Ureterointestinal Anastomosis Research Articles

Refluxing versus Non-Refluxing Ureteric Implantation in Continent Cutaneous Urinary Diversion: A Propensity-Scored Comparison regarding Long-Term Renal, Metabolic, and Functional Outcomes of Patients with Ileocecal Pouch

Introduction: Studies comparing refluxing versus non-refluxing ureteric implantation in continent cutaneous urinary diversion (CCUD) are scarce and often characterized by heterogeneous study populations. This work therefore aimed at comparing both techniques regarding long-term outcomes in a propensity-scored approach. Methods: We identified n = 19 patients, totaling n = 38 renal units (RU), who underwent CCUD surgery at our hospital out of a pool of 120 patients. Of these 38 RU, 27 RU were implanted via refluxing ureteric implantation utilizing various procedures due to special intraoperative circumstances (short ureters, damage due to radiation). In terms of preoperative renal function, a comorbidity index (Age-Adjusted Charlson Comorbidity Index [ACCI]), and gender, we compared them to n = 38 patients with a total of 76 RU with non-refluxing ureteric implantation in all RU (1:2 matching). The mean follow-up was 56 (IQR: 23–112) months. Results: Long-term renal function was comparable in CCUD patients receiving refluxing versus non-refluxing ureteric implantation (estimated glomerular filtration rate: 63.11 mL/min vs. 71.7 mL/min, p = 0.22) with an average decline of 17.4 mL/min and 13.69 mL/min during the follow-up period, respectively. Also, the rate of new-onset chronic kidney disease (CKD) (both 15%, p = 1), the need for alkalizing medication, or the number of pyelonephritis episodes did not significantly differ between the groups. In Cox regression analysis, ACCI was the single most predictive parameter for the development of new-onset CKD (HR: 1.71 [1.10–2.66], p = 0.0167). None of the RU in the refluxing group needed revisional surgery concerning the ureterointestinal anastomosis, whereas 7 RU of the non-refluxing group did. Conclusions: Our study confirms that refluxing ureteric implantation in CCUDs is a valid and safe procedure regarding long-term renal, metabolic and functional outcomes. Our data also suggest that patients should be counseled according to their comorbidities regarding long-term renal function.

The effect of retroperitonealization of ureteroileal anastomosis on perioperative complications of radical cystectomy with ileal conduit urinary diversion.

Radical cystectomy (RC) has been considered the standard management of muscle-invasive bladder cancer. Despite the improvements in surgical techniques and perioperative care, RC is still associated with high perioperative morbidity and mortality. This study aims to evaluate the effect of retroperitonealization of ureteroileal anastomosis on perioperative complications of RC with ileal conduit urinary diversion. This is a retrospective cohort study. We reviewed medical charts of 876 patients who underwent RC between 2016 and 2021. Based on the inclusion and exclusion criteria, 748 patients entered the study. According to retroperitonealization of the ureteroileal anastomosis, patients were categorized into two groups (group I without retroperitonealization of the ureteroileal anastomosis and group II with retroperitonealization of the ureteroileal anastomosis). Patients' characteristics and occurrences of any complications and high-grade complications were compared between these groups. In comparing the complication categories between the two groups, fewer patients in group II suffered from gastrointestinal, urinary, and cardiac events (p values were 0.018, 0.021, and 0.013, respectively). Moreover, fewer patients in group II experienced any complications and high-grade complications (p values were < 0.001 and < 0.001, respectively). The length of hospital stay was also significantly shorter in group II (p < 0.001). RC is associated with comparatively high perioperative morbidity and mortality. In the present study, 61% of the patients experienced at least one complication postoperatively. Retroperitonealization of the ureterointestinal anastomosis may decrease perioperative adverse events of RC with ileal conduit urinary diversion.

Feasibility and Safety of Stentless Uretero-Intestinal Anastomosis in Radical Cystectomy with Ileal Orthotopic Neobladder.

Background: We evaluated the feasibility and safety of stentless uretero-intestinal anastomosis (UIA) during radical cystectomy (RC) with an ileal orthotopic neobladder. Methods: We retrospectively reviewed 403 patients who underwent RC for bladder cancer between August 2014 and December 2018. The primary objective was to study the effect of stentless UIA on uretero-intestinal anastomosis stricture (UIAS), and the secondary objective was to evaluate the association between stentless UIA and other complications, including paralytic ileus, febrile urinary tract infection (UTI), and urine leakage. Kaplan–Meier survival analysis was used to estimate UIAS-free survival, and Cox proportional hazard models were applied to identify factors associated with the risk of UIAS. Results: Among 403 patients with 790 renal units, UIAS was identified in 39 (9.7%) patients and 53 (6.7%) renal units. Forty-four (83.0%) patients with UIAS were diagnosed within 6 months. The 1- and 2-year overall UIAS-free rates were 93.9% and 92.7%, respectively. Paralytic ileus was identified in 105 (26.1%) patients and resolved with supportive treatment. Febrile UTI occurred in 57 patients (14.1%). However, there was no leak of the UIA. Conclusions: Stentless UIA during RC with an ileal orthotopic neobladder is a feasible and safe surgical option. Further prospective randomized trials are required to determine the clinical usefulness of stentless UIA during RC.

A modified ileal conduit technique in patients undergoing radical cystectomy: Single-centre experience

Objective: We aimed to evaluate perioperative outcomes and complications of a modified technique of ileal conduit diversion. Methods: Forty-seven cases of radical cystectomy with modified ileal conduit diversion were performed at our institution from January 2015 to January 2020. After radical cystectomy, a segment of ileum was used to pack the conduit and was placed below the digestive anastomosis. Then, the mesentery window of the ileo-ileal anastomosis was sutured. The ureters were anastomosed on their native side on single loop ureteral stents. All procedures were performed by a single surgical team. Intra- and postoperative complications were classified and reported according to the Satava and Clavien–Dindo grading systems. Results: The mean age of population was 66.40±10.14 years, and 76.6% were male. Concomitant diabetes was found in 31.9% of patients. About three quarters of patients had T2G3 bladder cancer. Mean blood loss was 449.36±246.50 ml, and hospitalization was 10.32±5 days. With a mean follow-up of 17.36±12.63 months, the recurrence rate was 17%, and 14.9% of patients died of bladder cancer. Out of the 47 patients, three (4.3%) experienced intraoperative complications, while 15 (31.9%) had postoperative complications. Of these, only three patients experienced Clavien–Dindo complications ⩾grade 3. Multivariate logistic regression model showed that diabetes ( p=0.023) and higher blood loss ( p=0.010) were significantly associated with an increased risk of postoperative complications. We reported one case of ureterointestinal anastomosis stenosis on the left side and none on the right side. Despite our results being promising, larger randomized trials with longer follow-up are needed to explore further the feasibility of this technique on a larger scale. Conclusion: We describe a safe and simple surgical technique with a similar postoperative complications rate and a lower incidence of ureteroileal anastomosis stenosis compared to the standard technique. Level of evidence 4.

Мочеточнико-кишечные анастомозы: какой метод выбрать? История, современное состояние вопроса и собственный опыт

Introduction. At the moment, after performing a cystectomy, one of the most urgent issues remains the choice of technique for performing uretero-intestinal anastomoses. Materials and methods. The search of the information was conducted in the Pubmed and Scopus databases, with a scientific electronic library Elibrary.ru and websites of professional urological and oncological associations. The search was performed for the keywords «Radical cystectomy», «uretero-intestinal anastomosis», «bladder cancer», and «neobladder». For citation in the article, 44 publications were selected. We also present our own data – long-term functional results of radical cystectomy for muscle-invasive bladder cancer for the period from 2016 to 2020. Results. The article presents a literature review on the development of modern methods for creating uretero-intestinal anastomoses in various clinical situations. The methods are presented in chronological order of their description in the literature, indicating the advantages, disadvantages and long-term results. In all 75 cases included in the analysis, a direct uretero-intestinal anastomosis was performed. In the early postoperative period, the failure of the anastomosis with the development of urinary peritonitis was detected in 2 (2.7%) patients. Six months after the operation, unilateral anastomotic stricture was detected in 2 patients (2.7%). Reflux of urine, without radiological signs of expansion of the renal cavity system and decreased renal function, was observed in 1 patient after orthoptic plastic surgery of the bladder. Conclusion. Performing urinary-intestinal anastomoses without antireflux mechanisms does not lead to deterioration of long-term functional results and is associated with a low frequency of strictures.

Антирефлюксный уретероэнтероанастомоз при формировании ортотопического мочевого резервуара: за и против (обзор литературы)

Антирефлюксный уретероэнтероанастомоз при формировании ортотопического мочевого резервуара: за и против (обзор литературы)

Ureteric stricture rates and management after robot-assisted radical cystectomy: a single-centre observational study

Objective: Benign ureterointestinal anastomosis (BUIA) stricture is a recognized complication after open radical cystectomy. The evidence for stricture rates following robot-assisted radical cystectomy (RARC) is limited. This article reports stricture rates from a single high-volume RARC centre.Materials and methods: Between December 2003 and December 2015, 371 patients underwent RARC with a totally intracorporeal urinary diversion. All patients received a ureteric anastomosis utilizing the 'Wallace plate' with a running suture technique. Monofilament suture was used in the first 81 patients (22%) and a barbed suture (Quill™) in the remaining 290 patients (78%).Results: Median follow-up was 33 months and minimum follow-up was 7.9 months. The median time to stricture formation was 165 days (range 10–495 days). Twenty-four patients (6.5%) developed BUIA strictures. Six of 81 patients (7.4%) in the monofilament group and 18 of 290 (6.2%) in the barbed suture group developed strictures (p = .22). Fifteen patients (63%) had a stricture on the left side, seven (29%) on the right side and two patients (8%) developed bilateral ureteric strictures (p = .002). Strictures occurred in 11 of 131 patients (8.3%) with an orthotopic neobladder and 13 of 240 (5.4%) with an ileal-conduit urinary diversion (p = .17).Conclusions: The overall incidence of ureteric strictures is low in patients undergoing RARC with totally intracorporeal urinary diversion. Strictures were more common on the left side, which has been described in open series and is probably related to the increased mobilization on the left side required to cross the ureter to the right side.

Percutaneous Ureteral Dilations for Management of Uretero-Intestinal Anastomosis Stricture following Bricker Urinary Diversion

Percutaneous Ureteral Dilations for Management of Uretero-Intestinal Anastomosis Stricture following Bricker Urinary Diversion

Simultaneous antegrade and retrograde endoscopic treatment of non-malignant ureterointestinal anastomotic strictures following urinary diversion

BackgroundThe ureterointestinal anastomosis stricture (UAS) is a common complication of urinary diversion after radical cystectomy. For decades, open anastomotic revision remained the gold standard for the treatment of UAS. However, with the advancement in endoscopic technology, mini-invasive therapeutic approaches have been used in its management. Here, we report our experience with and long-term results of combined simultaneous antegrade and retrograde endoscopy (SARE) in the treatment of non-malignant UASs after urinary diversion in a consecutive series of patients.MethodsFrom March 2012 to January 2015, there were 32 consecutive patients with 32 non-malignant UASs following radical cystectomy and urinary diversion. Twenty-nine patients were treated with SARE technique and comprised the study group. Using simultaneous antegrade flexible ureteroscope combined with retrograde semi-rigid ureteroscope or nephroscope, partial or complete strictures were managed with laser incision and balloon dilation under direct visualization. A 7/12 Fr graded endopyelotomy stent was left for 3–6 months after the procedure. Success was defined as symptomatic improvement and radiographic resolution of obstruction.ResultsWith a median followup of 22 months (6–36), the overall success rate for SARE was 69.0%. Twenty patients with partial stricture had a success rate of 85%, and 9 patients with complete stricture had a success rate of 33.3%. Renal function, hydronephrosis grade, stricture type, and stricture length were significant influences on the outcome (P < 0.05). No complication was observed.ConclusionsThe SARE is a safe and effective treatment for UAS, and may be the only endoscopic treatment approach for complete UAS. While success rate for complete strictures is low compared to open revision, it should be considered as an initial approach given its low overall morbidity. For partial strictures, prudent patient selection results in higher success rates that are nearly comparable to open revision.

Technical features of intestinal ureteroplasty. Part 7: forming ureterointestinal anastomoses

To present the results and technical features of forming the ureterointestinal anastomoses in intestinal ureteral substitution. From 1998 to December 2016, 168 patients (mean age 51 +/- 8.7 years) underwent ureteral substitution using intestinal segments at the Urology Clinic of the I.I. Mechnikov NWSMU. Of them, 76 (45.2%) were males. In 119 (70.8%) patients, intestinal segments were used to replace various parts of the ureters (iliac in 92, colonic in 4, appendix in 23), and in 49 (29.2%) patients ureteroplasty was combined with orthotopic ileocystoplasty. 96 patients underwent isolated ureteral substitution with segments of the small and large bowel. Among the 96 patients, early postoperative complications occurred in 8 (8.3%) patients, whereof 5 (5.2%) required reoperations. Among them, 2 (2.1%) had a proximal anastomotic failure. Late postoperative complications occurred in 7 (7.3%) patients whereof 4 (4.2%) required surgical treatment. These patients developed strictures of the proximal ureter-intestinal anastomoses over 3 or more months after the operation. The urinary flow was restored by antegrade dilation. Vesicoureteral reflux occurred in 2 (2.1%) patients. However, it was not clinically evident and was not accompanied by hydroureteronephrosis and recurrent urinary tract infection. A perfect ureterointestinal anastomoses should be easy to create and have a low risk of stenosis and reflux. These requirements are met by direct anastomosis, which is associated with a minimal risk of stricture, and with isoperistaltic positioning and sufficient length (not less than 15 cm) of the graft provides antireflux protection. It should be noted that proximal (ureterointestinal) anastomoses are vulnerable in these operations and prone to the stricture formation. Unlike proximal, the distal anastomosis of the graft with the bladder is always wider, and therefore the risk of its narrowing is minimal. Isoperistaltic positioning of the graft prevents reflux formation.

The Immediate Results of Surgical Treatment of Bladder Cancer

The objective of this study was to evaluate the immediate results of the use of ureterointestinal anastomosis according to the Bricker technique at radical cystectomy (RC) for bladder cancer (BC). Materials and Results: The study included 96 patients (11.5% women and 88.5% men) with BC, aged from 31 to 74 years (mean age 63.8±7.2), who underwent RC in the Lipetsk Regional Oncology Center, in the period from 2005 to 2014. Among the early postoperative complications, we identified dynamic ileus (16.7%), inflammatory complications of the surgical wound (12.5%), acute pyelonephritis (10.4%), and failure of ureterointestinal anastomosis (4.2%). The frequency of postoperative acute pyelonephritis corresponded to the findings of other authors. Two (2.1%) patients died from early postoperative complications because of concomitant diseases (ischemic heart disease, myocardial infarction); thus, postoperative mortality in the early postoperative period was 4.2%. Chronic pyelonephritis with chronic renal failure detected in 15(15.6%) patients after one year after surgery was the most frequent late postoperative complication. The stricture of ureterointestinal anastomosis in 9(9.4%) patients has been eliminated through relaparotomy and resection of anastomosis. The development of urolithiasis in 12(12.5%) patients after one year after surgery has required the implementation of contact lithotripsy and litholytic therapy. (Int J Biomed. 2016;6(2):110-113.).

Urinary Tract Infections in Kidney Transplant Recipients Hospitalized at a Transplantation and Nephrology Ward: 1-Year Follow-up

IntroductionThe aim of this study was to investigate risk factors for urinary tract infections (UTI), the causative organisms of UTI and also their management and treatment. In addition, we evaluated the effects of UTI on renal graft function. MethodsThis analysis included 107 kidney transplant recipients (64% women) with a diagnosis of UTIs confirmed by positive results on urine culture. Type of pathogens, sensitivity to drugs, risk factors for infection, incidence of urosepsis, hospitalization period, treatment methods, and recurrence rates were analyzed. Statistical analysis was performed by using Pearson's χ2 test, Yates' χ2 test, the Student t test, Welch's t test, the Mann-Whitney U test, Fisher's exact test, and the Shapiro-Wilk normality test. ResultsThe most common species isolated from urine samples included Escherichia coli (42%), Klebsiella pneumoniae (15%), and Enterococcus faecalis (10%). The percentage of multidrug-resistant strains was 31%, and urosepsis was diagnosed in 16% of patients. Recurrences developed in 76% of infected patients. Bricker ureterointestinal anastomosis was performed in 11% of patients. Risk factors for severe infections included: pre-transplantation urinary tract surgery (P = .02), double-J stent insertion (more common in men) during KTx (N = 34; 32%), (P = .021), reoperations following transplantation (P = .36), elevated tacrolimus levels at the time of infection (P = .024). Severe infections were diagnosed in patients with lower eGFRs, were associated with a need for longer hospitalization (P = .04) and escalation of antibacterial treatment. Carbapenems were used in 22 patients (20.5%). ConclusionsUTIs were more common in women, in patients with impaired function of the kidney transplant, and in those with a history of urinary tract interventions. Severe infections were associated with a risk of urosepsis, longer hospitalization, and a need for escalation of antibiotic treatment.

Ileal Orthotopic Bladder Replacement without Stenting of the Ureterointestinal Anastomosis-10 Years Observation

Background: Stenting of ureterointestinal anastomosis is a standard precautionary measure, irrespective of the method of constructing the anastomosis; however no convincing scientific data exists to support this procedure. Objective: Clinical assessment of patients -radical cystectomy and ileal orthotopic bladder replacement without requirement for stenting of the ureterointestinal anastomosis or suprapubic cystostomy. Design, Setting, and Participants: To establish feasibility of ureterointestinal anastomosis without stenting. 426 radical cystectomies were performed between 1999 and 2009. Intervention(s): Ileal orthotopic bladder replacement with afferent loop was performed in 124 patients. Measurements: The following were evaluated: frequency of postoperative symptomatic urinary tract infections, duration of peritoneal drainage, length of hospitalization, duration of surgery, number of ureteral strictures type and number of major perioperative complications. Results and Limitations: Symptomatic pyelonephritis was observed in 10 patients (8%). The mean surgical time was 6.0 hours (4.5-9.0). The mean time of peritoneal drainage was 9.1 days (3 -40). The mean time of hospitalization was 14.1 days (7-40). Ureterointestinal anastomosis strictures were observed in 7 patients (5.6%). Major postoperative complications were observed in 12 patients (9.7%). Limitations: This is retrospective study without the control group.

Comparison Between Ambulatory and Conventional Urodynamics of the Modified Orthotopic Hautmann Neobladder.

Purpose:The aim of the present study was to determine the diagnostic accuracy of conventional and ambulatory urodynamic studies (UDS) in estimating neobladder function.Methods:We evaluated 32 patients who underwent radical cystectomy and orthotopic Hautmann W neobladder with Abol-Enein-Ghoneim uretero-intestinal anastomosis for bladder cancer. The patients were initially examined by using both conventional and ambulatory UDS.Results:Conventional UDS detected a very high mean intravesical pressure at maximum capacity (53.7±17.5 cm H2O). By contrast, the mean intravesical pressure detected by using ambulatory UDS (which reflects the dominant pattern of pressure variation during filling) was significantly lower (34.4±5.2 cm H2O, P<0.001). The comparison between intravesical pressure at half of maximum capacity in conventional UDS and the mean value in ambulatory UDS did not show significant difference (P=0.152). The mean voided volume in conventional UDS was greater than both the mean voided volume (P<0.001) and the mean maximum voided volume in ambulatory UDS (P=0.001). However, this difference did not affect the postvoid residual urine volume measured in both studies (P=0.207). Moreover, incontinence episodes recorded in ambulatory UDS were more frequent but not statistically significantly different from those recorded in conventional UDS (P=0.332).Conclusions:The estimation of neobladder function by means of ambulatory UDS seems to provide interesting research data for the mode of lower urinary tract function in patients with orthotopic substitution after radical cystectomy. The great high value in ambulatory UDS, in cases in which conventional UDS had failed, is due to the exposure of daily and nocturnal incontinence episodes, confirming our patients’ complaints.

S147 The assessment of the degree of renal failure in patients with ileal conduit urinary diversion dependent on the type of ureterointestinal anastomosis

S147 The assessment of the degree of renal failure in patients with ileal conduit urinary diversion dependent on the type of ureterointestinal anastomosis

S146 The assessment of the degree of renal deterioration in patients with ileal conduit urinary diversion dependent on the type of ureterointestinal anastomosis

S146 The assessment of the degree of renal deterioration in patients with ileal conduit urinary diversion dependent on the type of ureterointestinal anastomosis

The Impact of Running versus Interrupted Anastomosis on Ureterointestinal Stricture Rate after Radical Cystectomy

Benign ureterointestinal anastomotic stricture is not uncommon after radical cystectomy and urinary diversion. We studied the impact of the running vs the interrupted technique on the ureterointestinal anastomotic stricture rate. From July 2007 to December 2008 interrupted end-to-side anastomoses were created and from January 2009 to July 2010 running anastomoses were created. The primary study end point was time to ureterointestinal anastomotic stricture. Of 266 consecutive patients 258 were alive 30 days after radical cystectomy, including 149 and 109 with an interrupted and a running anastomosis, respectively. The groups did not differ in age, gender, body mass index, age adjusted Charlson comorbidity index, receipt of chemotherapy or radiation, blood loss, operative time, diversion type or postoperative pathological findings. The stricture rate per ureter was 8.5% (25 of 293) and 12.7% (27 of 213) in the interrupted and running groups, respectively (p = 0.14). Univariate analysis suggested that postoperative urinary tract infection (HR 2.1, 95% CI 1.1-4.1, p = 0.04) and Clavien grade 3 or greater complications (HR 2.6, 95% CI 1.4-4.9, p <0.01) were associated with ureterointestinal anastomotic stricture. On multivariate analysis postoperative urinary tract infection (HR 2.4, 95% CI 1.2-5.1, p = 0.02) and running technique (HR 1.9, 95% CI 1.0-3.7, p = 0.05) were associated with ureterointestinal anastomotic stricture. Median time to stricture and followup was 289 (IQR 120-352) and 351 days (IQR 132-719) in the running cohort vs 213 (IQR 123-417) and 497 days (IQR 174-1,289) in the interrupted cohort, respectively. Of the 52 strictures 33 (63%) developed within 1 year. Kaplan-Meier analysis controlling for differential followup showed a trend toward higher freedom from stricture for the interrupted ureterointestinal anastomosis (p = 0.06). A running anastomosis and postoperative urinary tract infection may be associated with ureterointestinal anastomotic stricture. Larger series with multiple surgeons are needed to confirm these findings.

Comparison of Seromuscular Tunnel and Split-cuff Nipple Antireflux Ureteroenteral Anastomosis Techniques in Orthotopic Taenia Myectomy Sigmoid Neobladder: A Prospective, Randomized Study

To compare the functional results and complications of seromuscular tunnel and split-cuff nipple antireflux ureteroenteral implantation techniques in orthotopic taenia myectomy sigmoid neobladder. A randomized prospective study was conducted from January 2004 to January 2009. A total of 62 patients (53 men and 9 women; all of Han ethnicity) with muscle-invasive urothelial carcinoma of the bladder and a normal upper urinary tract were enrolled in the present study. After pelvic lymphadenectomy and radical cystectomy, the ureters were randomized to implantation using seromuscular tunnel anastomosis or a split-cuff nipple technique. Regular follow-up visits included renogram intravenous urography and serum creatinine to evaluate renal function. The mean follow-up period was 52.0 ± 19.2 months (range 12-84). The serum creatinine levels remained normal in all patients throughout the study period. Stenosis occurred in 4 of 118 renoureteral units (4 patients), 2 with a seromuscular tunnel anastomosis and 2 with split-cuff nipple reimplantation. Only 1 stricture required treatment; the patient underwent retrograde balloon dilation after double-J stent insertion. The others received active surveillance, and the hydronephrosis did not worsen. No reflux was observed in any patient. One patient presented with bilateral hydronephrosis due to neovesicourethral stricture, which was treated successfully with transurethral urethrotomy. No difference in stricture formation was seen between the patients treated with the seromuscular tunnel or split-cuff nipple ureteroenteral anastomosis techniques in the orthotopic taenia myectomy sigmoid neobladder. No patients developed reflux. Our results suggest that both the seromuscular tunnel and the split-cuff nipple approach are reliable antireflux ureterointestinal anastomosis techniques, with low morbidity for orthotopic taenia myectomy sigmoid neobladder.

Effect of ureterointestinal anastomosis on renal function and morbidity in intestinal urinary diversion

Objective.The authors previously successfully applied the “flap-and-trough” (FT) method of antireflux ureterointestinal anastomosis (UIA) in a pilot set of 81 patients. This randomized prospective trial tested the effectiveness of this method in protecting the upper urinary tract from obstruction, reflux and infections. Material and methods.Forty-nine patients indicated for cystectomy and intestinal urinary diversion were randomly split into two groups, A and B. The FT antireflux UIA was applied in group A (n = 20), and refluxing direct elliptical UIA in group B (n = 29). Both groups were divided into two subcategories according to the type of diversion used: Ar (n = 10) and Br (n = 16) with low-pressure reservoirs and Ac (n = 10) and Bc (n = 13) with conduits. The follow-up evaluation compared the groups regarding perioperative complications, antireflux efficiency of FT, occurrence of obstruction and urinary infection, kidney morphology and glomerular filtration rate. Results.During the follow-up period (median 31 months), the obstruction occurred only in group Br (insignificant difference compared to Ar). A significant decrease in glomerular filtration rate and shortening of the left kidney occurred in group Br during the period and in comparison with Ar. There were no other considerable divergences in other studied parameters. Conclusions.The antireflux FT anastomosis represents a low risk for stenosis. The reduced occurrence of obstructive complications in comparison with direct UIA was statistically insignificant. Its construction did not increase the frequency of complications; on the contrary, it guarantees a better protection of renal morphology and function.

Serous-lined Unidirectional Valve for Construction of Continent Cutaneous Urinary Reservoir: The Test of Time

To assess the long-term outcome of using the serous-lined extramural tunnel technique for construction of continent-cutaneous urinary reservoir in an objective way. Cases that were operated until the end of 2003 and were eligible for evaluation at the time of the study were included. Continence, upper tract status, and complications were the targets of evaluation. Clear definition of continence was used, and biochemical kidney function profile was assessed with calculation of estimated glomerular filtration rate (eGFR) as a measure of the overall renal function in addition to the standard radiological assessment tools. A modified Clavien scale was followed for grading of complications. After a median of 121.3 months, the final continence rate was 91.1%. Maintained upper tract status was in almost 96.6% of cases and stricture of ureterointestinal anastomosis (UIA) was diagnosed in 3 renal units, and ureteral reflux was diagnosed in 24 renal units. Biochemical kidney function profile showed mean percent reduction of total eGFR to be 14.2%, and 3 patients had ≥50% reduction of total eGFR. On the Clavien scale, low-grade complications (GI-II) occurred in 30 patients (33%) and high-grade complications (≥GIII) occurred in 36 patients (40%). Stoma complications were the most frequent complications. At last follow-up, 42 patients (47%) were free of complications. The serous-lined extramural valve is an efficient technique for maintaining unidirectional flow. Over a decade, good functional outcome of the cutaneous reservoir has been evident. However, with a clear definition of continence and objective assessment of the outcome, at least one third of patients will have high-grade complications, with excellent reintervention outcome maintaining efficacy of the technique.