A nonrefluxing, serous lined extramural tunnel for ureteroileal anastomosis in ileal conduit urinary diversion: First clinical experience in 10 patients

Purpose: We report the surgical technique and functional outcome of a new a pplication for serous lined, anti-refluxing ureteroileal anastomosis in ile al conduit urinary diversion. Reflux prevention relies on the construction of a serous lined extramural ileal tunnel. Materials and Methods: A 25 cm. distal ileal segment was isolated. The prox imal 7 cm. of the ileal segment was folded and the 2 proximal 7 cm. segment s were joined by seromuscular sutures. The antimesenteric borders of these 7 cm. segments were incised and the medial edges of each ureter were joined . A mesenteric window was opened at the level of ileal folding and the uret ers were passed through it. They were inlaid within the trough and the conj oined ureteral end were anastomosed to the intestinal mucosa. The tunnel wa s then closed over the implanted ureters. The lateral limbs of the detubula rized ileal segment were then joined. The technique was performed in 10 pat ients with a mean followup of 9.9 months (range 3 to 19). The patients were evaluated clinically and radiologically. Results: None of the 10 patients had reflux on x-ray of the loop. One patie nt had previously undergone unilateral nephrectomy. Excretory urography sho wed a stabilized or improved upper tract in 18 renal units. Left ureterohyd ronephrosis was present in I renal unit because of ureteroileal stenosis. Conclusions: The initial clinical results of the serous lined extramural il eal tunnel technique for ureteroileal anastomosis in ileal conduit cases ar e promising. The technique appears effective and reliable.