Abstract
An 11-year-old boy was referred for further management of a 6-cm-long grossly stenosed
ureter following two failed left ureteropelvic junction (UPJ) obstruction repairs
elsewhere. A tapered segment of the descending colon (TDC) was used successfully for
ureteral reconstruction. The UPJ was exposed through a left flank incision. The stenosed
segment was excised; both ends appeared severely inflamed and thickened. Tissue interposition
was required and ureteroplasty with a TDC was performed by incising the peritoneum
adjacent to the excised ureter to mobilize the descending colon to the retroperitoneal
space. To prepare the TDC, an 8-cm segment of the colon with intact blood vessels
was isolated, tapered, and sutured into a funnel shape using a 14-Fr catheter as a
temporary stent. After colocolostomy, the colon was returned to the abdominal cavity,
the peritoneum was closed carefully to prevent vascular compromise, and the TDC was
anastomosed to the ureter and renal calyx with interrupted absorbable sutures. A double
J stent (DJS) and percutaneous nephrostomy tube were placed. Postoperative recovery
was uneventful. The DJS was removed on day 50 after confirming smooth urine flow through
both the ureter–TDC and calyx–TDC anastomoses. Diuretic renography performed 68 days
postoperatively was unobstructed. The patient is currently well after 12 months follow-up.
This would appear to be the first report of a TDC being used to create a funnel-shaped
segment to reconstruct a long, grossly stenosed ureter. The TDC is simpler than the
re-tubularizing colon but requires monitoring for postoperative mucus-related complications
and malignant transformation.
Keywords
ureteral reconstruction - ureteropelvic junction obstruction - tapered segment of
the descending colon - long ureteral stenosis
