The prosthetic replacement of the ureter: experimental and clinical results

The authors present their experience over several years in replacement of the ureter by a silicone prosthesis. This includes experimental work in dogs and clinical application performed in three different ways: (1) A uretero-vesical or pelvo-vesical bridge. Trials were started in 1967 and on the whole the results have been good, although in some cases deterioration was noted after a few months (18-20). The quality of the results obtained experimentally, encouraged clinical application and the authors employed ten prostheses in patients with advanced carcinoma and obstruction. The results have been excellent and a cutaneous fistula or diversion has been avoided. (2) Segmental replacement of the lumbo-iliac ureter. In experiments in 15 dogs, there were nine successful results, with survival periods of from 19 to 25 months. One patient has been treated with an immediate good result. (3) A renal-ureteric bridge. By implanting the top end of the prosthesis in the lower calyx and at the lower end in the lumbo-iliac ureter, the pelvis and proximal ureter are by-passed. This procedure has been applied in one patient. He has been followed up for only 4 months, but the results appear to be excellent.