Ma. Helal et al., A TRANS-RESERVOIR TECHNIQUE FOR CORRECTION OF URETEROINTESTINAL OBSTRUCTION IN CONTINENT URINARY-DIVERSION, The Journal of urology, 153(4), 1995, pp. 1108-1109
Following construction of a continent colonic urinary reservoir, 5 ure
tero-colonic reimplantations became obstructed at the anastomotic site
. In these obstructed units previous percutaneous balloon dilation and
stent placement had failed and they were subsequently treated by a ne
w reimplantation procedure. Preoperatively, in all ureteral units a pe
rcutaneous ureteral stent was inserted to facilitate intraoperative re
cognition of the ureteral meatus. The technique included a trans-reser
voir approach, which allowed easy localization of the stent and anasto
motic site. The ureter was dissected free from the intestinal wall and
then was mobilized into the lumen of the reservoir. After excision of
the scarred distal ureteral segment and spatulation of the proximal h
ealthy ureter, a new direct mucosa-to-mucosa reimplantation was perfor
med leaving the ureter stented. This trans-reservoir approach (occasio
nally done through an abdominal transverse muscle splitting incision)
allows for shortening of the operation, and avoids the time-consuming
and more complicated transabdominal lysis of adhesions. All newly reim
planted ureters (100%) showed evidence of adequate ureteral drainage w
ithout residual obstruction on followup excretory urography or furosem
ide renography up to 45 months postoperatively. The trans-reservoir ap
proach for refractory ureteral reimplantation obstruction in continent
colonic reservoirs has been associated with no morbidity or mortality
, and facilitates the solution to a difficult clinical problem.