Direct (nontunneled) ureterocolonic reimplantation in association with continent reservoirs.
A total of 190 patients underwent continent urinary diversion using the Florida pouch. Direct mucosa-to-mucosa ureterocolonic reimplantation was used in 165 patients (326 ureters). Of the first 30 ureters in patients who underwent antireflux tunneled reimplantation obstruction occurred in 4 (13.3%). Obstruction developed directly in 16 of the ureters reimplanted (4.9%), and 3 of the 6 plicated and reimplanted megaureters (50%). Among the obstructed units 3 (13%) were treated unexpectedly by autonephrectomy, while the other 20 units (87%) were treated with percutaneous balloon dilation and internal stenting for 6 to 8 weeks. In the latter group 12 units (60%) recovered function, 3 (15%) had pyelonephritis requiring nephrectomy and 5 (25%) stabilized following a new reimplantation. Reflux was demonstrated in 23 units (7%). All units with reflux are being followed conservatively and renal deterioration has not been demonstrated. The incidence of ureteral obstruction with direct reimplantation is lower compared to a tunneled technique. This reimplantation procedure is technically simpler than others and is safe in adults when performed in association with a large volume, continent colonic reservoir.
Helal
M
M
Department of Surgery, University of South Florida Health Sciences Center, H. Lee Moffitt Cancer and Research Institute, Tampa.
Pow-Sang
J
J
Sanford
E
E
Figueroa
E
E
Lockhart
J
J
D003106:Colon / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D014517:Ureteral Obstruction / Q000453:epidemiology / Q000209:etiology; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects / Q000379:methods*