Salvaging the obstructed ureterosigmoidostomy using an ileal interposition technique

Ureterointestinal obstruction is a major complication of ureterosigmoidostomy and one that usually forces a flight to other forms of urinary diversion. Many patients, however, are reluctant to give up the life- style that ureterosigmoidostomy offers and prefer an alternative that permits retention of the basic features of the procedure. To satisfy these demands a technique has been developed in which an intussuscepted segment of small bowel is interposed between the colon and the ureters. This operation has allowed salvage of an obstructed ureterosigmoidostomy in 6 patients and has given such good results that it has been done as a primary procedure in 1. In addition to its use for the salvage of existing ureterosigmoidostomies, the operation permits primary ureterosigmoidostomy to be done in patients with dilated ureters, and it may even lessen the risk of colon cancer by separating the urothelium from the colonic mucosa.