Stenosis of direct uretero-ileal anastomosis in replacement enterocystoplasty.

Objectives. Stenosis of the uretero-ileal anastomosis and reflux ate the co mmonest causes of secondary deterioration of renal function following enter ocystoplasty. Various direct anastomosis and antireflux techniques have bee n proposed in order to reduce the risk of stenosis and reflux. In this retr ospective study, the authors evaluated the risk of stenosis and reflux afte r right uretero-ileal anastomosis on an invaginated ileal loop, Material and Methods : The authors evaluated the uretero-ileal anastomosis stenosis and reflux rate and problems of the invaginated ileo-ileal valve i n 157 patients after bladder replacement enterocystoplasty. Results : The anastomosis stenosis rate was 3.8% (6/157 patients) and all 6 patients were reoperated. Stenotic complications on the valve were observe d in 1.2% of cases (2/157 patients). The total stenosis morbidity was 5% (8 /157 patients). Conclusion. Direct end-to-end uretero-ileal anastomosis is the simplest tec hnique associated with the lowest risk of stenosis. The low stenosis rate associated with invaginated valves is due to a modifi cation of the valvular system (limitation of the mesenteric exclusion manoe uvre, external anchorage of the invagination and fixation by two lines of r esorbable staples).