Improvement of ureteroileal anastomosis in continent urinary diversion with modified Le Duc procedure.

Abstract

Ureteroileal stricture after urinary diversion often has deleterious effects on the upper ureteral tract. A common ureteral implantation technique described by Le Duc et al has recently been criticized for a high rate of ureteral stricture. We assessed the rate of upper urinary tract dilatation and deterioration in 60 consecutive patients who underwent continent urinary diversion and ureteroileal anastomosis with a modified Le Duc procedure. A total of 60 patients underwent continent urinary diversion with an ileal neobladder (Hautmann). Ureteroileal implantation was performed using a modified Le Duc technique. Followup was performed prospectively for a median of 32 months. The clinical end point was postoperative development of upper urinary tract dilatation, or an increase in preoperative dilatation confirmed by excretory urography or furosemide isotope nephrography. Nonneoplastic deterioration of the upper urinary tract was noted in 4 of 117 renoureteral units (3.4%). No permanent decrease in renal function or increase in pyelonephritic episodes was noted. The modified Le Duc technique is simple and safe for ureteroileal anastomosis and has a low complication rate.