IMPROVEMENT OF URETEROILEAL ANASTOMOSIS IN CONTINENT URINARY-DIVERSION WITH MODIFIED LE DUC PROCEDURE

Purpose: Ureteroileal stricture after urinary diversion often has dele terious effects on the upper ureteral tract. A common ureteral implant ation technique described by Le Duc et al has recently been criticized for a high rate of ureteral stricture. We assessed the rate of upper urinary tract dilatation and deterioration in 60 consecutive patients who underwent continent urinary diversion and ureteroileal anastomosis viith a modified Le Duc procedure. Materials and Methods: A total of 60 patients underwent continent urinary diversion with an ileal neobla dder (Hautmann). Ureteroileal implantation was performed using a modif ied Le Duc technique. Followup was performed prospectively for a media n of 32 months. The clinical end point was postoperative development o f upper urinary tract dilatation, or an increase in preoperative dilat ation confirmed by excretory urography or furosemide isotope nephrogra phy. Results: Nonneoplastic deterioration of the upper urinary tract w as noted in 4 of 117 renoureteral units (3.4%). No permanent decrease in renal function or increase in pyelonephritic episodes was noted. Co nclusions: The modified Le Duc technique is simple and safe for ureter oileal anastomosis and has a low complication rate.