Upper Urinary Tract Decompression Using Ileal Ureter Replacement (IUR) In Comparison to Endoureteral Thermoexpandable Stent [Memokath® 051]

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 malignant) 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.