Ces Urol 2005, 9(1):26-30 | DOI: 10.48095/cccu2005005

Treatment of long and multiple ureteral strictures by their ileal substitution without an antireflux anastomosis

M. Urban¹, R. Zachoval¹, M. Záleský¹, P. Palascak²

¹ Urologická klinika 3. LF UK a FNKV, Praha, přednosta doc. MUDr. Michael Urban

² urologické oddělení, Centre Hospitaller de Paul-Morel, Vesoul, Francie

The purpose of this work was to evaluate the treatment of long and multiple ureteral strictures by their ileal substitution without an antireflux anastomosis and to cast light on some controversies concerning this method.
Twenty patients with average age 58 years (32 to 76 years) have undergone a partial or complete ureteral substitution by ileum with a simple anastomosis to the urinary bladder. The procedure was bilateral in six cases. In 18 cases the substitutions were primary treatment of the stricture. The follow-up period lasted from 10 to 78 (mean 41) months.
In five patients the preoperative renal insufficiency improved after the surgery, in 14 patients without preoperative renal insufficiency the renal functions remained stable and in one patient undergoing permanent dialysis residual urine output was maintained. According to IVP and renal scintigraphy 15 patients (75%) show no signs of obstruction after the surgery. In 5 patients (25%) a postoperative obstruction developed. It was ureteroileal sticture in 3 cases and ileovesical stricture in 2 cases. The stricture was successfully handled by endoscopic incision or reimplantation of the ileum. Two patients with moderate renal insufficiency showed postoperative mild hyper-chloremic acidosis. In nine patients there is an asymptomatic vesicoureteral reflux into the distal part of the ileum without any influence on renal and metabolic functions. The urinary infection occurred in 40% both before and after the operation. The patients with preoperative nosocomi-al infection tend to develop a stricture in the anastomosis. The quality of life after the surgery was ranked high by all the patients and compared with the preoperative urinary derivation, especially by means of nephrostomy, it became much better.
The treatment of long and multiple ureteral strictures by ileal substitution is, when indicated correctly, a method that protects renal functions, has low morbidity and renders a good quality of life.

Keywords: ureteral substitution, ileum, long and multiple strictures

Published: January 1, 2005