An Alternative Technique for Treating Complex Ureteral Strictures and Defects using A Peritoneal Graft by Trenti Emanuela in BJSTR
Abstract
Purpose: To describe a new technique of ureteral reconstruction using a free peritoneal graft.
Methods: Between 2006 and 2015 we identified 8 patients with
complex ureteral strictures involving in 7 cases the middle ureter.
Stricture length ranged from 4 to 12 cm. Two cases were secondary to
long strictures from retroperitoneal fibrosis after vascular surgical, 3
cases followed an extensive resection, required for large intraureteral
masses, 2 cases were secondary to repeated endoscopic procedures for
urinary stones and 1 case followed repeated pyeloplastics. After
ureteral incision a free peritoneal graft was harvested from nearby
healthy
peritoneum. An onlay patch was fixed with running suture to the
remaining ureteral plate after placement of an ureteral catheter. The
ureter
was wrapped with omentum.
Results: Follow-up has ranged from 14 to 76 months. Five
patients were free from recurrence after 6, 30, 36, 54 and 60 months,
showing
good passage of the contrast without dilatation of the upper urinary
tract on the uro-CT/urography. In 2 patients occurred a recurrence below
the reconstructed ureter after 6 and 60 months without symptoms and with
mild hydronephrosis. The last patient showed asymptomatic
obstruction of the reconstructed segment with hydronephrosis of the
upper pole system 6 months after the procedure. The limitation of this
study is the small sample series, due to the selective indications.
Conclusion: This technique allows for preservation of any remaining vascular supply of the ureter and can be a feasible and use full
alternative to nephrectomy, ileal ureter and autotransplantation in highly selected cases.
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