A TRANS-RESERVOIR TECHNIQUE FOR CORRECTION OF URETEROINTESTINAL OBSTRUCTION IN CONTINENT URINARY-DIVERSION

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.