Ileal Replacement

Ileal replacement operation is performed to remove obstruction in ureter. This is as safe as any other traditional surgeries and blood transfusion may not be necessary.

Even in complicated and difficult cases, urologist recommend Ileal ureteric replacement as a safe and reliable option.

Length of Surgery:

3- 4 hours.

Diagnosis:

Procedure of Dilatation and stenting is precededbyfollowing diagnosis tests:

  • Physical exam and complete Medical history.
  • KUB ( abdominal X-ray)
  • EKG (electrocardiogram)
  • CBC (complete blood count)
  • PT / PTT (blood coagulation profile)
  • Comprehensive Metabolic Panel (blood chemistry profile)
  • Urinalysis
  • Renal ultrasound: grade of hydronephrosis
  • Intravenous urography or abdominal CT
  • Endoscopy: Retrograde pyelography and ureterorenoscopy

Treatment:

Use of ileal bowel segment in Ureteral replacement /Ureteral Reconstruction has been part of the urologist’s armamentarium for nearly 35 years. Ileal ureter reconstruction is resorted to when other more conservative surgical operartions are not advisable.

Preparation:

Certain medications to be specifically avoided pre surgery:

  • Aspirin.
  • Ibuprofen Motrin.
  • Voltaren, Plavix, Lovenox, Vioxx, Celebrex.
  • Advil, Ticlid, Alka Seltzer, Coumadin, Vitamin E.
  • Arthritis medications: avoided since before a week of the surgery otherwise it can cause bleeding during the surgery.
  • In case of UTI Urinary Tract Infection, it should be treated before the surgery by prescribed antibiotics.
  • In case of severe lung/ heart conditions, it is advisable to exercise extra caution before and during the procedure

Procedure:

Nowadays, Ureteric replacement by small intestine is standard and well established as a useful and safe procedure and is no longer a surgical curiosity. Small intestine( ileum) is especially preferable for reconstruction of long-segment ureteral strictures. Urologic surgeon selects an appropriate part of the ileum which is then carried to the retroperitoneum via a small window in the colonic mesentery. This selected portion of small intestine is joined(anatomized) with the renal pelvis and bladder using full-thickness watertight sutures.

Risks:

  • Bleeding after the operation
  • Infection
  • Poor wound healing ( following open surgery)
  • Fever.
  • Fatigue.
  • Urinary abnormalities.
  • Infection.
  • Lower body aches.
  • renal insufficiency,
  • bladder dysfunction,
  • inflammatory bowel disease.

Follow- up:

  • 24 hour surveillance.
  • Visit doctor: for removal of cathedral after surgery.
  • Emergency Follow up:
  • Chest pain/ breathing difficulty.
  • Vomiting/ nausea
  • Worsening pain .
  • Large amounts of blood clots in the urine.
  • Difficult/ painful voiding and fully emptying the bladder.
  • Hospital stay for one to three days after radical prostatectomy.
  • During the operation, urinary catheter is inserted and few patients may be required to wear the catheter for some more days to a few weeks even after discharge from hospital.
  • Retaining catheter kept in skin after surgery should be there for some more days after discharge from hospital.

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient. Only a well experienced urologist should perform the above treatment.