AB112. Long-term result of ileal-ureter substitution in ureteral urothelial carcinoma patients: a single-center experience

OBJECTIVE: In the southwest coast of Taiwan, the high prevalence rate of upper tract urothelial carcinomas (UTUCs) has been described. Renal preserving surgeries are of great importance when ureteral urothelial carcinoma (UC) happens in solitary kidney, in bilateral upper urinary tract simultaneously, or in patients with chronic kidney disease. We present the single center experience of total ureterectomy plus ileal-ureteral substitution for the ureteral UCs in the southwest of Taiwan over the last two decades. METHODS: We retrospectively reviewed patients who had undergone total ureterectomy plus ileal-ureteral substitution for ureteral UC at our center from January 1988 to December 2013. Chart review was done to obtain the information including age, sex, underlying medical diseases, oncology status before the surgery, baseline renal function, long-term renal function, duration of hospitalization, perioperative surgical complications, long-term complications, and oncological outcomes. RESULTS: Overall, 8 patients were treated with ileal ureteral substitution for ureteral UC, with a mean follow-up period of 66.5 months. All the resected ureters had confirmed to have UC on the final pathology reports. A total of four major complications (grade III) and 1 minor complication (grade I-II) developed according to the Clavien-Dindo complication grading system during a 30-day post-operative period. No perioperative mortality occurred in these patients. There were 3 patients (37.5%) who experienced long-term complications, including recurrent urinary tract infection and recurrent gross hematuria. At the end of follow-up, the renal function remained stable in 4 patients (50.0%), improved in 2 patients (25.0%), and deteriorated in 2 patients (25.0%). Only one of the deteriorated patient required long-term hemodialysis (12.5%). About the oncological outcome, only 1 patient (12.5%) was found to have tumor recurrence over the pelvic-ileal anastomotic site. CONCLUSIONS: Ileal-ureteral substitution has been described as a reserved procedure for an extensively diseased ureter that other reconstructive procedures are not feasible. It provides good long-term outcomes for preservation of renal function, and also has acceptable safety concerns. In carefully selected patients, the procedure can also be carried out as nephro-sparing surgery for patients who have ureteral malignancy.