M. Helal et al., DIRECT (NONTUNNELED) URETEROCOLONIC REIMPLANTATION IN ASSOCIATION WITH CONTINENT RESERVOIRS, The Journal of urology, 150(3), 1993, pp. 835-837
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.