OBJECTIVES: Evaluation of appendiceal on-lay flap ureteroplasty for repairing complex right proximal and mid ureteral strictures.
PATIENTS AND METHODS: Between August 2006 and August 2012 four women and two men (mean age 34.2 years) underwent right laparoscopic appendiceal on-lay flap ureteroplasty. Mean stricture length was 2.5 cm. Stricture formation was secondary to impacted ureteral stones in three patients and failed pyeloplasty for congenital ureteropelvic junction obstruction in the remaining three. Each patient had ipsilateral flank pain prior to surgery.
RESULTS: Mean operative time, estimated blood loss and hospital stay were 244 minutes, 175 ml, and 3.2 days, respectively. No intraoperative or perioperative complications were noted. The objective success rate was 100% (all patients had radiographic and/or endoscopic resolution of their ureteral strictures). The subjective success rate was 66%, (two patients developed recurrent discomfort, which upon exploration was found to be due to fibrosis away from the appendiceal on-lay graft where the gonadal vessels crossed the ureter). Both patients with recurrent pain underwent laparoscopic ureterolysis and bladder advancement flap proximal to the appendiceal on-lay, which markedly improved one patient's pain but the other patient continued to have discomfort ultimately resulting in a laparoscopic nephroureterectomy.
CONCLUSIONS: Appendiceal on-lay ureteroplasty is a viable treatment option for patients with complex right proximal and mid ureteral strictures, while minimizing the potential morbidity of appendiceal and ileal interposition.
Written by:
Duty BD, Kreshover JE, Richstone L, Kavoussi LR. Are you the author?
Oregon Health & Science University, 3303 SW Bond Ave, CH10U, Portland, Oregon.
Reference: BJU Int. 2014 Jan 28. Epub ahead of print.
doi: 10.1111/bju.12651
PubMed Abstract
PMID: 24471943
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