Ureteroileal reimplantation in bladder substitutions: Direct technique

Abstract

We evaluated renal function, scarring and bacteruria after ileal bladder substitution with and without antireflux ureteral reimplantation. A total of 160 ileal bladder replacements were performed from April 1990 to April 1994. 78 patients underwent bilateral antireflux ureteroileal anastomosis (group A) while a direct end-to-side reimplantation was used in 82 patients (group B). All patients were evaluated by urodynamic study, i.v.p., retrograde and voiding cystogram, urine culture and DMSA renal scanning. Anastomotic strictures occurred in 8 patients of group A: one bilateral and seven monolateral, for a total of nine obstructed units (5.8%). The strictures were treated with balloon dilatation in 3 cases and surgical reimplantation in 6. In group B, 3 monolateral strictures were observed (1.8%) and were treated successfully by balloon dilatation and stenting for 6 to 8 weeks. We also observed 6 refluxes in group A (1.8%) and 12 in group B (3.7%). All the patients with reflux were asymptomatic and none had acute urinary tract infection, fever, flank pain or pyelonephritis. DMSA scintigraphy did not detect any parenchymal damage or additional scar. Compared to the antireflux technique, the incidence of ureteral obstruction with direct reimplantation is lower. Although the incidence of reflux in group B is higher, no renal deterioration was observed at a mean follow-up of 52 months.