Résumé
Objective We summarized the clinical experience of modified ileal ureter substitution for treating long segment ureteral defection.Methods We retrospectively analyze the clinical data of 2 patients with long segment ureteral defect who treated with Yang-Monti ileal ureter substitution between March 2015 and November 2015.One 75 years old male patient was diagnosed as upper ureteral malignance and solitary kidney.The length of defection from renal pelvis to bladder was 22 em.His serum creatinine was 100 μmol/L,blood urea nitrogen was 5.7 mmol/L,serum chloride was 98 mmol/L.Another one 41 years old female patient was diagnosed as middle and lower ureteral iatrogenic injury.The traumatic length was 15 cm.Her serum creatinine was 70 μmol/L,blood urea nitrogen was 5.1 mmol/L,serum chloride was 100 mmol/L.they were both treated by Yang-Monti ileal ureter substitution.The ileal intestinal segment was used for the ureteral replacement,which were more than 15 cm to the ilealcecum.The length of intestine was 10.0 cm and 7.5 cm,respectively.The ileal mesentery was preserved.After closing the mesangial hiatus,the ileal segment was pull into the retroperitoneal space and pulling out via descending colonic mesangial window.The ileal segment was divided into three parts,which was 2.5 to 3.0 cm in each part.Each part was opened via long axis and then rotated 90 degree.The 4-0 absorable suture was used to suture the edge of each intestinal part continuously.The sutured intestine was re-tubularized,using 4-0 absorable suture and the F16 catheter was used as the tube model.The length of reconstructed ureter was 22 cm and 18 cm,respectively.The neo-ureter was re-anastomosed with renal pelvis and bladder wall.Two F6 double J stents were placed in the neo-ureter.Results The operative time was 160 min and blood loss was 200 ml in the first case.In the second case,the operative time was 180 min and blood loss was 220 ml.No significant complications were noticed intra-operation and post-operation.Six months after operation,the male patient's serum creatinine was 112 pmol/L,blood urea nitrogen was 6.1 mmol/L,serum chloride was 106.0 mmol/L and electrolytes were normal.In another patient,serum creatinine was 79 μmol/L,blood urea nitrogen was 5.9 mmol/L and serum chloride was 103.0 mmol/L.The GFR was 24.9 ml/min and 22.1 m]/min 3 and 6 months after operation,respectively.Ureteral obstruction wasn't detected on IVU images 3 months after operation.Conclusions For patient with long ureteral defect,which cannot be replaced by other urinary tissue,YangMonti ileal ureter substitution is one of the optional modalities.As a new technique of ureteral substitution,Yang-Monti ileal ureter substitution is simple and fewer complications and can improve the quality of life in patient compared with traditional ureteral substitution.
Résumé
Under the specific circumstances the appendix may be an appropriate organ for plastic repair of a large ureteral defect. We report a case of antireflux surgery using an appendiceal pedicle graft in recurrent right vesicoureteral reflux after augmentation gastrocystoplasty and uretera1 reimplantation. This graft was successfully replaced the right lower ureter to repair long defect caused by postoperative adhesion and follow up urogram showed disappearance of reflux and improvement of hydronephrosis at three months postoperatively.