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Results of the ureteral reimplantation with serous‐lined extramural tunnel in orthotopic ileal W‐neobladder
Author(s) -
TÜRKÖLMEZ KADIR,
BALTACI SÜMER,
GÖǦÜŞ ÇAǦATAY,
BEDÜK YAŞAR,
GÖǦÜŞ ORHAN
Publication year - 2004
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.2004.00807.x
Subject(s) - medicine , serous fluid , urology , replantation , surgery
Background: Our experience in uretero‐ileal anastomosis using the serous‐lined extramural tunnel in orthotopic ileal W‐neobladder is presented. Methods: Between June 1998 and November 2001, 42 patients (40 men and two women) underwent radical cystectomy and orthotopic ileal neobladder for invasive bladder cancer. The ureters were reimplanted into serous‐lined extramural tunnels as described by Abol‐Enein and Ghoneim. However, we made minor modifications during the ureteral reimplantation in cases that necessitated distal ureteral excision and with grossly dilated ureters. Evaluation included clinical and radiographic studies to determine functional and oncological outcomes. Results: There was no operative mortality. The mean follow‐up period was 28 months (range 12–52). Early complications occurred in four patients (9.5%). An endarterectomy for acute popliteal arterial embolism, the excision of the pouchointestinal fistula and a temporary colostomy were performed in two of these four patients. The other two patients were treated conservatively. Late complications occurred in eight patients (19%). Reflux was observed in three renal units (3.7%), ureterointestinal strictures in another three renal units (3.7%) and urethroileal stenosis in two patients (4.8%). In all cases, stabilization or improvement of renal function was achieved. No metabolic complications were observed. Conclusions: Ileal W‐neobladder with a serous‐lined extramural tunnel is a safe, reliable form of lower urinary tract reconstruction. The method can be carried out with equal ease in grossly dilated ureters and in cases that necessitate distal ureteral excision.