Aim: To present the technical features and results of intestinal and appendicular ureteral replacement.
Material and methods: From 1998 to 2020, a total of 196 patients aged 18 to 77 years (mean age 49.5 +/- 1.2 years) were undergone to intestinal and appendicular ureteral reconstruction in our clinic. There were 123 women (62.8%). The most frequent indications for surgery were complications of open and endoscopic ureteral procedures, radiation-induced ureteral stricture, and iatrogenic injuries of the ureters during gynecological and surgical interventions (81.6%). In 165 (84.2%) patients, for ureteral replacement the ileal segment was used, while in 4 (2.0%) and 27 (13.8%) cases the colon segment and the appendix were chosen, respectively. Unilateral ileal ureteral replacement was performed in 131 (79.4%) cases, while in 34 (26.6%) patients a bilateral procedure was done. Partial and complete ureteral replacement was performed in 107 (81.7%) and 24 (18.3%) cases, respectively. Laparoscopic intestinal and appendicular ureteral replacement was performed in 44 (22.4%) patients, while two patients were undergone to robot-assisted procedure (1.0%).
Results: Early postoperative complications were noted in 17 (8.7%) cases. The most severe included acute bowel obstruction, leakage of entero-ureteral anastomoses, necrosis of the ileal graft and bleeding in 10 (5.1%) patients. In all cases, repeat intervention was performed. There were no lethal complications. Late postoperative complications developed in 24 (14.3%) patients.
Conclusion: Today our clinic has the worlds largest experience in intestinal and appendicular ureteral reconstruction, including original procedures, confirmed by 5 patents for inventions. The minimum number of postoperative complications, the absence of deaths and good long-term results provide the basis for the introduction of ileal and appendicular ureteral replacement into clinical practice.
Keywords: ileal graft; intestinal and appendicular ureteral replacement; ureteral substitution.