This 13-year-old boy was referred in 1976 for reconstructive surgery of an ileal loop done after ureteral reimplantation had failed in two prior hospitals 5 years previously. As an infant, he had been treated successfully for HIrschsprung’s Disease by colon resection and pull through. It was presumed that he had a neuropathic bladder.
Preoperative evaluation showed a 100-ml bladder, with good sensation and ability to empty the bladder when it was filled with saline.
Several useful maneuvers are illustrated in this operation. First, is the use of transureteroureterostomy, which we have used extensively. Care must be taken to avoid wedging the crossing ureter beneath a mesenteric vessel, especially the left colic artery. The loop was tapered to substitute for loss of right ureter.
Comment from Dr. Hendren: Patients with small bowel in the urinary tract very commonly will develop one or more well defined strictures which may need dilatation or even cutting as he did. This will require careful long-term observation.
Anatomy (Select Image for High-quality Version). (Top) Before and (Bottom) after reconfiguring his urinary tract.
X-ray (Select Image for High-quality Version). Antegrade study via left kidney. Note discrete narrowing of tapered bowel loop just prior to its entry to bladder. He is allergic to I.V. contrast. Subsequent evaluations have been done by ultrasonography.
The patient convalesced smoothly and lived a normal life style. In Oct. 2003, at age 40, he developed some abdominal pain from a stricture within his tapered ileal loop segment. This was incised endoscopically with relief of the back pressure. The patient, age 51 in 2014, was in good general health as a husband and step father.