URETEROILEAL IMPLANTATION IN ORTHOTOPIC NEOBLADDER WITH THE LE-DUC-CAMEY MUCOSAL-THROUGH TECHNIQUE - RISK OF STENOSIS AND LONG-TERM FOLLOW-UP

Purpose: We determined the postoperative risk of nonneoplastic uretero ileal implantation stenosis using the Le Duc-Camey technique, and asse ssed the extent to which followup is mandatory. Materials and Methods: Between October 1980 and October 1989, after a cystoprostatectomy, 15 8 consecutive men underwent lower urinary tract reconstruction by mean s of a U-shaped orthotopic ileal neobladder. Of these cases 109 were t ubularized and 49 were detubularized. The 313 ureteral implantations w ere performed according to the Le Duc-Camey mucosal-through technique. Followup studies in all patients consisted of excretory urography or renal sonography carried out before discharge home, at least every 6 m onths during the first year after surgery and once a year thereafter. Followup was more than 2 years for 123 patients. The study was conduct ed retrospectively. Results: The rate of anastomotic stenosis was 4.9% among 123 patients who were followed a minimum of 2 years. No obstruc tions were detected after 2 years. The rates of ureteral reimplantatio n and nephrectomy for chronic kidney obstruction were 3.7% and 2%, res pectively. All strictures were located at the anastomosed site, and re trograde catheterization was uncertain. Surgical reimplantation throug h an elective extraperitoneal approach was easy to perform and effecti ve. Conclusions: The anastomotic stenosis rate after Le Duc-Camey uret eroileal implantation in orthotopic U-shaped neobladder was 4.9%. Duri ng the first year after surgery, the difference between true stenosis and temporary edema was not easy to assess. The U-shaped neobladder al lows for the implantation of a minimally dissected iliac ureter, which could be a factor in minimizing the risk of obstruction.