RECONSTRUCTION AND UNDIVERSION OF THE SHORT OR SEVERELY DILATED URETER - THE ANTIREFLUX ILEAL NIPPLE REVISITED

Purpose: Patients undergoing reconstruction of short or severely dilat ed aperistaltic ureters are at significant risk for mechanical or func tional obstruction and reflux, particularly when the ureters are being reimplanted into gastric or intestinal segments. For this problem we describe a simple handsewn, ''stapleless'' antireflux ileal nipple, wh ich serves as a useful bridge between a short ureter and the bladder o r reservoir. Materials and Methods: A total of 12 patients, 4 to 42 ye ars old (mean age 19), 9 with severely dilated and 3 with short ureter s have received the stapleless antireflux ileal nipple as part of vari ous reconstructive efforts. Briefly, a 12 to 15 cm. segment of ileum i s isolated and the mesentery is stripped from the middle 8 cm. of the isolated segment, preserving the blood supply to the proximal and dist al 2 cm. of ileum. Intussusception is created and maintained with mult iple (5 to 7) circumferential rows of 4 to 6 interrupted seromuscular stitches of 3-zero silk. Results: Mean followup is 27.5 months (range 6 to 60). Upper tract dilatation has stabilized or improved in all pat ients, deteriorating temporarily in 1 who had distal nipple stenosis. All patients underwent followup video urodynamic studies, which demons trated no reflux. Nipple related complications included nipple stenosi s in 1 patient and dessusception in another. Both complications were c orrected without sequelae. Ureteroileal stenosis or stone formation ha s not occurred. Conclusions: The stapleless antireflux ileal nipple is safe and reliable in preventing reflux. It is a versatile adjunct to urinary reconstruction in patients with short or severely dilated, ape ristaltic ureters in whom the alternative of a tapered reimplantation into a segment of bowel or stomach poses a significant complication th reat.