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Treatment of Irradiation Injury to the Ureter by Ileal Substitution

From the Department of Obstetrics and Gynecology and the Department of Radiology, Wilford Mall USAF Medical Center, Lackland Air Force Base, Texas

Abstract

Ureteral obstruction following radiotherapy for cervical cancer is most often due to recurrent tumor. However, in a few patients ureteral stricture is secondary to radiation damage. surgical treatment of this obstruction requires special consideration since many procedures for urinary diversion may be contraindicated in an irradiated pelvis. Ileal substitution (uretero ileoncocystostomy) preserves renal function without resorting to external diversion of urine.A discussion of the method together with a report of 6 patients treated in this manner is presented. Results were excellent, with followup ranging from 1 1/2 to 4 years. A brief history of irradiation damage to the ureter and the use of small bowel as substitute ureter is discussed. Patient acceptance of this surgical approach was gratifying.