Abstract
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.
Similar content being viewed by others
Data availability
All articles mentioned in this review are freely searchable on PubMed.
Code availability
Not applicable.
References
Nakada SY, Best SL (2015) Management of upper urinary tract obstruction. Campbell-Walsh urology, 11th edn. Elsevier, Philadelphia, PA, pp 1135–1139
Lee Z, Lee M, Koster H et al (2020) A multi-institutional experience with robotic ureteroplasty with buccal mucosa graft: an updated analysis of intermediate-term outcomes. Urology. https://doi.org/10.1016/j.urology.2020.08.003
Kroepfl D, Loewen H, Klevecka V, Musch M (2010) Treatment of long ureteric strictures with buccal mucosal grafts. BJU Int 105:1452–1455. https://doi.org/10.1111/j.1464-410X.2009.08994.x
Zhao LC, Weinberg AC, Lee Z et al (2018) Robotic ureteral reconstruction using buccal mucosa grafts: a multi-institutional experience. Eur Urol 73:419–426. https://doi.org/10.1016/j.eururo.2017.11.015
Waldorf B, Lee Z, Kidd L et al (2017) Robotic buccal ureteroplasty: a review of the current literature. Curr Urol Rep 18:1–7. https://doi.org/10.1007/s11934-017-0683-x
Naude JH (1999) Buccal mucosal grafts in the treatment of ureteric lesions. BJU Int 83:751–754. https://doi.org/10.1046/j.1464-410x.1999.00019.x
Lee Z, Waldorf BT, Cho EY et al (2017) Robotic ureteroplasty with buccal mucosa graft for the management of complex ureteral strictures. J Urol 198:1430–1435. https://doi.org/10.1016/j.juro.2017.06.097
Badawy AA, Abolyosr A, Saleem MD, Abuzeid AM (2010) Buccal mucosa graft for ureteral stricture substitution: initial experience. Urology 76:971–975. https://doi.org/10.1016/j.urology.2010.03.095
Dagash H, Sen S, Chacko J et al (2008) The appendix as ureteral substitute: a report of 10 cases. J Pediatr Urol 4:14–19. https://doi.org/10.1016/j.jpurol.2007.08.004
Jun MS, Stair S, Xu A et al (2020) A multi-institutional experience with robotic appendiceal ureteroplasty. Urology. https://doi.org/10.1016/j.urology.2020.06.062
Shen X, Xv M, Liu G et al (2012) Ureteral replacement with appendix in a pediatric group: a report of two cases and review of the literature. Eur J Pediatr Surg 22:329–331. https://doi.org/10.1055/s-0032-1313335
Gn M, Lee Z, Strauss D, Eun D (2018) Robotic appendiceal interposition with right lower pole calycostomy, downward nephropexy, and psoas hitch for the management of an iatrogenic near-complete ureteral avulsion. Urology 113:e9–e10. https://doi.org/10.1016/j.urology.2017.12.005
Cao H, Zhou H, Yang F et al (2018) Laparoscopic appendiceal interposition pyeloplasty for long ureteric strictures in children. J Pediatr Urol 14:551.e1-551.e5. https://doi.org/10.1016/j.jpurol.2018.06.017
Obaidah A, Mane SB, Dhende NP et al (2010) Our experience of ureteral substitution in pediatric age group. Urology 75:1476–1480. https://doi.org/10.1016/j.urology.2009.07.1327
Yarlagadda VK, Nix JW, Benson DG, Selph JP (2017) Feasibility of intracorporeal robotic-assisted laparoscopic appendiceal interposition for ureteral stricture disease: a case report. Urology 109:201–205. https://doi.org/10.1016/j.urology.2017.08.017
Duty BD, Kreshover JE, Richstone L, Kavoussi LR (2015) Review of appendiceal onlay flap in the management of complex ureteric strictures in six patients. BJU Int 115:282–287. https://doi.org/10.1111/bju.12651
Antonelli A, Zani D, Dotti P et al (2005) Use of the appendix as ureteral substitute in a patient with a single kidney affected by relapsing upper urinary tract carcinoma. ScientificWorldJournal 5:276–279. https://doi.org/10.1100/tsw.2005.36
Thomas A, Eng MM, Hagan C et al (2004) Appendiceal substitution of the ureter in retroperitoneal fibrosis. J Urol 171:2378. https://doi.org/10.1097/01.ju.0000125333.41865.52
Pisters PW, Pettaway CA, Liu P et al (2012) Is transureteroureterostomy performed during multi-organ resection for non-urothelial malignancy safe and effective? J Surg Oncol 106:62–65. https://doi.org/10.1002/jso.23039
Richter S, Kollmar O, Lindemann W, Schilling MK (2007) Transureteroureterostomy allows renal sparing radical resection of advanced malignancies with rectosigmoid invasion. Int J Colorectal Dis 22:949–953. https://doi.org/10.1007/s00384-006-0235-1
Kawamura J, Tani M, Sumida K et al (2017) The use of transureteroureterostomy during ureteral reconstruction for advanced primary or recurrent pelvic malignancy in the era of multimodal therapy. Int J Colorectal Dis 32:135–138. https://doi.org/10.1007/s00384-016-2672-9
Joung JY, Jeong IG, Seo HK et al (2008) The efficacy of transureteroureterostomy for ureteral reconstruction during surgery for a non-urologic pelvic malignancy. J Surg Oncol 98:49–53. https://doi.org/10.1002/jso.21086
Iwaszko MR, Krambeck AE, Chow GK, Gettman MT (2010) Transureteroureterostomy revisited: long-term surgical outcomes. J Urol 183:1055–1059. https://doi.org/10.1016/j.juro.2009.11.031
Barry JM (2005) Surgical atlas transureteroureterostomy. BJU Int 96:195–201. https://doi.org/10.1111/j.1464-410X.2005.05552.x
Armatys SA, Mellon MJ, Beck SDW et al (2009) Use of ileum as ureteral replacement in urological reconstruction. J Urol 181:177–181. https://doi.org/10.1016/j.juro.2008.09.019
Roth JD, Monn MF, Szymanski KM et al (2017) Ureteral reconstruction with ileum: long-term follow-up of renal function. Urology 104:225–229. https://doi.org/10.1016/j.urology.2017.02.026
Chung BI, Hamawy KJ, Zinman LN, Libertino JA (2006) The use of bowel for ureteral replacement for complex ureteral reconstruction: long-term results. J Urol 175:179–183. https://doi.org/10.1016/S0022-5347(05)00061-3
Baumgarten AS, Shah BB, Patel TB, Wiegand LR (2017) Robotic ileal interposition for radiation-induced ureteral stricture disease. Urology 104:9–10. https://doi.org/10.1016/j.urology.2017.02.033
Juwono T, Balbona J, Heinsimer KR, Herron TR, Davis D, Wiegand LR (2020) Hand-Sewn or Stapled? A Single Institution Experience on Bowel Anastomosis in Reconstructive Urologic Procedures. Soc Int Urol, 40th Congress. Accessed 10 Oct 2020
Bodie B, Novick AC, Rose M, Straffon RA (1986) Long-term results with renal autotransplantation for ureteral replacement. J Urol 136:1187–1189. https://doi.org/10.1016/S0022-5347(17)45278-5
Ruiz M, Hevia V, Fabuel JJ et al (2017) Kidney autotransplantation: long-term outcomes and complications. Experience in a tertiary hospital and literature review. Int Urol Nephrol 49:1929–1935. https://doi.org/10.1007/s11255-017-1680-1
Moghadamyeghaneh Z, Hanna MH, Fazlalizadeh R et al (2017) A nationwide analysis of kidney autotransplantation. Am Surg 83(2):162–169
Sood A, Jeong W, Ahlawat R et al (2015) Minimally invasive renal autotransplantation. J Surg Oncol 112:717–722. https://doi.org/10.1002/jso.23939
Stiegler P, Schemmer P (2018) Robot-assisted transplant surgery - vision or reality? A comprehensive review. Visc Med 34:24–30
Kroczak T, Reynolds LF, Ordon M (2018) Robotic autotransplantation and management of post-transplant anastomotic strictures: the future is here. Curr Urol Rep 19:10–13. https://doi.org/10.1007/s11934-018-0781-4
Araki M, Wada K, Mitsui Y et al (2017) Robotic renal autotransplantation: first case outside of North America. Acta Med Okayama 71:351–355
Gordon ZN, Angell J, Abaza R (2014) Completely intracorporeal robotic renal autotransplantation. J Urol 192:1516–1522. https://doi.org/10.1016/j.juro.2014.02.2589
Lee JY, Alzahrani T, Ordon M (2015) Intra-corporeal robotic renal auto-transplantation. J Can Urol Assoc 9:E748–E749. https://doi.org/10.5489/cuaj.3015
Arora S, Campbell L, Tourojman M et al (2017) Robotic buccal mucosal graft ureteroplasty for complex ureteral stricture. Urology 110:257–258. https://doi.org/10.1016/j.urology.2017.06.037
Hefermehl LJ, Tritschler S, Kretschmer A et al (2020) Open ureteroplasty with buccal mucosa graft for long proximal strictures: a good option for a rare problem. Investig Clin Urol 61:316–322. https://doi.org/10.4111/icu.2020.61.3.316
Zhong W, Hong P, Ding G et al (2019) Technical considerations and outcomes for ileal ureter replacement: a retrospective study in China. BMC Surg 19:1–7. https://doi.org/10.1186/s12893-019-0472-1
Monn MF, Roth JD, Bihrle R, Mellon MJ (2018) Long term outcomes in the use of ileal ureter for radiation-induced ureteral strictures. Int Urol Nephrol 50:1375–1380. https://doi.org/10.1007/s11255-018-1904-z
Kim A, Nam W, Song SH et al (2018) Use of the ileum for ureteral stricture and obstruction in bilateral, unilateral, and single-kidney cases. Urology 111:203–207. https://doi.org/10.1016/j.urology.2017.08.008
Matlaga BR, Shah OD, Hart LJ, Assimos DG (2003) Ileal ureter substitution: a contemporary series. Urology 62:998–1001. https://doi.org/10.1016/S0090-4295(03)00766-0
Webster JC, Lemoine J, Seigne J et al (2005) Renal autotransplantation for managing a short upper ureter or after ex vivo complex renovascular reconstruction. BJU Int 96:871–874. https://doi.org/10.1111/j.1464-410X.2005.05729.x
Tran G, Ramaswamy K, Chi T et al (2015) Laparoscopic nephrectomy with autotransplantation: safety, efficacy and long-term durability. J Urol 194:738–743. https://doi.org/10.1016/j.juro.2015.03.089
Funding
None.
Author information
Authors and Affiliations
Contributions
All authors contributed to inception, literature review, data analysis, writing and editing of the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The author declares no conflict of interest.
Ethical approval
Not applicable.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bilotta, A., Wiegand, L.R. & Heinsimer, K.R. Ureteral reconstruction for complex strictures: a review of the current literature. Int Urol Nephrol 53, 2211–2219 (2021). https://doi.org/10.1007/s11255-021-02985-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-021-02985-6