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Feasibility and Outcomes of Ureteroureterostomy and Extravesical Ureteroneocystostomy as Part of Radical Surgery for Infiltrating Gynecologic Disease
  1. Andreas Hackethal, MD, PhD,
  2. Donal J. Brennan, MD, PhD,
  3. Russell Land, MD,
  4. Marcelo Nascimento, MD, PhD,
  5. James Nicklin, MD and
  6. Andreas Obermair, MD
  1. Queensland Centre for Gynaecological Cancer, Royal Brisbane & Women’s Hospital, Queensland, Brisbane, Australia.
  1. Address correspondence and reprint requests to Andreas Hackethal, MD, PhD, Queensland Centre for Gynaecological Cancer, Royal Brisbane & Women’s Hospital, 6th Floor, Ned Hanlon Bldg, Herston, Queensland 4029, Brisbane, Australia. E-mail: hackvalley@me.com.

Abstract

Objective Abdominopelvic infiltrative disease may require aggressive surgical procedures. This study reports on our experience with distal ureterectomy, ureteroureterostomy, and extravesical ureteroneocystostomy as part of radical surgery for infiltrating gynecologic disease.

Patients and Methods Twenty-one women required surgery to the distal ureter at the Queensland Centre for Gynecological Cancer, Australia, from January 2006 to September 2012. Details of the patient’s history, operation record, inpatient notes, and follow-up data were obtained through chart review.

Results Patients’ median age was 57.8 ± 14.7 years (range, 30–80 years). Seventeen patients had gynecologic cancer. Mean operating time was 3.9 ± 0.9 hours (range, 2.5–5.5 hours). Restoration of continuity was achieved through extravesical ureteroneocystostomy and ureteroureterostomy in 18 and 3 patients, respectively. Boari flap was used in 3 patients, and psoas hitch was the technique chosen in 11 patients. Urinary tract infection was the most common clinical adverse event. Albeit clinically irrelevant, 38% of the patients showed structural renal tract changes postoperatively.

Conclusions To achieve maximal surgical radicalness, resection of the distal ureter with subsequent ureteroureterostomy or extravesical ureteroneocystostomy is feasible and safe. Radical surgery to the urinary tract should be considered as a legitimate part of a gynecologic oncologist’s surgical armamentarium to increase a patient’s probability of survival and its positive effect on kidney function.

  • Ureter resection
  • Cytoreduction
  • Ureteroneocystostomy
  • Ureteroureterostomy
  • Ovarian cancer
  • Endometriosis

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Footnotes

  • No funding was received for this study.

  • A.H. acted as consultant for Ethicon products, Terumo, Nordic Pharma, and Fisher & Paykel and received consulting fees, salary, and travel support. D.J.B., R.L., M.N., J.N., and A.O. declare no conflicts of interest.

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