LONG-SEGMENT URETERAL REPLACEMENT WITH EXPANDED POLYTETRAFLUOROETHYLENE GRAFTS

Objectives. Traumatic loss of significant lengths of ureter all too of ten results in nephrectomy when vascu larized pedicles of bower or bla dder fail or are not available for substitution. Historically, allopla stic replacement of ureters has failed due to obstruction, bioincompat ibility, or graft migration. This study was undertaken to test the per formance of ringed expanded polytetrafluoroethylene (PTFE) tube grafts as ureteral replacements in a canine model. Methods, Eight female dog s underwent partial ureteral replacement with ringed PTFE tube grafts. An involuting anastomosis was used to anchor the graft to the bladder . The dogs were followed with intravenous urograms and Whitaker infusi on pressure tests for up to 12 months. Results, Six of 8 animals (75%) had preservation of excellent renal function with normal intravenous urograms and low Whitaker infusion pressures. One animal had mild hydr onephrosis with an elevated infusion pressure. One animal died of spon taneous renal rupture secondary to obstruction at the ureteral-graft a nastomosis. All other grafts were patent by histologic examination wit hout encrustation or infection. Conclusions. Although not suggested as first-line therapy after ureteral loss, expanded PTFE may have a use as a prosthetic ureteral replacement in situations where conventional surgical therapies are unsuccessful. This material appears to be bioco mpatible, and the technique of bladder anastomosis described here prev ented migration of the prosthesis.