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Use of ileum for complex ureteric reconstruction: Assessment of long-term outcome, complications, and impact on renal function

INTRODUCTION: Defect in ureteral continuity can be due to various etiologies. The surgical options for management of complex long-segment ureteric defects are limited. Use of ileum is indicated in these cases; however, the technique is challenging and outcomes need to be assessed in detail. MATERIAL...

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Autores principales: Pamecha, Yash, Shelke, Umesh, Patil, Bhushan, Patwardhan, Sujata, Kini, Siddharth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194786/
https://www.ncbi.nlm.nih.gov/pubmed/30386088
http://dx.doi.org/10.4103/UA.UA_5_18
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author Pamecha, Yash
Shelke, Umesh
Patil, Bhushan
Patwardhan, Sujata
Kini, Siddharth
author_facet Pamecha, Yash
Shelke, Umesh
Patil, Bhushan
Patwardhan, Sujata
Kini, Siddharth
author_sort Pamecha, Yash
collection PubMed
description INTRODUCTION: Defect in ureteral continuity can be due to various etiologies. The surgical options for management of complex long-segment ureteric defects are limited. Use of ileum is indicated in these cases; however, the technique is challenging and outcomes need to be assessed in detail. MATERIAL AND METHODS: It is an observational study conducted over 4 years. After preoperative optimization, ureteric reconstruction was performed using standard techniques of ileal interposition in cases of unilateral and bilateral long-segment ureteric defects. Patients were followed up at regular interval to assess outcomes and see for complications. RESULTS: A total of 14 patients were studied. Two most common indications for performing ileal ureter were iatrogenic injury and radiation-induced strictures (5–5 cases). Most common site of ureteric involvement was lower and midureter seen in 6 cases. The mean length of the ileum used was 11.2 cm. Mean preoperative nadir creatinine level was 1.57 mg/dL in this study. Average postoperative creatinine level at 4-week follow-up was 1.75 mg/dL and 1.45 mg/dL and 1.37 mg/dL, at 3 and 12 months, respectively. The most common short-term complication was paralytic ileus and long-term complication was recurrent urinary tract infection UTI. There was no mortality. CONCLUSION: Ileal ureter is found to be relatively easy and safe surgery even in patients with borderline high creatinine. There was no worsening of renal function attributable to the conduit in this study. In patients with limited surgical options, it is a suitable alternative, rather than keeping patient on permanent percutaneous nephrostomy or regular stent change. Metabolic acidosis and mucous-associated complications such as pain, infection, and stone formation can be minimized by adherence to strict protocol.
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spelling pubmed-61947862018-10-31 Use of ileum for complex ureteric reconstruction: Assessment of long-term outcome, complications, and impact on renal function Pamecha, Yash Shelke, Umesh Patil, Bhushan Patwardhan, Sujata Kini, Siddharth Urol Ann Original Article INTRODUCTION: Defect in ureteral continuity can be due to various etiologies. The surgical options for management of complex long-segment ureteric defects are limited. Use of ileum is indicated in these cases; however, the technique is challenging and outcomes need to be assessed in detail. MATERIAL AND METHODS: It is an observational study conducted over 4 years. After preoperative optimization, ureteric reconstruction was performed using standard techniques of ileal interposition in cases of unilateral and bilateral long-segment ureteric defects. Patients were followed up at regular interval to assess outcomes and see for complications. RESULTS: A total of 14 patients were studied. Two most common indications for performing ileal ureter were iatrogenic injury and radiation-induced strictures (5–5 cases). Most common site of ureteric involvement was lower and midureter seen in 6 cases. The mean length of the ileum used was 11.2 cm. Mean preoperative nadir creatinine level was 1.57 mg/dL in this study. Average postoperative creatinine level at 4-week follow-up was 1.75 mg/dL and 1.45 mg/dL and 1.37 mg/dL, at 3 and 12 months, respectively. The most common short-term complication was paralytic ileus and long-term complication was recurrent urinary tract infection UTI. There was no mortality. CONCLUSION: Ileal ureter is found to be relatively easy and safe surgery even in patients with borderline high creatinine. There was no worsening of renal function attributable to the conduit in this study. In patients with limited surgical options, it is a suitable alternative, rather than keeping patient on permanent percutaneous nephrostomy or regular stent change. Metabolic acidosis and mucous-associated complications such as pain, infection, and stone formation can be minimized by adherence to strict protocol. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC6194786/ /pubmed/30386088 http://dx.doi.org/10.4103/UA.UA_5_18 Text en Copyright: © 2018 Urology Annals http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Pamecha, Yash
Shelke, Umesh
Patil, Bhushan
Patwardhan, Sujata
Kini, Siddharth
Use of ileum for complex ureteric reconstruction: Assessment of long-term outcome, complications, and impact on renal function
title Use of ileum for complex ureteric reconstruction: Assessment of long-term outcome, complications, and impact on renal function
title_full Use of ileum for complex ureteric reconstruction: Assessment of long-term outcome, complications, and impact on renal function
title_fullStr Use of ileum for complex ureteric reconstruction: Assessment of long-term outcome, complications, and impact on renal function
title_full_unstemmed Use of ileum for complex ureteric reconstruction: Assessment of long-term outcome, complications, and impact on renal function
title_short Use of ileum for complex ureteric reconstruction: Assessment of long-term outcome, complications, and impact on renal function
title_sort use of ileum for complex ureteric reconstruction: assessment of long-term outcome, complications, and impact on renal function
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194786/
https://www.ncbi.nlm.nih.gov/pubmed/30386088
http://dx.doi.org/10.4103/UA.UA_5_18
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