V01-12 Ileocystoplasty With Chimney and Ureteral Reimplant for Radiation Induced Distal Ureteral Stricture With Concomitant Reduced Bladder Compliance

You have accessJournal of UrologyUpper Tract Reconstruction (V01)1 May 2024V01-12 ILEOCYSTOPLASTY WITH CHIMNEY AND URETERAL REIMPLANT FOR RADIATION INDUCED DISTAL URETERAL STRICTURE WITH CONCOMITANT REDUCED BLADDER COMPLIANCE David M. Strauss and Mihir Desai David M. StraussDavid M. Strauss and Mihir DesaiMihir Desai View All Author Informationhttps://doi.org/10.1097/01.JU.0001008884.22400.05.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The surgical management of distal radiation induced ureteral strictures can be complex. Understanding the bladder dynamics and capacity often dictates the adjunct maneuvers that many need to be employed in ureteral neocystostomy. Pelvic radiation can both damage the vascularity to the bladder as well as reduce the capacity, making the management of long distal ureteral strictures even more challenging by excluding a boari flap as an feasible adjunct. A ileocystoplasty with studer style chimney is a solution to both a capacity and long segment distal ureteral stricture and may be considered in these difficult situations. METHODS: The patient is a 55 year old healthy female with history of hysterectomy and radiation for cervical cancer. She had recurrent urinary infections and right sided hydronephrosis, which was worked up to reveal a distal right ureteral stricture. Given mixed incontinence, she additionally was worked up with urodynamic studies pre-operatively to assess her bladder function. Urodynamics revealed reduced capacity and compliance, as the patient was extremely uncomfortable at 200cc of fill, with a detrusor pressure of 32 cm H2O. After discussion of options, a robotic assisted laparoscopic ileocystoplasty with afferent limb and right ureteral reimplantation was planned. After ureteral dissection and transection at the proximal end of the stricture, the bladder was bivalved in an anterioposterior fashion. 45 cm of terminal ileum was harvested for the future augment and bowel continuity was reestablished. Approximately 30 cm of the 45 cm ileal segment was opened on its antimesenteric border, and converted into a U shaped plate utilizing 3-0 barbed suture. The ileal plate was anastomosed to the open bladder with running 2-0 barbed suture. Reimplantation of the right ureter was performed with interrupted 4-0 vicryl suture into the ileal chimney, after it was fixed to the psoas tendon. The bladder was filled and there was no sign of leak at the augment site or the ureteral anastomoses site. RESULTS: The patient was discharged on POD3. She maintained a Foley catheter for 2 weeks and a ureteral stent for 6 weeks after surgery. At 5 months postoperatively, she is pain free and voiding spontaneously. CONCLUSIONS: In patients with radiation cystitis, or reduced bladder compliance, with a concomittant ureteral stricture, an ileocystoplasty with studer-style aferent ileal chimney may be a useful technique to add into the armamentarium of distal ureteral stricture reconstruction techniques. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e99 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information David M. Strauss More articles by this author Mihir Desai More articles by this author Expand All Advertisement PDF downloadLoading ...