Further experience with the modified ileal ureter.
A total of 50 patients for whom an ileal ureter was indicated was prospectively randomized between 2 treatment groups according to the surgical technique used. In group 1 the standard ileal ureter procedure was performed, while in group 2 a tailored and valved (modified) ileal ureter was fashioned. Of the patients 19 in group 1 and 23 in group 2 were available for followup of 69 +/- 5.8 months (range 60 to 80). Among the 23 patients in group 2, 5 (22%) experienced reflux due to dessusception of the nipple valve and 4 (17%) had bladder stones. Metabolic acidosis was observed in 9 patients in group 1 (47%) and 4 in group 2 (17%). Urinary outflow obstruction occurred in 5 patients in group 1 and 1 in group 2. Although renal function was comparable among patients in both treatment groups, comparison between patients in group 1 and those without reflux in group 2 showed better renal function in the latter group. We conclude that reflux prevention is of central importance in preservation of renal function in patients with an ileal ureter. A distal nipple valve at the ileovesical anastomosis is associated with significant problems. These observations would urge urologists to search for a more suitable procedure that provides an efficient antireflux principle with minimal adverse sequelae.
Shokeir
A A
AA
Urology and Nephrology Center, Mansoura University, Egypt.
Ghoneim
M A
MA
D000138:Acidosis / Q000209:etiology; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001437:Bacteriuria / Q000382:microbiology; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000652:urine; D012964:Sodium / Q000097:blood; D014513:Ureter / Q000601:surgery; D014515:Ureteral Diseases / Q000209:etiology / Q000601:surgery*; D001744:Urinary Bladder Calculi / Q000209:etiology; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D016055:Urinary Retention / Q000209:etiology
D012964:Sodium; D003404:Creatinine; D011188:Potassium