Abstract

Background

We present a simple technique for construction of wide ureteral plate, consisting of four ureters, incorporated in ureteroileal anastomosis of ileal conduit urinary diversion.

Methods

We retrospectively reviewed the charts of six cases of ureteral duplication (five bilateral and one unilateral) and muscle-invasive bladder cancer, treated with radical cystectomy and ileal conduit diversion, at our institution from 2015 to 2020. Briefly, our technique includes construction of wide ureteral plate, consisting of four ureters from two separate ureteral units, after previous construction of right and left ureteral plates for each unit, according to the standard Wallace technique. Additionally, during construction of definite ureteral anastomotic plate, we used a modified Wallace I technique consisted of eversion of posteromedial ureteral walls of both ureteral units, with muco-mucosal running suture.

Results

Four males and two females underwent radical cystectomy with ileal conduit for muscle invasive bladder cancer. A total of 12 complications (CDC I–III) were registered in 4/6 (66.6%) patients, whereby ten of them (83.3%) occurred within 90 days post-surgery. High-grade (CDC III) complications were registered in 33.3% of patients. Within the first three months post-surgery, hydronephrosis and high-grade vesicoureteral reflux were associated with pyelonephritis and observed in two patients (33.3%), while uretero-intestinal anastomotic stricture or leakage were not detected during follow-up in any patients.

Conclusion

Modified Wallace uretero-ileal anastomosis after radical cystectomy and ileal conduit urinary diversion is functionally and cosmetically effective way to treat patients with bilateral duplex ureters harbouring muscle invasive bladder cancer.

中文翻译：

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双侧双侧输尿管根治性膀胱切除及回肠导管尿流改道患者输尿管-回肠吻合术的初步体会

摘要

背景

我们提出了一种简单的技术，用于构建由四个输尿管组成的宽输尿管板，用于回肠导管尿流改道的输尿管回肠吻合术。

方法

我们回顾性回顾了 2015 年至 2020 年在我院接受根治性膀胱切除术和回肠导管改道治疗的 6 例输尿管重复（5 例双侧和 1 例单侧）和肌肉浸润性膀胱癌的图表。简而言之，我们的技术包括构建广泛的输尿管板，由来自两个独立输尿管单元的四个输尿管组成，之前根据标准华莱士技术为每个单元构建了左右输尿管板。此外，在确定输尿管吻合板的构建过程中，我们使用了改良的 Wallace I 技术，包括将两个输尿管单元的后内侧输尿管壁外翻，并进行黏膜黏膜连续缝合。

结果

四名男性和两名女性接受了根治性膀胱切除术和回肠导管治疗肌肉浸润性膀胱癌。4/6 (66.6%) 的患者共记录了 12 种并发症 (CDC I-III)，其中 10 例 (83.3%) 发生在术后 90 天内。33.3% 的患者出现高级别 (CDC III) 并发症。在术后的前三个月内，肾积水和高级别膀胱输尿管反流与肾盂肾炎相关，并在 2 名患者（33.3%）中观察到，而在任何患者的随访中均未发现输尿管-肠吻合口狭窄或渗漏。

结论

根治性膀胱切除术和回肠导管尿流改道后改良的华莱士输尿管-回肠吻合术是治疗双侧双侧输尿管肌肉浸润性膀胱癌患者的功能和美容有效方法。