A direct uretero-enteroanastomosis: a return to the past?

Abstract

The authors analyse their experience with ureter implantations into
a small intestinal retaining reservoir - both direct and antireflux.
From 1994 to 2004 orthotopic replacement of the urinary bladder
(UB) with an ileal segment was performed in 62 patients (59 males,
3 females) for UB cancer (n = 55), microcystis (posttraumatic, radiation-induced,
tuberculous)(n = 7). Orthotopic replacement of the
UB was made according to VIP (vesica ileale Padovano) technique
with creation of antireflux uretero-enteroanastomoses by Le Due
(group 1, 43 patients, 82 anastomoses) and Hautmann technique in
modification of Lippert-Theodorescu (group 2, 14 patients, 28 direct
uretero-enteroanastomoses). A direct uretero-enteroanastomosis was
performed by Nesbit and Bricker technique. Five patients were withdrawn
from the final analysis: 3 of them died early after the surgery
because of complications, 2 patients died due to progression within
3 and 4 months after the operation. A total length of the ileac segment
used for UB repair in both groups was 60 cm. Upper urinary tracts
(UUT) and kidneys after the operation were assessed by the results
of ultrasonic investigation of the caliceropelvic system, kidneys, UB,
residual urine, serum creatinine, excretory urography, spiral CT (on
demand), etc., after recovery of miction (3-4 weeks after operation),
3 and 6 (-(-cystography) after the operation, 12 months after the operation
and annually. Comparison of the results of direct and antireflux
anastomoses suggests a conclusion that a high rate of strictures
due to antireflux anastomoses provoking UUT and renal dysfunction
makes their benefit doubtful. Antireflux bypass ureteral surgery with
neocystis of low pressure seems unjustified. In creation of capable
uroreservoir of low pressure a direct implantation of the ureter into
it is simple to do and less risky in respect to development of anastomotic
stricture and damage to the renal function