TECHNICAL FEATURES OF INTESTINAL URETEROPLASTY. PART 6: SIMULTANEOUS URETERAL AND BLADDER SUBSTITUTION

Aim. To present the results and technical features of different methods of simultaneous ileal ureteral and bladder substitution. Materials and methods. From 2001 to 2016, 154 patients (mean age 52±9.2 years) underwent ileal and appendicular ureteroplasty. Of them, 70 (45.4%) were men and 84 (54.6%) women. Among them, 49 (31.8%) patients underwent ureteroplasty concurrently with orthotopic ileocystoplasty. The Studer’s ileal-ureter cystoplasty and Y-shaped bladder and ureteral reconstruction were performed in 38 (77.5%) and 11 (24.5%) cases, respectively. Results. Early postoperative complications occurred in 8 (16.3%) patients: 4 of them suffered recurrent bouts of pyelonephritis, 3 experienced an acute adhesive intestinal obstruction, and another one had a failure the right-sided pouch-ureteral anastomosis. Late postoperative complications occurred in 7 (14.3%) patients. Of them, 3 suffered recurrent bouts of chronic pyelonephritis, 2 developed a pouch-ureteral-pelvic reflux, and 2 had strictures of ileoureteral anastomosis, requiring antegrade dilation with ureteral stenting. Conclusion. Simultaneous ureteral and bladder substitution is one of the most challenging and traumatic surgical interventions. Sometimes, due to severe comorbidities, disorders of upper tract urodynamics and decreased renal function, two-stage surgery may be necessary. At the first stage, cystectomy with cutaneous ureterostomy should be performed, and then, after the patient’s stabilization ileal substitution of the bladder and pelvic parts of ureters may be done.

ureter stricture, ileal substitution