[Alloplastic ureter substitution and limitations in clinical application. A status analysis]

Operative ureteral replacement with the patient's own body tissue or by reconstructive ureteral surgery is indicated relatively often. The operative methods applied vary: they include pelvic flap pyeloplasty, caudal transposition of the kidney, interposition of the small intestine, trans-ureterostomy, calico-ureterostomy, of bladder flap transplantation and autotransplantation of the kidney. When the indications are correctly observed with reference to the kind and location of the ureteral lesion all these methods are successful. The methods of alloplastic replacement of the ureter, in contrast, have lost clinical importance and should be performed only in rare, isolated cases, mainly as a short-term solution. Possible indications are a poor general condition in patients for whom alloplastic ureteral replacement is the only alternative to permanent nephrostomy and malignant tumours requiring immediate irradiation, which cannot be postponed until definitive wound healing has taken place following a plastic operation. It is important that problems of biocompatibility have now been largely overcome. Segmental ureteral replacement with alloplastic materials is not possible, however, and the functional difficulties with urinary transport have not been solved in the long term, even in models with pumps and reflux-preventing mechanisms.