examination. The results showed that in all cases perfect viability of the graft was maintained and there was no evidence of graft shrinkage or of loss of patency. In one instance a stricture developed at the mid point of the graft, but this was entirely explicable on technical grounds. Urine drainage was not impaired on account of the insertion of a muscle-free (and therefore aperistaltic) segment into the ureter.