Long-term Renal Preservation and Complication Profile With Ileal Ureter Creation

Mary E Soyster; Ramzy T Burns; James E Slaven; Jason L Zappia; Peter J Arnold; Joshua D Roth; Richard Bihrle; M Francesca Monn; Matthew J Mellon

doi:10.1016/j.urology.2024.04.025

Long-term Renal Preservation and Complication Profile With Ileal Ureter Creation

Urology. 2024 Apr 22:S0090-4295(24)00297-8. doi: 10.1016/j.urology.2024.04.025. Online ahead of print.

Authors

Mary E Soyster¹, Ramzy T Burns², James E Slaven³, Jason L Zappia², Peter J Arnold², Joshua D Roth², Richard Bihrle², M Francesca Monn⁴, Matthew J Mellon²

Affiliations

¹ Department of Urology, Indiana University School of Medicine, Indianapolis, IN. Electronic address: msoyster@iu.edu.
² Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
³ Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN.
⁴ Department of Urology, Indiana University School of Medicine, Indianapolis, IN; Division of Urology, Southern Illinois University School of Medicine, Springfield, IL.

PMID: 38657870
DOI: 10.1016/j.urology.2024.04.025

Abstract

Objective: To examine long-term ileal ureter replacement results at over 32 years at our institution. Long segment or proximal ureteral strictures pose a challenging reconstructive problem. Ureteroureterostomy, psoas hitch, Boari flap, buccal ureteroplasty, and autotransplantation are common reconstructive techniques. We show that ileal ureter remains a lasting option.

Methods: We performed a retrospective review of patients undergoing open ileal ureter creation from 1989-2021. Patient demographics, operative history, and complications were examined. All patients were followed for changes in renal function. Demographic data were analyzed and Cox proportional hazard models were performed.

Results: One hundred and fifty-eight patients were identified with median follow-up time of 40 months. Eighty-one percent had a unilateral ileal ureter creation. Fifty percent were female, median age was 53.3. Twenty-seven percent of patients had radiation-induced strictures. Preoperatively, 56.3% of patients were chronic kidney disease stage 1-2 and 43.7% were stage 3-5. Post-operatively, 54% were stage 1-2 and 46% were stage 3-5. Cox proportional hazard models demonstrated no significant correlation between worsening renal function and stricture cause, bilateral repair, complications, or sex (biologically male or female). Seventy-seven percent had no 30-day complications. Clavien complications included grade 1 (18), grade 2 (4), grade 3 (9), and grade 4 (5). Long-term complications included worsening renal function (3%), incisional hernia (8.2%), and small bowel obstruction (6.9%). Five (3.1%) patients ultimately required dialysis and 5 (3.1%) patients developed metabolic acidosis.

Conclusion: Ileal ureteral reconstruction is often a last resort for patients with complex ureteral injuries. Clinicians can be reassured by our long-term data that ileal ureteral creation is a safe treatment with good preservation of renal function and low risk of hemodialysis and metabolic acidosis.