Ileal ureter creation for long-segment ureteral injury - A surgical film.

OBJECTIVE

Demonstrate surgical steps of ileal ureter creation (IUC) for long-segment ureteral injury.

METHODS

79-year-old woman with platinum-sensitive ovarian cancer with recurrence to upper vagina who underwent secondary debulking surgery with ureteral transection due to disease involvement and subsequent placement of percutaneous nephrostomy tube. She responded well to adjuvant chemotherapy and PARP inhibitor maintenance and presented for ureteral reconstruction surgery.

RESULTS

This video demonstrates surgical technique for IUC. An isoperistaltic ileal segment is used, ensuring adequate blood supply and tension-free anastomosis. The ureter was spatulated and sutured in full-thickness fashion to a small defect created in the chosen segment of ileum. A double-J ureteral stent was placed into the renal pelvis over a guidewire and a defect was made in bladder dome for ileal ureter implantation.

CONCLUSIONS

Ileal ureter creation (IUC) was first described in 1906 by Shoemaker and later popularized by Goodwin et al in the 1950 s (Goodwin et al., 1959). IUC has been shown in large case series to have a success rate of 69 to 96 %, however is associated with 29.8 to 42.9 % 30-day postoperative complication rate (Monn et al., 2018, Armatys et al., 2009, Zhong et al., 2019). Approximately 75 % of patients have stable serum creatinine after the procedure, however caution is advised in patients with baseline renal impairment (Armatys et al., 2009). IUC can be technically challenging as it involves a larger surgical field for harvesting a segment of bowel and is typically reserved for long-segment injuries deemed not amenable to alternate surgical methods (Armatys et al., 2009). In one study, overall long-term morbidity approximated 23 % therefore careful patient selection and adequate preoperative counseling is necessary (Armatys et al., 2009).