[Vermiform appendix used as a segment of the ureter].

Area of Science:

• Urology
• Surgical Oncology
• Regenerative Medicine

Background:

• Transitional cell carcinoma of the ureter presents challenges in surgical management, especially with extensive ureteral defects.
• Standard ureteral reconstruction techniques may not be feasible in cases requiring significant length reconstruction or in patients with limited surgical options.
• The management of ureteral defects in patients with a single kidney necessitates careful consideration of functional preservation.

Observation:

• A 67-year-old male patient with a solitary kidney presented with hematuria and elevated creatinine.
• Imaging revealed a poorly differentiated invasive transitional cell tumor in the mid-right ureter, necessitating a 10 cm resection.
• Conventional ureteral reconstruction methods were deemed unsuitable due to the large defect size.

Findings:

• The vermiform appendix was successfully utilized as an interpositional graft to bridge the 10 cm ureteral defect.
• The appendiceal graft demonstrated satisfactory function post-operatively, maintaining urinary continuity.
• Despite initial graft success, the patient experienced cancer recurrence and succumbed to the disease one year later.

Implications:

• Appendiceal interposition serves as a viable alternative for ureteral reconstruction when standard techniques like Boari flap, uretero-ureterostomy, or renal autotransplantation are not applicable.
• This technique offers a potential solution for complex ureteral defects, particularly in patients with solitary kidneys where renal preservation is paramount.
• Further investigation into the long-term efficacy and oncological outcomes of appendiceal grafting for ureteral reconstruction is warranted.