Ileal ureter replacement and ileocystoplasty for the treatment of bilateral ureteral strictures and bladder contracture: technique and outcomes

BACKGROUND: The aim of this study was to explore the feasibility of ileal ureter replacement and ileocystoplasty for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture. METHODS: A retrospective review of clinical data from seven patients who underwent bilateral Ileal Ureter Replacement and ileocystoplasty from April 2019 to February 2023 was conducted. The surgeries were performed using open, laparoscopic, and robot-assisted laparoscopic approaches. Baseline characteristics, perioperative, and mid-term results of the patients were collected. Follow-up period of 3-28 months. A detailed description of the technique was reported. RESULTS: The mean age of the patients was 52.86 +/- 6.06 years. The average duration of surgery was 365 +/- 28.54 minutes, and the estimated intraoperative blood loss was 357.14 +/- 184.06 mL. The mean length of harvested ileum was 37.86 +/- 8.40 cm. The preoperative serum creatinine level was 88.02 +/- 18.05 mu mol/L, postoperative day 1 creatinine level was 90.7 +/- 12.93 mu mol/L, postoperative 3-month creatinine level was 93.77 +/- 33.34 mu mol/L, and the mean creatinine level at the last follow-up was 94.89 +/- 27.89 mu mol/L. The postoperative bladder capacity was 249.43 +/- 32.50 mL on average. The average length of hospital stay was 26.57 +/- 15.46 days. No complications of Clavien-Dindo grade 3 or higher were observed. During the follow-up period, no patients experienced deterioration of renal function after surgery. CONCLUSIONS: Bilateral ileal ureter replacement and ileocystoplasty are effective surgical technique for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture caused by radiation therapy.