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Barbieri CE , Schwartz MJ , Boorjian SA , Lee MM , Scherr DS
Ureteroileal Anastomosis With Intraluminal Visualization: Technique and Outcomes
Urology. 2010 Dec;76(6) :1496-1500
PMID: ISI:000284940400062   
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Abstract
OBJECTIVES Although the ileal conduit is the most well-established urinary diversion, the optimal technique for ureteroileal anastomosis remains controversial. Here, we present a technique for anastomosis of the ureters from within the lumen of the ileal conduit, under direct visualization. We examine the rate of ureteral stricture using this method, and review the literature regarding ureteroenteric anastomotic complications with various techniques. METHODS An intraluminal technique for ureteroenteric anastomsosis was performed by opening the conduit on the antimesenteric border to allow direct visualization of the ureteroileal anastomosis. Using our prospectively collected database, we investigated the prevalence of anastomotic stricture in patients undergoing urinary diversion using this method for anastomosis. RESULTS One-hundred eighteen patients underwent ileal conduit diversion with ureteroileal anastomoses performed as described. Median postoperative follow-up was 15 months. Ureteral strictures were identified in 5/118 patients (4.2%). Of the patients with strictures, one was successfully treated with endoscopic balloon dilatation, three were managed with chronic ureteral stents, and one was managed with a chronic percutaneous nephrostomy. Review of the recent literature reveals stricture rates up to 10% with current techniques. CONCLUSIONS We conclude from these results that during ileal conduit creation, intraluminal anastomosis of the ureters to the ileal segment under direct vision represents a viable alternative to other techniques, with complication rates that compare favorably with other reported series. UROLOGY 76: 1496-1500, 2010. (C) 2010 Elsevier Inc.
Notes
Barbieri, Christopher E. Schwartz, Michael J. Boorjian, Stephen A. Lee, Ming-Ming Scherr, Douglas S. 23 Elsevier science inc; 360 park ave south, new york, ny 10010-1710 usa 689pm