URETERAL SUBSTITUTION USING THE ISOLATED INTERPOSED VERMIFORM APPENDIX IN A PATIENT WITH A SINGLE KIDNEY AND TRANSITIONAL-CELL CARCINOMA OFTHE URETER

A patient with a single kidney presented with ureteral obstruction cau sed by a combination of primary transitional cell carcinoma of the ure ter and extrinsic involvement of the ureter by a second primary malign ant retroperitoneal lymphadenopathy. Due to the complexity of the case , we chose to perform a partial ureterectomy and used a method of uret eral substitution using the interposed vermiform appendix in combinati on with a psoas hitch. Application of the psoas hitch may allow the us e of the appendix in most cases in which ureteral substitution becomes necessary. Antireflux mechanism is easily achieved with the appendix using the split cuff nipple technique. Finally, the use of the appendi x allows complete retroperitonealization of the anastomoses to both ur eter and bladder. We anticipate that the appendix will be used more co mmonly in the future as a ureteral substitute as more urologists becom e more comfortable with it through its use in various reconstructive p rocedures.