Introduction: Ureteral substitution with ileum and appendix remains a technique of choice in patients with extended ureteral strictures, but data about long-term results and complications of these interventions is still limited. The aim of this study is to examine the long-term efficacy and safety of these procedures on the basis of 170 ureteral substitutions with ileum and appendix.
Methods: From 2001 to 2019 170 patients underwent ureteral substitution with ileum – 144 (84.7%) and appendix - 26 (15.3%) at our clinic. 31 (19.3%) patients underwent laparoscopic reconstruction of ureter: 27 (15.9%) - with ileal segment and 4 (2.4%) – with appendix. There were 105 (61.7%) women and 65 (38.3%) men with a median age of 53.6 ± 9.3 years (range from 18 to 69 years). The main causes of ureteral strictures were: retroperitoneal fibrosis following radiation therapy, colorectal and gynecological cancer surgery. All patients underwent long-term follow-up including routine laboratory analysis and urinary tract imaging. Outpatient visits occurred at 3 and 6 months postoperatively and at least annually thereafter.
Results: The follow up period was from 3 months up to 18 years (mean 8.5±0.8 years). Postoperative complications developed in 16 (9.4%) cases. Short-term complications (less than 30 days postoperatively) occurred in 12 (7.1%) patients and included: intestinal obstruction -4 (2.4%), ileal graft mesentery thrombosis -2 (1.2%), bleeding -2 (1.2%), and acute pyelonephritis – 4 (2.4%). Late complication – stricture of uretero-ileal anastomosis developed in 4 patients (2.4%) in 3 months after operation. Thus, the complications which have required surgical treatment occurred at 12 (7.1%) patients. The results of all operations were successful. According to all patients the renal function was restored. There were no cases of metabolic acidosis.
Conclusions: Ileal and appendicular ureteral reconstruction is a safe and efficacious procedures in patients with extended and multiple ureteral strictures. During long-term follow-up major complications are rare and renal function remains good. Source of