Ileal ureteral replacement for tuberculous ureteral strictures: 11 cases of experience.

PURPOSE: To evaluate the feasibility and safety of ileal ureteral replacement (IUR) for long-segment ureteral strictures secondary to urogenital tuberculosis (UGTB).

METHOD: 11 patients with complex tuberculous ureteral strictures underwent IUR across three tertiary centers between March 2015 and January 2024. Surgical approaches included open (n = 2), laparoscopic (n = 4), and robotic-assisted (n = 5). Demographic characteristics, perioperative data and follow-up outcomes were prospectively collected.

RESULT: 11 patients (8 males, 3 females) with a mean age of 38.3 ± 13.1 years were included. Two patients had bilateral involvement, and nine patients had unilateral involvement. Four patients underwent concomitant ileocystoplasty. The mean stricture length was 19.0 ± 6.3 cm, and the median length of ileum harvested was 25 cm. The mean operative time was 283.9 ± 28.1 min. The median estimated blood loss was 150 mL. The median postoperative hospital stay was 15 days, with the robotic approach significantly reducing hospitalization time (p = 0.015). During the median follow-up of 36 months, all patients achieved ureteral patency. The mean preoperative and latest estimated glomerular filtration rate were 82.0 ± 24.1 and 74.7 ± 22.9 mL/min/1.73 m(p = 0.062), respectively. Complications were reported in 8 patients, primarily metabolic acidosis (6/11) and urinary tract infections (4/11). Metabolic acidosis was associated with renal function decline (p = 0.015). Two patients experienced major complications, consisting of ileus and incision infection respectively.

CONCLUSION: IUR is a safe and effective last resort for patients with complex ureteral strictures secondary to UGTB. High complication rates and long-term metabolic risks limit its application, necessitating strict patient selection and rigorous lifelong management.