Covering of the terminal ureter with de-serosalized muscle layer of the ileum for antireflux ureteroileostomy: an experimental study in dogs and a preliminary clinical trial

We demonstrated a new operative technique for antireflux ureteroileostomy i n dogs. The severed ureter was reimplanted into the isolated ileum. Ten ter minal ureters were covered with a 2x2cm(2) section of de-serosalized ileal wall after direct ureteroileostomy, and another six terminal ureters were c overed with a 2x2cm(2) section of non-de-serosalized full-thickness ileal w all. Thirteen ureters were directly anastomosed to the ileum without any ad ditional procedures. The bladder was augmented by the detubularized ileum w ith the ureter. Postoperative evaluations on ureteral stenosis and reflux w ere performed monthly for 3 months. The ureters covered with the de-serosal ized ileal wall prevented ureteral reflux even when the intravesical pressu re climbed as high as 100 cm H2O. Although two of these ten ureters demonst rated strictures at the precise site of direct ureteroileostomy, the sectio ns of the ureters covered with the de-serosalized ileal wall were opened an d did not collapse. In the resected specimens, the terminal ureters were fo und in the intramural part of the ileum. The ureters covered with the full- thickness of ileal wall did not prevent reflux. Our method of covering the terminal ureter with the de-serosalized ileal wall worked well as an antire flux mechanism, and the intramural ureter did not cause ureteral stricture. After this animal experiment, we introduced this antireflux mechanism clin ically.