Transureteroureterostomy allows renal sparing radical resection of advanced malignancies with rectosigmoid invasion.
BACKGROUND
In case of advanced colorectal cancer or other malignancies with pelvic involvement, tumor invasion of the ureter may afford partial ureteral resection for curative multivisceral resection. One preferable approach for the primary reconstruction of the urinary tract to preserve the ipsilateral kidney and maintain normal urinary function is transureteroureterostomy, i.e. termino-lateral anastomosis of both ureters.


METHODS
Between June 2001 and August 2004, 15 multivisceral en bloc resections including a distal tumor-infiltrated ureteral segment were performed. Reconstruction was achieved by transureteroureterostomy with or without additional insertion of double J stents. Clinical outcome and especially complications of the urinary tract were monitored within the follow-up-period until August 2005.


RESULTS
Post-operative course was uncomplicated in 12 cases and double J stents were removed after ultrasound control on the 14th post-operative day. Percutaneous nephrostomy was post-operatively necessary in three patients who were initially operated without insertion of double J catheters: two suffered from leakage of the transureteroureterostomy and one patient had bilateral hydronephrosis due to stenosis of the transureteroureterostomy. After 6 weeks, percutaneous nephrostomy could be removed and urine flow was uncomplicated in all three patients.


CONCLUSIONS
For patients with advanced colorectal cancer or other pelvic malignancy, transureteroureterostomy is a favourable technique for definitive reconstruction of the urinary tract whenever tumor resection affords partial ureteral resection. Intra-operative insertion of double J stents into both ureters is highly recommended to prevent leakage or stenosis of the anastomosis.
Richter
Sven
S
Clinic of General, Visceral, Vascular and Pediatric Surgery, University Hospital of the Saarland, 66421, Homburg/Saar, Germany.
Kollmar
Otto
O
Lindemann
Werner
W
Schilling
Martin K
MK
D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012811:Sigmoid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D014567:Urography; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*