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Urology (Expert Forum)
Serious ureter obstruction
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Serious ureter obstruction
by Robert, Sep 23, 1999 12:00AM
To make a very long story short, my wife has had serious ureter obstruction problems for the past 15 months due to another surgery. The last test run was a Whitaker test that produced a number of 28, which I understand 0-14 is the normal range. An antegrade nephrostomy (I think that is the right term) was performed on the right ureter and showed about 3-4 inches of the ureter near the bladder was very narrowed. The options we have been given are:
1) Cut the narrow part of the right ureter out and move the good part over to the left ureter (TUU?)
2) Cut a piece of small intestine and make a new ureter (Ileal Neoureter?)
3) Cut the length of the narrowed part of the ureter and place a larger than normal stent in to allow growth around the ureter thereby enlarging it.
4) Take the kidney out.
None of the options sound to great to me. Are you aware of any other procedures to take care of such a large stricture? Thanks so much for the help. We are desparate for other options!
1) Cut the narrow part of the right ureter out and move the good part over to the left ureter (TUU?)
2) Cut a piece of small intestine and make a new ureter (Ileal Neoureter?)
3) Cut the length of the narrowed part of the ureter and place a larger than normal stent in to allow growth around the ureter thereby enlarging it.
4) Take the kidney out.
None of the options sound to great to me. Are you aware of any other procedures to take care of such a large stricture? Thanks so much for the help. We are desparate for other options!
Doctor's Answer
by HFHS M.D.-CK, Sep 30, 1999 12:00AM
Dear Robert,
Injury to the lower ureter has many different potential causes.
you have outlined many different corrective measures: TUU(transureteroureterostomy), Nephrectomy (removing the kidney), Endopyelotomy (cutting and widening the narrow segment), Ileal ureter (replacing the ureter with a segment of small bowel).
To this list I would add a Boari flap (tubularizing part of the bladder and attaching it up to the good portion of the ureter). A psoas hitch procedure is only reasonable for short narrowings of the ureter (not 4 inches). This involves mobilizing and swinging the bladder up to meet the wide portion of the injured ureter and reimplanting it into the bladder. Finally, a renal autotransp
lantation can be considered if all other options are exhausted (removing the kidney and reimplanting it down towards the bladder allowing the shortened ureter to be attached).
If the bladder capacity is adequate and the stricture is not too long, I would suggest a Boari flap.
This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available through our department at the Henry Ford Hospital and its suburban locations (I-800-653-6568).
Sincerely;
HFHS M.D.-CK
Injury to the lower ureter has many different potential causes.
you have outlined many different corrective measures: TUU(transureteroureterostomy), Nephrectomy (removing the kidney), Endopyelotomy (cutting and widening the narrow segment), Ileal ureter (replacing the ureter with a segment of small bowel).
To this list I would add a Boari flap (tubularizing part of the bladder and attaching it up to the good portion of the ureter). A psoas hitch procedure is only reasonable for short narrowings of the ureter (not 4 inches). This involves mobilizing and swinging the bladder up to meet the wide portion of the injured ureter and reimplanting it into the bladder. Finally, a renal autotransp
lantation can be considered if all other options are exhausted (removing the kidney and reimplanting it down towards the bladder allowing the shortened ureter to be attached).
If the bladder capacity is adequate and the stricture is not too long, I would suggest a Boari flap.
This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available through our department at the Henry Ford Hospital and its suburban locations (I-800-653-6568).
Sincerely;
HFHS M.D.-CK
