[Technical features of intestinal ureteroplasty. Part 1: left-sided ileoureteroplasty].

AIM

To examine the results of intestinal ureteroplasty and present the technical features of left-sided ileoureteroplasty.

MATERIAL AND METHODS

From 2001 to 2015, 78 patients underwent isolated substitutions of the ureter using a segment of the ileum, including 57 (73.1%) one-sided and 21 (26.9%), two-sided. One patient underwent concurrent left ileoureterocystoplasty and right appendicular ureterocystoplasty. In two observations of duplicated ureter Wallace-type ileoureterocystoplasty was carried out. In total, isolated segments of the ileum were used to substitute 101 ureters. Left and right ureters were substituted in 56 (55.4%) and 45 (44.6%) patients, respectively. In 7 (8.9%) patients laparoscopic approach was used.

RESULTS

Early postoperative complications occurred in 8 (10.2%) patients and 5 (6.4%) of them required reoperation. Long-term postoperative complications occurred in 7 (8.9%) patients and 4 required surgical treatment. These patients developed strictures of ileal-ureteral anastomosis 3 and more months after surgery. Urinary tract patency was restored by antegrade stricture dilation. All patients were found to have good results of conservative treatment and repeated operations. There were no deaths. All patients achieved restoration of urodynamics and normalization of kidney function.

CONCLUSION

Using isolated segment of the ileum allows replacing the defects of one or both ureters of any location and extent. Left-sided ileoureteroplasty is one of the most developed and simple modifications of gastrointestinal ureteral reconstructions. Isoperistaltic substitution of the left ureter is possible when the ileo-transplant is below and behind the intestinal anastomosis. The graft should be placed in isoperistaltic position and intraperitoneally, i.e. be left it in the conditions inherent in this organ.