Sustitución de uréter con apéndice cecal en un paciente con estenosis ureteral: primer caso reportado en México y revisión de la literatura

Abstract

Over a span of 20 years, urologic, gynecologic, and general surgery operations were responsible for 42%, 34%, and 24% of injuries, respectively. In 1912, Melnikoff described the first substitution of a ureter with the vermiform appendix as treatment for ureteral stricture.

Objective

Our aim was to present herein a case of ureter substitution with the cecal appendix to promote the feasibility of the procedure and to describe the first experience at a tertiary care hospital in Mexico.

Material and methods

A 35-year-old woman was diagnosed with right distal ureteral stricture secondary to injury after a total abdominal hysterectomy and right nephrostomy placement.

Results

Given that the course of the stricture was approximately 10 cm, transposition of the appendix was decided upon. The cecal end of the appendix was previously isolated and splinted with a double-J ureteral stent and then anastomosed to the ureter with the end-to-end method and the distal end was reimplanted into the bladder with the Politano-Leadbetter technique. At 11 months after the procedure, the patient presented with adequate progression, was asymptomatic, and the control imaging studies showed satisfactory passage of urine from the kidney to the bladder, with no pyelocaliceal dilation or stricture.

Conclusions

There are various advantages to using the appendix as a substitute material, among which are good contractibility, availability to be moved with a blood supply, the fact that it does not absorb urine, the possibility to create a submucosal tunnel to prevent reflux, and a caliber similar to that of the ureteral lumen.