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Harnleiterersatz unter Verwendung von Darmsegmenten

Use of bowel segments for ureter reconstruction

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Zusammenfassung

Zur Rekonstruktion langstreckiger, komplexer Harnleiterläsionen ist nach Ausschöpfung anderer plastisch-rekonstruktiver Verfahren die Verwendung von Darmsegmenten erforderlich. Unabhängig von der Art der verwendeten Darmsegmente (Ileum bzw. Kolon, mit oder ohne Rekonfiguration) haben alle Verfahren zum Ziel, die Funktionalität des Harntraktes wiederherzustellen und gleichzeitig die Nierenfunktion langfristig zu sichern. Der Harnleiterersatz unter Verwendung von Darmsegmenten stellt eine etablierte und bewährte Technik mit niedrigem Komplikationsprofil und hohen Erfolgsquoten dar. Limitationen bestehen bei ausgeprägter Niereninsuffizienz, Kindern sowie Patienten mit chronisch entzündlichen Darmerkrankungen und früherem Verlust längerer Darmabschnitte mit konsekutiv bestehendem Kurzdarmsyndrom. Bei bereits präoperativ bestehendem Nierenfunktionsverlust soll die Verwendung rekonfigurierter Ileum- und Kolonsegmente das Risiko metabolischer Konsequenzen mindern. Eine antirefluxive Implantation in die orginäre Harnblase oder einen orthotopen Blasenersatz erscheint nicht erforderlich, bei Implantation in ein kontinentes Darmreservoir mit kutanem Stoma wird eine antirefluxive Implantation empfohlen.

Abstract

When ureter damage is extensive or affects the midureter continuity can be restored using bowel segments. The principle issues of these techniques comprise reconstruction of the urinary tract preserving renal function in a long-term setting. The safety of ureters reconstructed from bowel segments has been validated in several large series as a reliable last resort solution with favorable results and low complication rates. Ureter reconstruction with bowel segments is doomed to fail in patients with short-bowel syndrome or Crohn’s disease. Furthermore, the applicability in children and patients with progressive renal deficiency is severely limited. To prevent renal deterioration the use of retubularized bowel segments as a substitute for ureter defects has been postulated. Whereas antirefluxive implantation seems unnecessary in patients with a native bladder in situ or orthotopic bladder substitution, it is recommended in continent bowel reservoirs with cutaneous stoma.

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  1. Klinik und Poliklinik für Urologie und Kinderurologie, Julius-Maximilians-Universität Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Deutschland

    A. Kocot, D.C. Vergho & H. Riedmiller

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  1. A. Kocot
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  2. D.C. Vergho
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  3. H. Riedmiller
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Correspondence to A. Kocot.

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Kocot, A., Vergho, D. & Riedmiller, H. Harnleiterersatz unter Verwendung von Darmsegmenten. Urologe 51, 928–936 (2012). https://doi.org/10.1007/s00120-012-2906-6

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