2012/9/6 Istanbul World Congress of Endourology 口頭発表

Toru HARABAYASHI, Makoto AZUMI, Yuchiro OISHI, Takahiro OSAWA, Keita MINAMI, Satoshi NAGAMORI 当施設

Laparoscopic bilateral ileal ureter substitution for hydronephrosis.

"With increasing experience of laparoscopic procedure, ileal ureter substitution for hydronephrosis has been reported, however, not yet for bilateral disease. We report the first case undergoing bilateral substitution. A 72-year-old man suffered from retroperitoneal fibrosis with bilateral hydronephrosis and required ureteral stenting over 9 years after failed steroid therapy and ureterolysis. During the period he had several episodes of pyelonephritis and his renal function gradually decreased. He was secured to the table in a supine position. A Hasson trocar was placed periumbilically and 4 ports were added. The table was rotated into a 45-degree right lateral position and mesecolon was incised. The left ureter was mobilized below the renal pelvis. Then in a 45-degree left lateral position, the right parietal peritoneum was incised and right ureter was mobilized. A 30 cm of terminal ileum was harvested extracorporeally through 3 cm periumbilical incision using a stapling device. After creating pneumoperitoneum again, the proximal portion of ileal segement was anastomosed to left ureter and the other end to right ureter. The center of segment was anastomosed to the bladder dome in Trendelenburg position. Repositioning of the patient was not required. The ureteral stents were placed in situ in each native ureter. Blood loss was minimum and operation time was 5 hours. Postoperatively he had urine leakage, which was conservatively managed, he did well at 6 months. Laparoscopic bilateral ileal ureter substitution was feasible, and bed rotation was helpful to approach for bilateral ureter. "