The current study aimed to evaluate short- and long-term complication rates and functional outcomes in a substantial cohort of patients undergoing ileal ureter interposition at two high-volume medical centres.

Materials and methods: A retrospective single-arm analysis was conducted on patients who underwent ureter reconstruction using ileum between 2003 and 2022 at the University Clinic of Cologne and the National Cancer Institute of Ukraine. Data on aetiology, surgical techniques, pre- and postoperative kidney function changes, readmission rates and complication management were collected. Postoperative complications were classified according to Clavien-Dindo, and estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula.

Results: Results revealed 107 cases with consistent data. Within 90 days post-surgery, 53% experienced complications, mainly graded as I-II. Grade III complications were seen in 13%, with two cases of grade IV complications leading to extended hospitalisation and patient death. The 90-day mortality rate was 1.8%. Over a mean follow-up of 52 months, clinically significant vesico-renal refluxes occurred in 28%, with only 5.4% leading to persistent urinary tract infection. Antireflux techniques appeared to reduce urine upflow incidence compared with conventional interposition. Anastomosis stricture occurred in 15% of patients, with 63% requiring permanent re-stenting and 37% needing re-anastomosis. Metabolic acidosis was clinically significant in 7.5% of cases. A slight improvement in renal function was observed during the first year post-surgery (average postoperative eGFR = 76 ± 22 ml/min; Mann-Witney U test, p = 0,0198). Affected kidney function improved in 56 (52%), was stable in 41 (38%) and deteriorated in 10 (9.3%). Loss of kidney function on the surgery side was seen in 4 (3.7%) patients and resulted in nephrectomy in 3 (2.8%) cases.

Conclusion: Ileal ureter interposition demonstrated a favourable safety profile and functional outcomes. This surgical intervention provides an effective tension-free bypass, irrespective of healthy ureter length.

Keywords: complex kidney tumours; indications to partial nephrectomy; nephrometry; organ‐sparing management; renal‐cell carcinoma.

© 2024 The Author(s). BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.

当前研究旨在评估两所高量医疗中心进行回肠尿道移植的大量患者短期内和长期内并发症率及功能结局。

材料与方法：

对2003年至2022年间在科隆大学诊所和乌克兰国家癌症研究所接受使用小肠重建输尿管手术的患者的回顾性单组分析。收集了病因、外科技术、术前术后肾功能变化、再入院率及并发症处理的数据。术后并发症根据Clavien-Dindo分级分类，估算肾小球滤过率（eGFR）采用CKD-EPI公式计算。

结果：

结果显示107例患者数据一致。在术后90天内，53%的患者经历了并发症，主要为I-II级。III级并发症出现在13%，其中两例IV级并发症导致延长住院和患者死亡。90天内的病死率为1.8%。在平均随访52个月期间，临床显著性膀胱-肾反流发生在28%的病例中，只有5.4%的病例导致持续泌尿道感染。抗反流技术似乎比常规移植减少了尿液上行的发生率。吻合口狭窄出现在15%的患者中，其中63%需要永久重新支撑，37%需再次进行吻合术。代谢性酸中毒在7.5%的情况下具有临床意义。术后第一年观察到肾功能略有改善（平均术后eGFR = 76 ± 22 ml/min；Mann-Witney U检验，p = 0,0198）。受影响的肾脏功能有56例(52%)有所改善，41例(38%)稳定不变，10例(9.3%)恶化。在手术侧失去肾功能的情况出现在4（3.7%）名患者中，并导致其中三名患者的肾切除。

结论：

回肠尿道移植显示出良好的安全性和功能性结果。这种外科干预提供了一种有效的无张力旁路，不考虑健康输尿管的长度。

关键词：

复杂肾脏肿瘤；部分肾切除指征；肾评分；器官保留管理；肾细胞癌。