Research ArticleOpen Access

An Alternative Technique for Treating Complex Ureteral Strictures and Defects using A Peritoneal Graft

Volume 1 - Issue 5

**Trenti Emanuela^1,2*, Palermo Salvatore M, D Elia Carolina, Comploj Evi, Ladurner Christian, Huqi Dorian, Tischler Tamara, Mian Christine and Pycha Armin**

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- ¹General Hospital of Bolzano, Department of Urology, Italy
- ²Sigmund Freud Private University, Medical School, Vienna, Austria
*Corresponding author: Emanuela Trenti, Department of Urology, Hospital of Bolzano, Bolzano, Italy

Received: October 25, 2017; Published: October 31ss, 2017

DOI: 10.26717/BJSTR.2017.01.000478

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Abstract

Purpose: To describe a new technique of ureteral reconstruction using a free peritoneal graft.

Methods: Between 2006 and 2015 we identified 8 patients with complex ureteral strictures involving in 7 cases the middle ureter. Stricture length ranged from 4 to 12 cm. Two cases were secondary to long strictures from retroperitoneal fibrosis after vascular surgical, 3 cases followed an extensive resection, required for large intraureteral masses, 2 cases were secondary to repeated endoscopic procedures for urinary stones and 1 case followed repeated pyeloplastics. After ureteral incision a free peritoneal graft was harvested from nearby healthy peritoneum. An onlay patch was fixed with running suture to the remaining ureteral plate after placement of an ureteral catheter. The ureter was wrapped with omentum.

Results: Follow-up has ranged from 14 to 76 months. Five patients were free from recurrence after 6, 30, 36, 54 and 60 months, showing good passage of the contrast without dilatation of the upper urinary tract on the uro-CT/urography. In 2 patients occurred a recurrence below the reconstructed ureter after 6 and 60 months without symptoms and with mild hydronephrosis. The last patient showed asymptomatic obstruction of the reconstructed segment with hydronephrosis of the upper pole system 6 months after the procedure. The limitation of this study is the small sample series, due to the selective indications.

Conclusion: This technique allows for preservation of any remaining vascular supply of the ureter and can be a feasible and use full alternative to nephrectomy, ileal ureter and autotransplantation in highly selected cases.

Keywords: Peritoneal Graft; Complex Ureteral Stricture; Middle Ureter; Ureter Reconstruction