ANTIREFLUX URETEROILEAL ANASTOMOSIS FOR ORTHOTOPIC ILEAL NEOBLADDER USING WALLACE TECHNIQUE IN A SINGLE TROUGH | ||
| Ain Shams Medical Journal | ||
| Article 15, Volume 70, 10, 11 & 12, July 2019, Pages 729-734 PDF (151.66 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/asmj.2019.101284 | ||
| Authors | ||
| Hany Mostafa Abdullah; Karim Omar Nassar; Hossam Mohamed El Awady; Sherif Osama Abdel Fattah | ||
| Department of Urology, Faculty of Medicine, Ain Shams University, Ain Shams University, Cairo, Egypt. | ||
| Abstract | ||
| Background: The creation of antireflux mechanism for ureteroileal anastomosis in a low- pressure pouch is controversial and benefits should be weighted by possible morbidity. Different techniques were used as antireflux to preserve the upper urinary tract. Aim of the Work: to evaluate a modification of the subserous extramural tunnel for non-refluxing uretero-ileal anastomosis in orthotopic diversion using Wallace technique in a single trough after 2-year-duration follow up in terms of uretero-ileal anastmosis stricture, reflux and urinary tract infections. Patients and Methods: In all, 100 patients underwent orthotopic urinary diversion after radical cystectomy. Inclusion criteria included age from 30 to 65 years old, negative positive urethral margin, serum creatinine less than 2 mg/dl and tumor stage T2-T3. Exclusion criteria were stricture urethra, single kidney and poor performance status. Patients were followed up by serum creatinine, pouchogram, renal ultrasound and intravenous pyelogram if serum creatinine below 1.5 mg/dl. Results: In all, 2 patients missed follow up and 98 patients were evaluable over 24 months. Mean serum creatinine raised from 1.16 preoperative to 1.20 after 2 years. Reflux has been detected in 3 patients while stricture has affected 3 patients. 9 patients had symptomatic urinary tract infections or being infected with organism other than E.coli that necessitated admission and parenteral antibiotics; three of which were advised to do clean intermittent catheterization. Conclusion: Combining serous-lined extramural tunnel and Wallace techniques is an effective technique and has a comparable result to the other antirefluxing techniques in terms of ureteroileal stricture, reflux and acute pyelonephritis. | ||
| Keywords | ||
| Radical Cystectomy; Urinary Diversion; Antireflux; Single Trough | ||
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