Upper Urinary Tract Decompression Using Ileal Ureter Replacement (IUR) In Comparison to Endoureteral Thermoexpandable Stent [Memokath® 051]
Main Article Content
Background and Objective: The usage of permanent thermo-expandable stents and the definitive surgical treatment, like the ileal ureter replacement (IUR), both represent alternatives to repeated endourological stenting of long ureteral strictures.
We aimed to assess the long-term outcomes and complications of the IUR compared to the use of Memokath® 051 for ureteral reconstruction.
Material and Methods: In the last 10 years, two groups of patients with ureteral strictures (benign or malig-nant) have been followed up retrospectively. The first group presented with ureteral obstruction and was treated with an endoureteral thermo-expandable stent Memokath®, whereas the second group received an IUR as an alternative treatment method. All patients received follow-up examinations on an outpatient basis 3-4 weeks after hospital discharge, annual controls for long-term monitoring, and routine laboratory analysis and imaging of the upper urinary tract. The main outcome measure was the rate of successful upper tract decompression.
Results: Mean patient age for the first group was 59 years and 55 years for the second group. In the first group (17 patients, 27 renal units), long-term upper tract decompression was successful in 6 renal units (35%); the remaining patients required auxiliary measures and further interventions. In the second group (27 patients, 32 renal units), upper tract decompression was achieved in 24 (88.8%) patients. Secondary complications occurred in 4 (14.8%) patients. Renal function remained stable in 25 of the 27 patients, and metabolic acidosis was not observed.
Conclusion: The IUR is an effective reconstructive measure of the upper urinary tract with a low complication rate and decent long-term functional results. The IUR should be preferred to the Memokath, which can be seen as an alternative niche solution.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of articles published in all DPG titles is retained by the author(s). The author(s) grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any party the rights to use the article freely for non-commercial purposes provided that the original work is properly cited.
2. Kocot A, Vergho DC, Riedmiller H. [Use of bowel segments for ureter reconstruction]. Urologe A. 2012;51(7):928–36. https://doi.org/10.1007/s00120-012-2906-6
3. Vaglio A, Salvarani C, Buzio C. Retroperitoneal fibrosis. Lancet. 2006;367(9506):241–51. https://doi.org/10.1016/S0140-6736(06)68035-5
4. Vrettos A, Prasinou M, Frymann R. Ureteral endo-metriosis: an uncommon cause of ureteral stricture. Quant Imaging Med Surg. 2016;6(2):231–2. https://doi.org/10.21037/qims.2016.01.02
5. de Jonge PK, Simaioforidis V, Geutjes PJ et al. Recent advances in ureteral tissue engineering. Curr Urol Rep. 2015;16(1):465. https://doi.org/10.1007/s11934-014-0465-7
6. Stühler V, Bedke J, Stenzl A. [Surgical reconstruc-tion of the ureter]. Urologe A. 2019;58(6):651–7. https://doi.org/10.1007/s00120-019-0944-z
7. Goodwin WE, Winter CC, Turner RD. Replacement of the ureter by small intestine: clinical application and results of the ileal ureter. Trans Am Assoc Genitourin Surg. 1958;50:56–68. https://doi.org/10.1016/s0022-5347(17)66035-x
8. Bier S, Amend B, Wagner E et al. The thermo-expandable nitinol stent: a long-term alternative in patients without nephropathy or malignancy. Scand J Urol. 2017;51(5):388–91. https://doi.org/10.1080/21681805.2017.1331262
9. Miernik A, Suarez-Ibarrola R, Bourdoumis A et al. Impact of Thermo-Expandable Memokath Ureteral Stent on Renal Function in the Management of Ureteroileal Anastomotic Stricture. Urol Int. 2018;101(3):313–9. https://doi.org/10.1159/000492720
10. Heidenreich A, Grabbert M, Kohl T et al. [Reconstructive surgery of ureteral stricture disease]. Aktuelle Urol. 2017;48(6):550–60. https://doi.org/10.1055/s-0043-120806
11. Boxer RJ, Fritzsche P, Skinner DG et al. Replacement of the ureter by small intestine: clinical application and results of the ileal ureter in 89 patients. J Urol. 1979;121(6):728–31.
12. Bonfig R, Gerharz EW, Riedmiller H. Ileal ureteric replacement in complex reconstruction of the urinary tract. BJU Int. 2004;93(4):575–80. https://doi.org/10.1111/j.1464-410x.2003.04672.x
13. Abol-Enein H, Ghoneim MA. Functional results of orthotopic ileal neobladder with serous-lined extramural ureteral reimplantation: experience with 450 patients. J Urol. 2001;165(5):1427–32.
14. Olsson CA. Ileal ureter and renal autotransplantation. Urol Clin North Am. 1983;10(4):685–97.
15. Stein RJ, Turna B, Patel NS et al. Laparoscopic assisted ileal ureter: technique, outcomes and comparison to the open procedure. J Urol. 2009;182(3):1032–9. https://doi.org/10.1016/j.juro.2009.05.013
16. Chopra S, Metcalfe C, Satkunasivam R et al. Initial Series of Four-Arm Robotic Completely Intracorporeal Ileal Ureter. J Endourol. 2016;30(4): 395–9. https://doi.org/10.1089/end.2015.0674
17. Wagner JR, Schimpf MO, Cohen JL. Robot-assisted laparoscopic ileal ureter. JSLS. 2008;12(3):306–9. 18. Maan Z, Patel D, Moraitis K et al. Comparison of stent-related symptoms between conventional Double-J stents and a new-generation thermoexpandable segmental metallic stent: a validated-questionnaire-based study. J Endourol. 2010;24(4):589–93. https://doi.org/10.1089/end.2009.0318