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. 2013 May 26:2013:725286.
doi: 10.1155/2013/725286. Print 2013.

Dipping technique for ureteroileal anastomosis in orthotopic ileal neobladder: 20-year experience in 670 patients-no stenosis with preservation of the upper tract

Mohamed M Wishahi  1 , Hosam Elganzoury, Amr Elkhouly, Ahmed Mehena
Affiliations

Dipping technique for ureteroileal anastomosis in orthotopic ileal neobladder: 20-year experience in 670 patients-no stenosis with preservation of the upper tract

Mohamed M Wishahi et al. ISRN Urol. .

Abstract

Objectives. Many techniques were described for ureteroileal anastomosis in orthotopic bladder substitution, ranging from nonrefluxing to refluxing techniques, all aiming at preservation of the upper tract. We describe our technique of dipping the ureter into the ileal pouch, which is simple and had no complications. Patients and Methods. Our technique implies dipping the ureter in the lateral side of the pouch, in right and left corners, with two rows of four sutures fixing the seromuscular layer of the ureter to the seromuscular layer of the ileal pouch. The procedure was applied in both normal ureteric calibre and dilated ureter. Total number of procedures done was 1,340 ureters in 670 patients after radical cystectomy for invasive carcinoma of the bladder of urothelial and nonurothelial cancer. Results. Followup of patients every six months and onward did not show stenosis in the ureteroileal anastomotic site. Filling of the ureter with contrast dye on ascending pouchogram was observed in patients who had considerably dilated ureters at the time of cystectomy. Normal ureter did not show clinical reflux but radiological filling of the ureter when the intravesical pressure exceeded the leak point pressure. Time to perform the dipping technique was 5-7 minutes for each site. Conclusion. Dipping technique for ureteroileal anastomosis in orthotopic ileal neobladder avoids the incidence of stenosis, preserves the upper tract, is a fast procedure, stands the evaluation in long-term followup, and was practiced successfully for twenty years.

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Figures

Figure 1
Figure 1
Dipping technique: construction of the detubularized ileal pouch U-form with complete closure apart from the site of urethral anastomosis, two holes being made in the lateral sided of the pouch to receive the two ureters.
Figure 2
Figure 2
Dipping technique: the ureter passed the pouch hiatus, and the drainage ureteric stent passes out of the pouch from a separate stab opening.
Figure 3
Figure 3
Dipping technique: the anchoring of the ureter to the ileal wall of the ileal pouch with two rows of sutures.
Figure 4
Figure 4
Dipping technique. the final pouch anastomosis to the urethra, pouch; and kidney drainage achieved with balloon uretheral catheter refixed with Harris stitch, suprapubic tube, and two drainage ureteric stents.
Figure 5
Figure 5
Five years postoperative urogram showing perfect upper tract with no stenosis, preservation of the kidneys, and normal caliber of the ureters.
See this image and copyright information in PMC

References

    1. Le duc A, Camey M, Teillac P. Antireflux uretero-ileal implantation via a mucosal sulcus. Annales d’Urologie. 1987;21(1):33–34. - PubMed
    1. Elmajjan DA, Stein JP, Esring D. The Koch ileal neobladder. Updated experience in 295 male patients. Journal of Urology. 1996;157:920–925. - PubMed
    1. Studer UE, Casanova GA, Ackerman DK. Ileal bladder substitute: antireflux nipple or afferent tubular segment? European Urology. 1990;143:398–395. - PubMed
    1. Studer UE, Danuser H, Hochreiter W, Springer JP, Turner WH, Zingg EJ. Summary of 10 years’ experience with an ileal low-pressure bladder substitute combined with an afferent tubular isoperistaltic segment. World Journal of Urology. 1996;14(1):29–39. - PubMed
    1. Abol-Enein H, Ghoneim MA. Further clinical experience with the ileal W-neobladder and a serous-lined extramural tunnel for orthotopic substitution. British Journal of Urology. 1995;76(5):558–564. - PubMed

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