DIRECT (NONTUNNELED) URETEROCOLONIC REIMPLANTATION IN ASSOCIATION WITH CONTINENT RESERVOIRS

A total of 190 patients underwent continent urinary diversion using th e Florida pouch. Direct mucosa-to-mucosa ureterocolonic reimplantation was used in 165 patients (326 ureters). Of the first 30 ureters in pa tients who underwent antireflux tunneled reimplantation obstruction oc curred in 4 (13.3%). Obstruction developed directly in 16 of the urete rs reimplanted (4.9%), and 3 of the 6 plicated and reimplanted megaure ters (50%). Among the obstructed units 3 (13%) were treated unexpected ly by autonephrectomy, while the other 20 units (87%) were treated wit h percutaneous balloon dilation and internal stenting for 6 to 8 weeks . ln the latter group 12 units (60%) recovered function, 3 (15%) had p yelonephritis requiring nephrectomy and 5 (25%) stabilized following a new reimplantation. Reflux was demonstrated in 23 units (7%). All uni ts with reflux are being followed conservatively and renal deteriorati on has not been demonstrated. The incidence of ureteral obstruction wi th direct reimplantation is lower compared to a tunneled technique. Th is reimplantation procedure is technically simpler than others and is safe in adults when performed in association with a large volume, cont inent colonic reservoir.