title: Feasibility and outcomes of ureteroureterostomy and extravesical ureteroneocystostomy as part of radical surgery for infiltrating gynecologic disease.
abstract: OBJECTIVE
  Abdominopelvic infiltrative disease may require aggressive surgical procedures. This study reports on our experience with distal ureterectomy, ureteroureterostomy, and extravesical ureteroneocystostomy as part of radical surgery for infiltrating gynecologic disease.
  
  
  METHODS
  Twenty-one women required surgery to the distal ureter at the Queensland Centre for Gynecological Cancer, Australia, from January 2006 to September 2012. Details of the patient's history, operation record, inpatient notes, and follow-up data were obtained through chart review.
  
  
  RESULTS
  Patients' median age was 57.8 ± 14.7 years (range, 30-80 years). Seventeen patients had gynecologic cancer. Mean operating time was 3.9 ± 0.9 hours (range, 2.5-5.5 hours). Restoration of continuity was achieved through extravesical ureteroneocystostomy and ureteroureterostomy in 18 and 3 patients, respectively. Boari flap was used in 3 patients, and psoas hitch was the technique chosen in 11 patients. Urinary tract infection was the most common clinical adverse event. Albeit clinically irrelevant, 38% of the patients showed structural renal tract changes postoperatively.
  
  
  CONCLUSIONS
  To achieve maximal surgical radicalness, resection of the distal ureter with subsequent ureteroureterostomy or extravesical ureteroneocystostomy is feasible and safe. Radical surgery to the urinary tract should be considered as a legitimate part of a gynecologic oncologist's surgical armamentarium to increase a patient's probability of survival and its positive effect on kidney function.
authors.affiliation: Queensland Centre for Gynaecological Cancer, Royal Brisbane & Women's Hospital, Herston, QLD 4029, Brisbane, Australia. hackvalley@me.com
authors.forename: Andreas
authors.initials: A
authors.lastname: Hackethal
authors.forename: Donal J
authors.initials: DJ
authors.lastname: Brennan
authors.forename: Russell
authors.initials: R
authors.lastname: Land
authors.forename: Marcelo
authors.initials: M
authors.lastname: Nascimento
authors.forename: James
authors.initials: J
authors.lastname: Nicklin
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermair
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001315:Australia; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000150:complications / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D013524:Surgical Flaps; D014513:Ureter / Q000601:surgery*; D014519:Ureterostomy; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*