[Stenosis following a direct uretero-ileal anastomosis technique in substitutive enterocystoplasty].

OBJECTIVES

Stenosis of the uretero-ileal anastomosis and reflux are the commonest causes of secondary deterioration of renal function following enterocystoplasty. Various direct anastomosis and antireflux techniques have been proposed in order to reduce the risk of stenosis and reflux. In this retrospective study, the authors evaluated the risk of stenosis and reflux after right uretero-ileal anastomosis on an invaginated ileal loop.

MATERIAL AND

METHODS

The authors evaluated the uretero-ileal anastomosis stenosis and reflux rate and problems of the invaginated ileo-ileal valve in 157 patients after bladder replacement enterocystoplasty.

RESULTS

The anastomosis stenosis rate was 3.8% (6/157 patients) and all 6 patients were reoperated. Stenotic complications on the valve were observed in 1.2% of cases (2/157 patients). The total stenosis morbidity was 5% (8/157 patients).

CONCLUSION

Direct end-to-end uretero-ileal anastomosis is the simplest technique associated with the lowest risk of stenosis. The low stenosis rate associated with invaginated valves is due to a modification of the valvular system (limitation of the mesenteric exclusion manoeuvre, external anchorage of the invagination and fixation by two lines of resorbable staples).