Ureterointestinal anastomosis in urinary diversion – current opinion
Authors:
J. Doležel
Authors place of work:
Oddělení urologické onkologie, Klinika operační onkologie LF Masarykovy univerzity a Masarykova onkologického ústavu, Brno
přednosta: doc. MUDr. R. Šefr, Ph. D.
Published in the journal:
Rozhl. Chir., 2017, roč. 96, č. 4, s. 146-150.
Category:
Review
Summary
Uretero-intestinal anastomosis (UIA) is one of the most critical points for the occurrence of severe complications of intestinal urinary diversion. Perfection of the current techniques and development of new UIA methods are motivated by the effort to reduce both early and late post-surgical complications. The necessity of using antireflux UIA, especially with an orthotopic neobladder, is controversial: according to some authors, antireflux UIA of any type generally increases, in comparison with reflux UIA, the risk of obstruction that endangers renal function more than the urine reflux itself. ICUD-EAU International Consultation on Bladder Cancer 2012 does not recommend applying antireflux UIA in orthotopic bladder substitutions. In ileal conduit diversions, most surgeons use only refluxing UIA. Studer and Turner recommend antireflux UIA only in cases where urine diversion can generate great intraluminal pressure and/or where there is a high risk of permanent bacterial colonization. The flap-and-trough technique (FT) of nonrefluxing UIA represents another flap-valve method for implanting normal as well as dilated ureters into various types of urinary diversion, with a low risk of stenotic complications.
Conclusions:
A simple refluxing end-to-side UIA to a low-pressure orthotopic reservoir is a procedure of choice with low complication rates. On the other hand, the need for reflux prevention with a conduit, continent cutaneous diversion or anal diversion is well-founded.
Key words:
ureterointestinal anastomosis
Zdroje
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