Upper urinary tract dilation due to conglutination of intraluminal distal ureters after orthotopic neobladder with split-cuff nipple ureteral reimplants: early results of 8 cases.
OBJECTIVE
We reviewed our experience with dilation of the upper urinary tract caused by the conglutination of distal ureters after orthotopic neobladder reconstruction using the split-cuff nipple ureteral reimplant technique.


METHODS
From January 2000 to April 2007, 250 consecutive patients underwent radical cystectomy and orthotopic neobladder reconstruction. Ureterointestinal anastomosis was performed using the split-cuff nipple technique in 291 renoureteral units. The patients from a single center were followed up for a mean period of 8 months (range 1-22) after surgery. We incised the conglutination band using a transurethral endoscope. Patient characteristics, endoscopic technique, measurement of serum creatinine levels, and results of ultrasonography, cystoscopy, and excretory urography were collected.


RESULTS
Hydronephrosis was found in 8 patients (14 renoureteral units) due to the conglutination of the distal ureters to each other (n = 6) or to the neobladder wall (n = 2). After the incision procedure, seven patients had obvious improvement in renal function and hydronephrosis, and their symptoms disappeared. In 1 patient, hydronephrosis developed again because of ureteroenteric stenosis after 7 months and was resolved by open surgical revision. The hydronephrosis had improved greatly in this patient by 5 months after revision.


CONCLUSIONS
Conglutination of the distal ureters is a cause of hydronephrosis after orthotopic neobladder reconstruction using the reimplant technique with the split-cuff nipple. Cystoscopy is mandatory in following up patients who have hydronephrosis with the split-cuff nipple ureteral reimplant technique, not only to confirm the diagnosis but to treat the complication by incising the conglutination band. Continued follow-up is required to evaluate the long-term results of this treatment.
Department of Urology, Cancer Center, Sun Yat-Sen University, Guangzhou, PR China.
Kai
K
Yao
Guo-Liang
GL
Hou
Zhuo-Wei
ZW
Liu
Shao-Long
SL
Yu
Yong-Hong
YH
Li
Fang-jian
FJ
Zhou
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D012809:Colon, Sigmoid / Q000601:surgery; D015653:Cystectomy; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology* / Q000601:surgery*; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012092:Replantation / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects