Long-term Renal Preservation and Complication Profile With Ileal Ureter Creation

Abstract

Objectives

To examine long-term ileal ureter replacement results at over 32 years at our institution. Long segment or proximal ureteral strictures pose a challenging reconstructive problem. Ureteroureterostomy, psoas hitch, boari flap, buccal ureteroplasty and autotransplantation are common reconstructive techniques. We show that ileal ureter remains a lasting option.

Methods

We performed a retrospective review of patients undergoing open ileal ureter creation from 1989-2021. Patient demographics, operative history, and complications were examined. All patients were followed for change in renal function. Demographic data was analyzed and cox proportional hazard models performed.

Results

158 patients were identified with median follow-up time of 40 months. 81% had a unilateral ileal ureter creation. 50% were female, median age was 53.3. 27% of patients had radiation-induced strictures. Pre-operatively, 56.3% of patients were CKD stage 1-2 and 43.7% were stage 3-5. Post-operatively, 54% were stage 1-2 and 46% were stage 3-5. Cox proportional hazard models demonstrated no significant correlation between worsening renal function and stricture cause, bilateral repair, complications, or sex. 77% had no 30-day complications. Clavien complications included grade 1(18), grade 2(4), grade 3(9), grade 4(5). Long-term complications included worsening renal function(3%), incisional hernia(8.2%), and small bowel obstruction(6.9%). 5(3.1%) patients ultimately required dialysis and 5(3.1%) patients developed metabolic acidosis.

Conclusion

Ileal ureteral reconstruction is often a last resort for patients with complex ureteral injuries. Clinicians can be reassured by our long-term data that ileal ureteral creation is a safe treatment with good preservation of renal function and low risk of hemodialysis and metabolic acidosis.