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Comparative Study
. 2024 Jun 10;24(1):118.
doi: 10.1186/s12894-024-01509-5.

Minimally invasive versus open ileal ureter with ileocystoplasty: comparative outcomes and 5-year experience

Silu Chen #  1 , Xiang Wang #  1 , Zhihua Li #  1 , Xinfei Li  1 , Guanpeng Han  1 , Zihao Tao  1 , Zhenyu Li  1 , Peng Zhang  2 , Hongjian Zhu  3 , Kunlin Yang  4 , Xuesong Li  5
Affiliations
Comparative Study

Minimally invasive versus open ileal ureter with ileocystoplasty: comparative outcomes and 5-year experience

Silu Chen et al. BMC Urol. .

Abstract

Purpose: To present the experience of ileal ureter with ileocystoplasty (IUC), and compare the outcomes of IUC in minimally invasive procedures to open procedures.

Patients and methods: From December 2017 to April 2023, twenty patients underwent IUC in open or minimally invasive (including laparoscopic and robotic) procedures. The baseline characteristics, perioperative data and follow-up outcomes were collected. Success was defined as relief of clinical symptoms, stable postoperative serum creatine and absence of radiographic obstruction. The perioperative and follow-up outcomes of open procedures and minimally invasive procedures were compared.

Results: The etiology included pelvic irradiation (14/20), urinary tuberculosis (3/20) and surgical injury (3/20). Bilateral ureter strictures were repaired in 15 cases. The surgeries conducted consisted of open procedures in 9 patients and minimally invasive procedures in 11 patients. Compared to open procedures, minimally invasive surgeries had less median estimated blood loss (EBL) (100 ml vs. 300 min, p = 0.010) and shorter postoperative hospitalization (27 d vs. 13 d, p = 0.004). Two patients in the open group experienced grade 3 complications (sigmoid fistula and acute cholecystitis in one patient, and pulmonary embolism in another patient). Over a median follow-up period of 20.1 months, the median bladder functional capacity was 300 ml, with a 100% success rate of IUC.

Conclusion: IUC is feasible in both open and minimally invasive procedures, with acceptable complications and a high success rate. Minimally invasive procedures can have less EBL and shorter postoperative hospitalization than open procedure. However, prospective studies with larger groups and longer follow-up are needed.

Keywords: Ileal ureter replacement; Ileocystoplasty; Minimally invasive surgery; Ureteral stricture with bladder contracture.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Surgical technique of ileal ureter with ileocystoplasty. (A) Ureteral localization. (B) Detubularization of the distal-most 15-cm ileum. C-D. Construction of a U-shaped augmentation pouch. E. End-to-end ileoureteral anastomosis. F. Contralateral end-to-side ileoureteral anastomosis for bilateral ileal ureter replacement. G. V-like shape cystotomy. H-I. Ileovesical anastomosis
Fig. 2
Fig. 2
The construction of U-shaped ileocystoplasty pouch. A. Detubularization for 15 cm at distal ileal segment. B-C. Fold of the distal ileal segment with the two neighboring edges suture together D.Ileovesical anastomosis
Fig. 3
Fig. 3
Postoperative radiographic examination during follow-up. (A) Postoperative three-dimensional CTU (B) Functional cine MRU
See this image and copyright information in PMC

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