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Introduction. The frequency of involvement of the ureters in case of pelvis tumors ranges from 15 to 20 %. It is important to determine treatment strategies for long-segment ureteral defects (LSUD) in patients with recurrent complex ureteral strictures after initial treatment. The use of the appendix as a plastic material for the reconstruction of LSUD remains controversial.
Materials and Methods. From August 2019 to June 2021 at N.N. Petrov NMRC of Oncology, nine surgeries were performed to replace ureteral defects (UD) by flap transposition of the appendix: six on the left (66.67 %), three on the right (33.3 %). seven women (77.78 %) and two men (22.2 %) were operated. Mean age was 53.8 ± 11 years. Average BMI was 24.6 kg/m2.
Results. The average diastasis was 5.4 ± 2.6 cm. The average length of the appendix was 8.4 ± 1.8 cm. In four cases (44.4%) end-to-end anastomoses were formed, and in five cases (55.6%) replacement of the ureter with an appendix and a flap of the bladder according to the Demel method was performed. Mean duration of surgery 251 ± 38.2 min, blood loss 112 ± 58.2 ml. Median time from the date of surgery until the ureteral stent removal was 36 ± 17.2 days. Average length of hospital stay was 14 ± 5 days. Median follow-up was 15 ± 6.6 months. Early complications (< 30 days): three cases of urinary edema (Clavien-Dindo II), one case of ipsilateral hydronephrosis (Clavien-Dindo I). Late complications (> 30 days): two cases of non-functioning kidney (Clavien-Dindo III-IVa), one case of reflux nephropathy (Clavien-Dindo IIIa), two cases of pyelectasis (Clavien-Dindo I).
Conclusion. Flap transposition with the appendix is a technically difficult but possible option for treating extended ureteral strictures. However, various pathologies that have developed against the background of previous treatment potentially increase the risk of recurrent anastomotic defects. Therefore, given the small cohort of patients, further research is required.
References
Li H-Z, Ma X, Qi L, et al. Retroperitoneal laparoscopic ureteroureterostomy for retrocaval ureter: report of 10 cases and literature review. Urology. 2010;76:873-6. https://doi.org/10.1016/j.urology.2009.12.056.
Komninos C, Koo KC, Rha KH. Laparoendoscopic management of midureteral strictures. Korean J. Urol. 2014;55:2-8. https://doi.org/10.4111/kju.2014.55.1.2.
Bonfig R, Gerharz EW, Riedmiller H. Ilealureteric replacement in complex reconstruction of the urinary tract. BJU Int. 2004;93:575-80. https://doi.org/10.1111/j.1464-410X.2003.04672.x.
Knight RB, Hudak SJ, Morey AF. Strategies for open reconstruction of upper ureteral strictures. Urol Clin North Am. 2013;40:351-61. https://doi.org/10.1016/j.ucl.2013.04.005.
Gild P, Kluth LA, Vetterlein MW, et al. Adult iatrogenic ureteral injury and stricture-incidence and treatment strategies. Asian J Urol. 2018;5:101-6. https://doi.org/10.1016/j.ajur.2018.02.003.
Liu P, Wu X, Zhu YZ, et al. [Ileal ureteric replacement for iatrogenic long segment ureteric injuries (In Chin.)]. Beijing Da Xue Xue Bao Yi Xue Ban. 2015;47(4):643-7.
Adams J, Djakovic N, Gilfrich Cetal. Ureteric replacement with Meckel’s diverticulum. BJU Int. 2007;99:647-50. https://doi.org/10.1111/j.1464-410X.2006.06608.x.
Melnikoff AE. Sur le remplacement de l’urettre par anse isolee de I’intestin grille. [On the replacement of the urethra by isolated loop of the small intestine (In Fren.)]. Rev Clin Urol. 1912;1:601.
Yarlagadda VK, Nix JW, Benson DG, et al. Feasibility of intracorporeal robotic-assisted laparoscopic appendiceal interposition for ureteral stricture disease: a case report. Urology. 2017;109:201-5. https://doi.org/10.1016/j.urology.2017.08.017.
Комяков Б.К., Ал-Аттар Т.Х., Гулиев Б.Г. Кишечная и аппендикулярная реконструкция мочеточников. Урология. 2021;2:14-20 [Komyakov BK, Al-Attar TKh, Guliev BG. Intestinal and appendicular ureteral substitution. Urologiia. 2021;2:14-20 (In Russ.)]. https://doi.org/10.18565/urology.2021.2.14-20.
Shen X, Xv M, Liu G, et al. Ureteral replacement with appendix in a pediatric group: a report of two cases and review of the literature. Eur J Pediatr Surg. 2012;22(4):329-31. https://doi.org/10.1055/s-0032-1313335.
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