Long-term result of total ureterectomy with ileal-ureteral substitution in the treatment of ureteral cancer, a single-center experience

Purpose: In the treatment of ureteral urothelial carcinoma, renal-sparing procedures are of great importance for some well-selected patients. However, these procedures may carry risks of under-staging and may not be feasible in multifocal tumor. We performed total ureterectomy in order to achieve maximal resection of the pathological ureter, and repaired the ureteral defect with ileal-ureteral substitution.

Materials and Methods: We retrospectively reviewed the medical records of all patients who underwent total ureterectomy with ileal-ureteral substitution for ureteral urothelial carcinoma at our center from January 1988 through December 2015. Patient demographics, baseline renal function, disease etiology, surgical procedures, pathology reports, perioperative and long-term complications, long-term renal function, and the oncological outcome were recorded for analysis.

Results: A total of eight patients received total ureterectomy with ileal ureteral substitution with a mean follow up period of 81.8 months. Indications included solitary kidney, chronic kidney disease, and bilateral disease. The common perioperative complications were anastomotic urine leakage and temporary hemodialysis, and the long-term complication was mainly urinary tract infection. Preservation for renal functional was good, with only one deteriorated patient that need life-long hemodialysis. Only one patient (12.5%) experienced upper tract recurrence, and three patients (37.5%) had bladder recurrence during follow up. The 5-year recurrence free survival and cancer specific survival rate were 50% and 75%, respectively.

Conclusion: Total ureterectomy with ileal ureteral substitution is a feasible choice to treat ureteral UC when renal-sparing procedure is indicated. It provides good long-term oncological outcome over upper tract, and also preserves the renal function.