Long-Term Outcome of Ileal Ureteric Replacement with an Iliopsoas Muscle Tunnel Antirefluxing Technique for the Treatment of Long-Segment Ureteric Strictures

OBJECTIVE - To investigate the long-term outcome of ileal ureteric replacement using a proximal antirefluxing technique for the treatment of long-segment ureteric strictures.

PATIENTS AND METHODS - Between January 1997 and December 2013, 41 patients with a long ureteral stricture or defect and the 3 patients with unilateral mid-lower ureteral cancer (20 bilateral and 24 unilateral, 28 male and 16 female) were treated by ureteral substitution using a proximal antirefluxing technique.

The distal part of the upper ureter (4 cm) was fixed between the psoas muscle and the ileal segment (the iliopsoas tunnel technique). The distal ileum was connected to the urinary bladder with an end-to-side anastomosis. A successful outcome was defined as the absence of major complications, worsening baseline renal function, metabolic derangements or obstruction.

RESULTS - One patient with unilateral mid-lower ureteral cancer died 3 years postoperatively because of metastasis, and the remaining 43 patients were followed for 12-180 months (mean 69 months). Intravenous urography showed that the hydronephrosis improved significantly or disappeared after 6 to 12 months in 34 patients, with improvement in nine patients. Cystography showed no evidence of ileoureteral reflux. Seven patients needed long-term oral alkalization to prevent hyperchloremic acidosis.

CONCLUSIONS - In our experience, outcomes following subtotal ureteric replacement are encouraging. The ileal ureter replacement by the proximal antirefluxing technique appears to be a reliable procedure for treating long-segment ureteral stricture and preservation of renal function.

Urology. 2015 Nov 11 [Epub ahead of print]

Yue-Min Xu, Chao Feng, Haruaki Kato, Hong Xie, Xin-Ru Zhang

Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China. Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China. , Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan. , Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China. , Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China.

PubMed