BERKELEY, CA (UroToday Inc.) - Despite advances in surgical technology, iatrogenic ureteral injuries occur during a variety of endourologic, laparoscopic and open procedures. Extensive injuries often require multiple attempts at endourologic repair and may ultimately require more complex reconstruction. The use of ileum as a ureteral substitute to restore functional integrity of the upper urinary tract is appropriate for cases in which a ureteral defect is not amenable to reconstruction by other means.

A contemporary series of 18 ileal ureter substitutions performed in 16 patients was reported by Matlaga B.R., Shah, O.D., et al, from Wake Forest University, in the December, 2003 issue of Urology. All procedures were performed over a 6 year period. The mean age of the patient was 49.4 years and the mean follow-up was 18.6 months.

Eight patients incurred a ureteral injury in the course of an endourologic procedure for stone removal. Five patients incurred their ureteral injury after colorectal surgery for malignancy, and three of these five also received adjuvant external beam radiotherapy. Three other patients suffered ureteral strictures after failed ureteropelvic junction obstruction repair. The mean length of the ureteral stricture was 5.84cm. Nine patients had strictures of the proximal ureter, eight of the middle ureter, and one of the distal ureter.

All ileal ureter substitutions were performed in an isoperistaltic refluxing fashion, with most anastamoses being to the renal pelvis in an end-to-end fashion. Patients were followed with serum chemistry testing, nuclear renography or intravenous pyelography, urinalysis and culture when appropriate.

Analysis of results showed no significant metabolic changes occurred in any of the patients during follow-up testing. No patient showed a relative loss in renal architecture on their most recent urogram, and all renal units were unobstructed. No patient had deterioration in baseline renal function, and no patient developed any radiographic evidence of new stone activity. In addition, there were no reports of mucus-related problems or lower urinary tract symptoms. This data suggests that ileal ureter substitution is a safe and effective method for salvaging a renal unit with an extensively damaged ureter.

Urology. 2003; 62(6):998-1001