Extravesical ureteral reimplantation in stricture lower end ureter

ABSTRACT

Ureteral stricture is a problem that always has confronted the surgeons. Traditionally, stricture occurs most often in the ureter injured at operation and repair of the stricture has been accomplished by open surgical management. The aim of the work was to evaluate the extravesical ureteral reimplantation in stricture lower end ureter. The study was carried out on 11 patients [8 males and 3 females] with stricture lower end ureter, selected from Al-Azhar University Hospital [New Damietta] between April 2005 to April 2007. All cases were submitted to full history taking, clinical examination and laboratory investigations [urine analysis, blood urea and serum creatinine]. Imaging studies in the form of abdominopelvic ultrasound and excretory urography both pre and postoperatively. In addition to ascending cystography postoperatively at 3, 9 and 18 months. Post operative follow up by Ultrasound revealed improvement in 8 patients out of 10 with pervious moderate hydronephrosis while 2 patients show stabilization. In one patient with severe hydronephrosis shows stabilization without further deterioration. Using excretory urography followup, 6 patients of grade II hydronephrosis and 4 patients of grade III hydronephrosis showed improvement while in one patient with grade IV hydronephrosis remained stabilized. Hospital stay ranged from 5 to 6 days. The results of the present study demonstrated that extravesical ureteral reimplantation is a reliable procedure with a low complication rate, and we have found that this approach is applicable to many different situations but is especially advantageous for ureteral tailoring and the vesical psoas hitch since retrovesical exposure is excellent