Ureteral reconstruction for complex strictures: a review of the current literature

• Published in: International urology and nephrology Vol. 53; no. 11; pp. 2211 - 2219
• Main Authors: Bilotta, Alyssa, Wiegand, Lucas R., Heinsimer, Kevin R.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.11.2021; Springer Nature B.V
• Subjects: Acidosis; Appendix; Balloon treatment; Buccal mucosa; Constriction, Pathologic - surgery; Humans; Literature reviews; Medicine; Medicine & Public Health; Metabolic acidosis; Morbidity; Nephrology; Renal insufficiency; Stricture; Success; Ureter; Ureter - surgery; Ureteral Obstruction - pathology; Ureteral Obstruction - surgery; Urologic Surgical Procedures - methods; Urology; Urology - Review; Ureteral stricture; Ileal ureter; Ureteral reconstruction; Appendiceal interposition; Buccal graft; Transureteroureterostomy; Autotransplantation
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-021-02985-6

Purpose Frequently employed procedures for ureteral reconstruction include balloon dilation, pyeloplasty and ureteral re-implants. However, these procedures do not work for complex ureteral disease. The goal of this literature review is to report on techniques and success rates for the following techniques: buccal graft ureteroplasty, appendiceal interposition, transureteroureterostomy, ileal ureter and autotransplantation. Methods A comprehensive literature search for English-language original and review articles was conducted using PubMed. The following terms were queried: “ureteral reconstruction”, “buccal graft”, “appendiceal interposition”, “ileal ureter”, “transureteroureterostomy”, “autotransplantation”. Results Procedures involving the buccal mucosa or appendix offer minimally invasive techniques and low morbidity with good short-term success. Drawbacks to appendiceal interposition include the availability and length of appendix, and 10–20% of patients may have insufficient appendix upon intra-operative assessment. Transureteroureterostomy is typically limited to extensive exonerations due to concerns of injury to the contralateral kidney, even with reported success rates > 90%. Ileal ureter may carry a risk of metabolic acidosis in patients with renal insufficiency along with bowel-related complications. Ileal ureter and autotransplantation are reserved for the most severe cases due to their high morbidity but do offer options for the complex patient. Conclusion Ureteral stricture disease not amenable to pyeloplasty, ureteroureterostomy or ureteroneocystostomy offers a challenge to urologist. Careful patient selection with pre-operative assessment of renal and bladder is vital to a successful operation with minimal complications.