Ureteral replacement with reconfigured colon substitute.

Abstract

Upper ureteral defects are often too extensive to repair by direct anastomosis or with use of a bladder flap. Ureteral substitution may be the only remaining alternative to restoring urinary drainage from the kidney to the bladder. This effect is usually achieved by interposing a segment of small bowel between the proximal collecting system and bladder. If ileum is not available other substitution alternatives must be sought. We report a new technique in which a tube constructed from a small piece of ascending colon was used to replace a large ureteral defect. Excellent short-term results were achieved by replacing the strictured ureteral segment with a reconfigured colon segment as shown by symptomatic and radiographic improvement. A reconfigured colon segment can be used for ureteral reconstruction in the patient with limited alternatives. This tube has several advantages for ureteral reconstruction over ileal segments.