Ureter‐ileum‐interposition: Combined experience from two high‐volume centres
Abstract The current study aimed to evaluate short‐ and long‐term complication rates and functional outcomes in a substantial cohort of patients undergoing ileal ureter interposition at two high‐volume medical centres. Materials and methods A retrospective single‐arm analysis was conducted on patien...
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Wiley
2024-10-01
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| Series: | BJUI Compass |
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| Online Access: | https://doi.org/10.1002/bco2.434 |
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| author | Maksym Pikul David Pfister Constantin Rieger Christian Bach Oleg Voylenko Oleksandr Stakhovskyi Sofiya Semko Iurii Vitruk Oleksii Kononenko Eduard Stakhovsky Axel Heidenreich |
| author_facet | Maksym Pikul David Pfister Constantin Rieger Christian Bach Oleg Voylenko Oleksandr Stakhovskyi Sofiya Semko Iurii Vitruk Oleksii Kononenko Eduard Stakhovsky Axel Heidenreich |
| author_sort | Maksym Pikul |
| collection | DOAJ |
| description | Abstract The current study aimed to evaluate short‐ and long‐term complication rates and functional outcomes in a substantial cohort of patients undergoing ileal ureter interposition at two high‐volume medical centres. Materials and methods A retrospective single‐arm analysis was conducted on patients who underwent ureter reconstruction using ileum between 2003 and 2022 at the University Clinic of Cologne and the National Cancer Institute of Ukraine. Data on aetiology, surgical techniques, pre‐ and postoperative kidney function changes, readmission rates and complication management were collected. Postoperative complications were classified according to Clavien–Dindo, and estimated glomerular filtration rate (eGFR) was calculated using the CKD‐EPI formula. Results Results revealed 107 cases with consistent data. Within 90 days post‐surgery, 53% experienced complications, mainly graded as I–II. Grade III complications were seen in 13%, with two cases of grade IV complications leading to extended hospitalisation and patient death. The 90‐day mortality rate was 1.8%. Over a mean follow‐up of 52 months, clinically significant vesico‐renal refluxes occurred in 28%, with only 5.4% leading to persistent urinary tract infection. Antireflux techniques appeared to reduce urine upflow incidence compared with conventional interposition. Anastomosis stricture occurred in 15% of patients, with 63% requiring permanent re‐stenting and 37% needing re‐anastomosis. Metabolic acidosis was clinically significant in 7.5% of cases. A slight improvement in renal function was observed during the first year post‐surgery (average postoperative eGFR = 76 ± 22 ml/min; Mann–Witney U test, p = 0,0198). Affected kidney function improved in 56 (52%), was stable in 41 (38%) and deteriorated in 10 (9.3%). Loss of kidney function on the surgery side was seen in 4 (3.7%) patients and resulted in nephrectomy in 3 (2.8%) cases. Conclusion Ileal ureter interposition demonstrated a favourable safety profile and functional outcomes. This surgical intervention provides an effective tension‐free bypass, irrespective of healthy ureter length. |
| format | Article |
| id | doaj-art-a73948f0f4c840128931c3efac88c1e6 |
| institution | Kabale University |
| issn | 2688-4526 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Wiley |
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| series | BJUI Compass |
| spelling | doaj-art-a73948f0f4c840128931c3efac88c1e62024-12-24T02:30:44ZengWileyBJUI Compass2688-45262024-10-015101038104710.1002/bco2.434Ureter‐ileum‐interposition: Combined experience from two high‐volume centresMaksym Pikul0David Pfister1Constantin Rieger2Christian Bach3Oleg Voylenko4Oleksandr Stakhovskyi5Sofiya Semko6Iurii Vitruk7Oleksii Kononenko8Eduard Stakhovsky9Axel Heidenreich10Department of Plastic and Reconstructive Oncourology National Cancer Institute of Ukraine Kyiv UkraineDepartment of Urology, Faculty of Medicine, University Hospital Cologne University Cologne Cologne GermanyDepartment of Urology, Faculty of Medicine, University Hospital Cologne University Cologne Cologne GermanyDepartment of Urology, Faculty of Medicine, University Hospital Cologne University Cologne Cologne GermanyDepartment of Plastic and Reconstructive Oncourology National Cancer Institute of Ukraine Kyiv UkraineDepartment of Plastic and Reconstructive Oncourology National Cancer Institute of Ukraine Kyiv UkraineDepartment of Plastic and Reconstructive Oncourology National Cancer Institute of Ukraine Kyiv UkraineDepartment of Plastic and Reconstructive Oncourology National Cancer Institute of Ukraine Kyiv UkraineDepartment of Plastic and Reconstructive Oncourology National Cancer Institute of Ukraine Kyiv UkraineDepartment of Plastic and Reconstructive Oncourology National Cancer Institute of Ukraine Kyiv UkraineDepartment of Urology, Faculty of Medicine, University Hospital Cologne University Cologne Cologne GermanyAbstract The current study aimed to evaluate short‐ and long‐term complication rates and functional outcomes in a substantial cohort of patients undergoing ileal ureter interposition at two high‐volume medical centres. Materials and methods A retrospective single‐arm analysis was conducted on patients who underwent ureter reconstruction using ileum between 2003 and 2022 at the University Clinic of Cologne and the National Cancer Institute of Ukraine. Data on aetiology, surgical techniques, pre‐ and postoperative kidney function changes, readmission rates and complication management were collected. Postoperative complications were classified according to Clavien–Dindo, and estimated glomerular filtration rate (eGFR) was calculated using the CKD‐EPI formula. Results Results revealed 107 cases with consistent data. Within 90 days post‐surgery, 53% experienced complications, mainly graded as I–II. Grade III complications were seen in 13%, with two cases of grade IV complications leading to extended hospitalisation and patient death. The 90‐day mortality rate was 1.8%. Over a mean follow‐up of 52 months, clinically significant vesico‐renal refluxes occurred in 28%, with only 5.4% leading to persistent urinary tract infection. Antireflux techniques appeared to reduce urine upflow incidence compared with conventional interposition. Anastomosis stricture occurred in 15% of patients, with 63% requiring permanent re‐stenting and 37% needing re‐anastomosis. Metabolic acidosis was clinically significant in 7.5% of cases. A slight improvement in renal function was observed during the first year post‐surgery (average postoperative eGFR = 76 ± 22 ml/min; Mann–Witney U test, p = 0,0198). Affected kidney function improved in 56 (52%), was stable in 41 (38%) and deteriorated in 10 (9.3%). Loss of kidney function on the surgery side was seen in 4 (3.7%) patients and resulted in nephrectomy in 3 (2.8%) cases. Conclusion Ileal ureter interposition demonstrated a favourable safety profile and functional outcomes. This surgical intervention provides an effective tension‐free bypass, irrespective of healthy ureter length.https://doi.org/10.1002/bco2.434complex kidney tumoursindications to partial nephrectomynephrometryorgan‐sparing managementrenal‐cell carcinoma |
| spellingShingle | Maksym Pikul David Pfister Constantin Rieger Christian Bach Oleg Voylenko Oleksandr Stakhovskyi Sofiya Semko Iurii Vitruk Oleksii Kononenko Eduard Stakhovsky Axel Heidenreich Ureter‐ileum‐interposition: Combined experience from two high‐volume centres BJUI Compass complex kidney tumours indications to partial nephrectomy nephrometry organ‐sparing management renal‐cell carcinoma |
| title | Ureter‐ileum‐interposition: Combined experience from two high‐volume centres |
| title_full | Ureter‐ileum‐interposition: Combined experience from two high‐volume centres |
| title_fullStr | Ureter‐ileum‐interposition: Combined experience from two high‐volume centres |
| title_full_unstemmed | Ureter‐ileum‐interposition: Combined experience from two high‐volume centres |
| title_short | Ureter‐ileum‐interposition: Combined experience from two high‐volume centres |
| title_sort | ureter ileum interposition combined experience from two high volume centres |
| topic | complex kidney tumours indications to partial nephrectomy nephrometry organ‐sparing management renal‐cell carcinoma |
| url | https://doi.org/10.1002/bco2.434 |
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