B Ubrig1, M Waldner, S Roth. 1. Department of Adult and Pediatric Urology, University of Witten/Herdecke, Klinikum Wuppertal GmbH, Wuppertal, Germany.
Abstract
PURPOSE: We present a technique in which colon segments are reconfigured as substitutes for ureteral defects. MATERIALS AND METHODS: Via a flank incision a 3 cm. segment was obtained from the ascending or descending colon and reconfigured into a well vascularized tube. In 2 patients a single retubularized colon segment was interposed into an extensive defect of the upper and mid ureter, respectively. In an additional 2 patients 2 combined anastomosed reconfigured colon segments were used for pyelo-colo-cutaneostomy. RESULTS: At a followup of 9 to 27 months (mean 15), no complications related to the reconfigured colon segments were noted. One patient died of progressive disease 9 months postoperatively but with no evidence of ureteral substitute malfunction. CONCLUSIONS: Reconfigured colon segments may be used successfully to reconstruct extensive ureteral defects. Access is via a flank or pararectal incision and intraperitoneal surgery is minimal. The colon segments are obtained immediately proximal to the ureteral defect, necessitating little mobilization of the mesenteric pedicle. Metabolic consequences should be absent or low since only minimal amounts of intestine are isolated. In patients with renal insufficiency or a history of irradiation this technique may be superior to the use of ileum.
PURPOSE: We present a technique in which colon segments are reconfigured as substitutes for ureteral defects. MATERIALS AND METHODS: Via a flank incision a 3 cm. segment was obtained from the ascending or descending colon and reconfigured into a well vascularized tube. In 2 patients a single retubularized colon segment was interposed into an extensive defect of the upper and mid ureter, respectively. In an additional 2 patients 2 combined anastomosed reconfigured colon segments were used for pyelo-colo-cutaneostomy. RESULTS: At a followup of 9 to 27 months (mean 15), no complications related to the reconfigured colon segments were noted. One patient died of progressive disease 9 months postoperatively but with no evidence of ureteral substitute malfunction. CONCLUSIONS: Reconfigured colon segments may be used successfully to reconstruct extensive ureteral defects. Access is via a flank or pararectal incision and intraperitoneal surgery is minimal. The colon segments are obtained immediately proximal to the ureteral defect, necessitating little mobilization of the mesenteric pedicle. Metabolic consequences should be absent or low since only minimal amounts of intestine are isolated. In patients with renal insufficiency or a history of irradiation this technique may be superior to the use of ileum.