Background: Ileal ureter replacement is a selective technique for ureteral reconstruction without being limited by the defect length. This study aim to present the techniques, experiences, and outcomes related to ileal ureter replacement among patients in a multicenter in China.
Methods: A multicenter retrospective study of patients with long ureteral defects who underwent ileal ureter replacement was conducted from January 2010 to January 2015. Patient characteristics, indications for surgery, intraoperative variables, surgical complications, and postoperative outcomes were reviewed. Follow-ups, including clinical evaluation, serum creatinine, electrolyte level, urine routine test, and radiographic examination were performed.
Results: A total of 23 patients in 7 tertiary care centers underwent ileal ureter replacement. Specifically, 20 underwent unilateral ileal ureter replacement, 2 received combined ileal-ureter substitution and Boari flap-psoas hitch, and 1 had bilateral ileal ureter replacement. The main indication for surgical intervention was presence of iatrogenic injuries (n=15), the majority of which resulted from a urologic surgical procedure (n=11). Median follow-up time was 45 months. Six early complications (grade 2) and 6 late complications occurred postoperatively. Small bowel-related complication occurred in only 1 patient with incomplete ileus, which was resolved by conservative treatment. Renal function improved or remained stable in 22 patients (95.7%). Metabolic acidosis was detected in only 1 patient who underwent bilateral ureteral replacement.
Conclusions: Ileal ureter replacement remains feasible and safe for the treatment of long ureteral defects. Technical considerations described in the study may ease and reduce complications following the procedure.
