Upper urinary tract dilation due to conglutination of intraluminal distal ureters after orthotopic neobladder with split-cuff nipple ureteral reimplants: Early results of 8 cases

• Published in: Urologic oncology 2009-11, Vol.27 (6), p.611-616
• Main Authors: Yao, Kai, M.D, Hou, Guo-Liang, M.D, Liu, Zhuo-Wei, M.D, Yu, Shao-Long, M.D, Li, Yong-Hong, M.D, Zhou, Fang-jian, M.D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anastomosis, Surgical; Biological and medical sciences; Colon, Sigmoid - surgery; Conglutination; Cystectomy; Dilatation, Pathologic; Endoscopy; Female; Humans; Hydronephrosis - etiology; Hydronephrosis - surgery; Ileum - surgery; Male; Medical sciences; Middle Aged; Neobladder; Nephrology. Urinary tract diseases; Nipples; Recurrence; Replantation - methods; Treatment Outcome; Tumors; Ureter - pathology; Ureter - surgery; Urinary Bladder Neoplasms - complications; Urinary Bladder Neoplasms - surgery; Urinary Diversion - adverse effects; Urinary Diversion - methods; Urinary Reservoirs, Continent - adverse effects; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2009.01.034

Abstract Objective We reviewed our experience with dilation of the upper urinary tract caused by the conglutination of distal ureters after orthotopic neobladder reconstruction using the split-cuff nipple ureteral reimplant technique. Materials and methods From January 2000 to April 2007, 250 consecutive patients underwent radical cystectomy and orthotopic neobladder reconstruction. Ureterointestinal anastomosis was performed using the split-cuff nipple technique in 291 renoureteral units. The patients from a single center were followed up for a mean period of 8 months (range 1–22) after surgery. We incised the conglutination band using a transurethral endoscope. Patient characteristics, endoscopic technique, measurement of serum creatinine levels, and results of ultrasonography, cystoscopy, and excretory urography were collected. Results Hydronephrosis was found in 8 patients (14 renoureteral units) due to the conglutination of the distal ureters to each other ( n = 6) or to the neobladder wall ( n = 2). After the incision procedure, seven patients had obvious improvement in renal function and hydronephrosis, and their symptoms disappeared. In 1 patient, hydronephrosis developed again because of ureteroenteric stenosis after 7 months and was resolved by open surgical revision. The hydronephrosis had improved greatly in this patient by 5 months after revision. Conclusion Conglutination of the distal ureters is a cause of hydronephrosis after orthotopic neobladder reconstruction using the reimplant technique with the split-cuff nipple. Cystoscopy is mandatory in following up patients who have hydronephrosis with the split-cuff nipple ureteral reimplant technique, not only to confirm the diagnosis but to treat the complication by incising the conglutination band. Continued follow-up is required to evaluate the long-term results of this treatment.