Overview
Malignant neoplasm of the ureteral orifice involves cancerous growth affecting the ureteral opening, often necessitating complex reconstructive urological interventions due to extensive damage or resection 13.Diagnosis
Imaging studies (CT, MRI) to assess extent of tumor and involvement 1.
Cystoscopy and ureteroscopy for direct visualization 1.
Biopsy confirmation of malignancy 1.Management
Surgical Reconstruction:
- Ileal segment replacement for ureteral reconstruction, particularly in cases with single kidney or recurrent pathologies 3.
- Colon segment reconfiguration as an alternative when ileum is unavailable 1.
- Renal autotransplantation with pelvioureteral anastomosis for irreparable upper ureteral damage 4.
Papilla Formation: Formation at the distal end of the ileal segment to reduce vesico-ileal reflux risk 3.Special Populations
Elderly Patients: Specific considerations for surgical complexity and recovery not detailed in abstracts 134.
Comorbidities: Management strategies tailored to coexisting conditions not explicitly covered 134.Key Recommendations
Utilize ileal segments for ureteral reconstruction in cases of extensive ureteral malignancy or when preserving renal function is critical (Evidence: Moderate 3).
Consider reconfigured colon segments as a viable alternative when ileal segments are not available for ureteral replacement (Evidence: Weak 1).
Employ renal autotransplantation with pelvioureteral anastomosis as a satisfactory alternative to nephrostomy or nephrectomy in cases of irreparable upper ureteral damage (Evidence: Expert opinion 4).References
1 Pope J, Koch MO. Ureteral replacement with reconfigured colon substitute. The Journal of urology 1996. link
2 Bloom RA, Crooks KK, Wise HA. Complete ureteral triplication with ectopia. Urology 1985. link90538-2)
3 Kvarstein B, Mathisen W. Total replacement of ureter with a segment of ileum. Scandinavian journal of urology and nephrology 1977. link
4 Deweerd JH, Paulk SC, Tomera FM, Smith LH. Renal autotransplantation for upper ureteral stenosis. The Journal of urology 1976. link58657-7)