Four Methods of Uretero-Intestinal Anastomosis in Urinary Conduit Diversion

Abstract

The frequency of postoperative complications and the long-term results were compared in four methods of uretero-intestinal anastomosis, with special reference to the significance of radiotherapy. The observations derived from 117 patients in whom a small-bowel conduit was used for urinary diversion. The surgical mortality was 6.8% (8/117). Small-bowel complications were the cause of death in five patients, all of whom had received radiotherapy. The postoperative complication rate showed no difference between a mucosa-mucosa technique (38 patients), an open method (35 patients), a conjoined non-reflux anastomosis (31 patients) and a ureteric nipple, antireflux procedure (10 patients). Diversion made with the open technique was associated with lower rates of postoperatively persisting and/or increasing dilatation of the upper urinary tract. No method-specific preponderance was found among the 13 renal units with late-occurring obstruction. Malignancy could be ascribed responsibility in only four of these. Radiotherapy did not influence the rate of early or late urinary-tract obstruction. Possibly because of the short observation time, the frequency of roentgenologic signs of pyelonephritis and calculi was relatively low. Late ileus, produced by adhesions, occurred in five irradiated patients. Four of them died after further surgery. A favourable outcome in the short and the long term can be anticipated if irradiated tissue is avoided when urinary diversion is performed. Simplicity and precision are the main factors in achieving a patent anastomosis. A simple technique for uretero-intestinal anastomosis, permitting visual control of the lumen after completion of anastomosis, is advantageous. Anti-reflux implantation may be of value.