Pyeloureterostomy with interposition of the appendix.
OBJECTIVE
We describe the successful repair of a 6 cm. ureteral stricture involving the right ureteropelvic junction and proximal ureter using appendix as a ureteral substitute.


METHODS
A 37-year-old man involved in a motorcycle accident presented with a retroperitoneal urinoma and a 6 cm. proximal ureteral stricture. At flank exploration we were unable to perform successfully primary pyeloureterostomy through renal descensus with ureteral mobilization. The appendix was selected to bridge the ureteral defect. The right colon and cecum were mobilized to the area of the diseased ureter and the appendix was transected across the base of the cecum. Ureteral scar tissue was resected and the appendix was interposed in an isoperistaltic orientation from renal pelvis to proximal ureter.


RESULTS
Convalescence was unremarkable. Retrograde pyelography and flexible ureteroscopy 2 months postoperatively demonstrated a patent anastomosis and viable appendix. The ureteral stent was removed at that time. Excretory urography 3 months postoperatively revealed prompt enhancement of the 2 kidneys and visualization of the 2 ureters. Mercaptoacetyltriglycine-3 renal scan 5 months postoperatively confirmed no scintigraphic evidence of obstruction. The patient was asymptomatic 6 months postoperatively and renal function tests were normal.


CONCLUSIONS
The appendix can be considered for proximal ureteral defects extending to the right renal pelvis.
Jang
Thomas L
TL
Department of Urology, Northwestern University Medical School, Chicago, Illinois 60611, USA.
Matschke
H Merrill
HM
Rubenstein
Jonathan N
JN
Gonzalez
Chris M
CM
D000328:Adult; D001065:Appendix / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D014513:Ureter / Q000293:injuries / Q000601:surgery; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D014567:Urography; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery