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Pan-caliceal ileoneocystostomy—a variant of ileal ureter
Letters to the Editor
European Urology
European Urology 43 (2003) 201±207
Pan-caliceal ileoneocystostomyöa variant of ileal ureter Re: Verduyckt F, Heesakkers J, Debruyne F. Long-term results of ileum interposition for ureteral obstruction. Eur Urol 2002;42:181-7 We read with great interest the abovementioned article of Verduyckt et al. and would like to congratulate the authors on successfully extending the use of ileo-ureteral substitution to non-tuberculous indications. We note that in ten of the eighteen patients, ileal interposition was performed, evidently as a salvage procedure, after up to four previous reconstructive operations. In the current series, the ileal segments were anastomosed to either the proximal native ureter or the native renal pelvis. We wish to add that in more complicated cases, where intra-renal pelvic strictures are present and the calices are non-communicating, it is still possible to preserve the functioning renal unit with an ileal ureter. In these situations, pan-caliceal ileoneocystostomy can be contemplated [1]. As in anatrophic nephrotomy, a bloodless plane is developed from the lateral aspect of the kidney. A side to side anastomosis between the entire caliceal system and the proximal ileal segment is then carried
out. Previous experience indicated this procedure is safe and the results are gratifying in carefully selected patients [2]. Such a surgical option can be included in the armamentarium in managing patients who are candidates for ileal ureteral substitution. References [1] Wong SH, Chan YT. Pan-caliceal ileoneocystostomyÐa new operation for intrapelvic tuberculotic strictures of the renal pelvis. J Urol 1981;126:734±6. [2] Wong SH, Lau WY. Pan-caliceal ileoneocystostomy: indications, modi®cations and further evaluation. J Urol 1984;132:668±9.
K.M. Ho Division of Urology, Department of Surgery University of Hong Kong Medical Center Queen Mary Hospital, Pokfulam Hong Kong, China Corresponding author Tel. 852-2812-7187 Fax: 852-2812-7187 E-mail address: [email protected] S.H. Wong Department of Surgery The Hong Kong Sanatorium Hong Kong, China
doi:10.1016/S0302-2838(02)00589-4
Reply to K.M. Ho and S.H. Wong It is interesting to know that in even more complicated cases a pan-caliceal ileoneocystostomy can be performed successfully. This is clearly the case in patients suffering from tuberculosis with intrarenal structuring. In our series no cases of intrarenal scarring because of tuberculosis were present, so we did not have to consider an intrarenal reconstruction. We did not have an indication for reconstructive surgery for intrarenal tuberculosis since 1981. Therefore we do not possess any surgical routine expertise with intrarenal tuberculosis. If these kind of patients will visit our
clinic in the future, the surgery will be even more challenging than extrarenal ileum interposition. Hopefully the outcome will then also be as good as those from our colleagues from Hong Kong.
doi:10.1016/S0302-2838(02)00590-0 0302-2838/02/$ ± see front matter # 2002 Elsevier Science B.V. All rights reserved.
John Heesakkers Department of Urology, UMC St. Radboud P.O. Box 9101, 6500 HB Nijmegen The Netherlands Tel. 31-24-361-6712 Fax: 31-24-354-1031 E-mail address: [email protected]
European Urology
European Urology 43 (2003) 201±207
Pan-caliceal ileoneocystostomyöa variant of ileal ureter Re: Verduyckt F, Heesakkers J, Debruyne F. Long-term results of ileum interposition for ureteral obstruction. Eur Urol 2002;42:181-7 We read with great interest the abovementioned article of Verduyckt et al. and would like to congratulate the authors on successfully extending the use of ileo-ureteral substitution to non-tuberculous indications. We note that in ten of the eighteen patients, ileal interposition was performed, evidently as a salvage procedure, after up to four previous reconstructive operations. In the current series, the ileal segments were anastomosed to either the proximal native ureter or the native renal pelvis. We wish to add that in more complicated cases, where intra-renal pelvic strictures are present and the calices are non-communicating, it is still possible to preserve the functioning renal unit with an ileal ureter. In these situations, pan-caliceal ileoneocystostomy can be contemplated [1]. As in anatrophic nephrotomy, a bloodless plane is developed from the lateral aspect of the kidney. A side to side anastomosis between the entire caliceal system and the proximal ileal segment is then carried
out. Previous experience indicated this procedure is safe and the results are gratifying in carefully selected patients [2]. Such a surgical option can be included in the armamentarium in managing patients who are candidates for ileal ureteral substitution. References [1] Wong SH, Chan YT. Pan-caliceal ileoneocystostomyÐa new operation for intrapelvic tuberculotic strictures of the renal pelvis. J Urol 1981;126:734±6. [2] Wong SH, Lau WY. Pan-caliceal ileoneocystostomy: indications, modi®cations and further evaluation. J Urol 1984;132:668±9.
K.M. Ho Division of Urology, Department of Surgery University of Hong Kong Medical Center Queen Mary Hospital, Pokfulam Hong Kong, China Corresponding author Tel. 852-2812-7187 Fax: 852-2812-7187 E-mail address: [email protected] S.H. Wong Department of Surgery The Hong Kong Sanatorium Hong Kong, China
doi:10.1016/S0302-2838(02)00589-4
Reply to K.M. Ho and S.H. Wong It is interesting to know that in even more complicated cases a pan-caliceal ileoneocystostomy can be performed successfully. This is clearly the case in patients suffering from tuberculosis with intrarenal structuring. In our series no cases of intrarenal scarring because of tuberculosis were present, so we did not have to consider an intrarenal reconstruction. We did not have an indication for reconstructive surgery for intrarenal tuberculosis since 1981. Therefore we do not possess any surgical routine expertise with intrarenal tuberculosis. If these kind of patients will visit our
clinic in the future, the surgery will be even more challenging than extrarenal ileum interposition. Hopefully the outcome will then also be as good as those from our colleagues from Hong Kong.
doi:10.1016/S0302-2838(02)00590-0 0302-2838/02/$ ± see front matter # 2002 Elsevier Science B.V. All rights reserved.
John Heesakkers Department of Urology, UMC St. Radboud P.O. Box 9101, 6500 HB Nijmegen The Netherlands Tel. 31-24-361-6712 Fax: 31-24-354-1031 E-mail address: [email protected]