Lower ureteral replacement using a tubularized gastric segment.
OBJECTIVE
To review our early experience with the use of a gastric segment for lower ureteral replacement in patients with bilateral ureteral stenosis after pelvic radiotherapy.


METHODS
Four adult patients (three women and one man) underwent bilateral ureteral substitution using stomach. All patients received whole pelvic irradiation for malignant disease and had undergone bilateral nephrostomy because of severe bilateral ureteral stenosis. The postoperative follow-up period was 11 to 50 months.


RESULTS
No major complication was recognized, and the bilateral nephrostomy tubes were removed in all patients. Three female patients could void urethrally without incontinence, and the male patient needed regular self-catheterization. The three women were alive with normal renal function at a follow-up of 11 to 50 months. The man had a vesicorectal fistula 8 months postoperatively, and colostomy was performed. He died of a cause unrelated to the operation 11 months after surgery.


CONCLUSIONS
Stomach has not been used commonly for ureteral replacement. In patients with bilateral severe ureteral stenosis after pelvic radiotherapy, ureteral substitution with a gastric segment can be safely performed and will increase the patient's quality of life.
Muraishi
O
O
Department of Urology, Jichi Medical School, Tochigi, Japan.
Yashi
M
M
Shioji
Y
Y
Suzuki
K
K
Sugaya
Y
Y
Tokue
A
A
D000368:Aged; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000150:complications / Q000601:surgery*; D013270:Stomach / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000379:methods; D014515:Ureteral Diseases / Q000209:etiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods