Appendiceal Interposition for Ureteral Stricture Disease: Technique and Surgical Outcomes

Published:September 19, 2020DOI:



      To report our initial experience with ureteral appendiceal interposition (UAI) in a series of adult patients undergoing ureteral reconstruction for ureteral stricture.


      We retrospectively collected data of patients who underwent UAI for ureteral stricture disease from December 2015 to March of 2020. Success of surgery was defined as one that required no subsequent procedural intervention for recurrent ureteral stricture disease, or loss of kidney function.


      Eleven patients underwent UAI for ureteral stricture. Etiologies for stricture disease included radiation exposure, nephrolithiasis, and iatrogenic injury. Median follow-up was 363 days. Three patients had Clavien-Dindo class III complications during their hospitalization. No patient required repeat intervention due to recurrent ureteral stricture disease. On imaging, 9 patients had no obstruction on Lasix renal scan postoperatively, or improvement in hydronephrosis on CT scan. Two patients with poor renal function preop continued to show poor function after surgery.


      The use of the appendix is a safe and feasible option for ureteral reconstruction in appropriately selected adult patients when primary ureteral repair is not possible.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Xiong S
        • Zhu W
        • Li X
        • Zhang P
        • Wang H
        • Li X
        Intestinal interposition for complex ureteral reconstruction: a comprehensive review.
        Int J Urol. 2020; 27: 377-386
        • Pamecha Y
        • Shelke U
        • Patil B
        • Patwardhan S
        • Kini S
        Use of ileum for complex ureteric reconstruction: assessment of long-term outcome, complications, and impact on renal function.
        Urol Ann. 2018; 10: 369-374
        • Boxer RJ
        • Fritzsche P
        • Skinner DG
        • et al.
        Replacement of the ureter by small intestine: clinical application and results of the ileal ureter in 89 patients.
        J Urol. 1979; 121: 728-731
        • Komyakov B
        • Ochelenko V
        • Guliev B
        • Shevnin M
        Ureteral substitution with appendix [published online ahead of print, 2020 May 31].
        Int J Urol. 2020; 10
        • Dagash H
        • Sen S
        • Chacko J
        • et al.
        The appendix as ureteral substitute: a report of 10 cases.
        J Pediatr Urol. 2008; 4: 14-19
        • Duty BD
        • Kreshover JE
        • Richstone L
        • Kavoussi LR
        Review of appendiceal onlay flap in the management of complex ureteric strictures in six patients.
        BJU Int. 2015; 115: 282-287
        • Komyakov B
        • Ochelenko V.
        16 Replacement of ureteral defects with vermiform appendix: report of 16 cases.
        J Urol. 2013; 189: e6-e7
        • Melnikoff A
        Sur le replacement de l'uretere par anse isolee de l'intestine grele.
        Rev Clin Urol. 1912; 1: 601
        • Yarlagadda VK
        • Nix JW
        • Benson DG
        • Selph JP
        Feasibility of intracorporeal robotic-assisted laparoscopic appendiceal interposition for ureteral stricture disease: a case report.
        Urology. 2017; 109: 201-205
        • Wang J
        • Xiong S
        • Fan S
        • et al.
        Appendiceal onlay flap ureteroplasty for the treatment of complex ureteral strictures: initial experience of nine patients.
        J Endourol. 2020; 34: 874-881
        • Lee Z
        • Waldorf BT
        • Cho EY
        • Liu JC
        • Metro MJ
        • Eun DD
        Robotic ureteroplasty with buccal mucosa graft for the management of complex ureteral strictures.
        J Urol. 2017; 198: 1430-1435
        • Laurin M
        • Everett ML
        • Parker W
        The cecal appendix: one more immune component with a function disturbed by post-industrial culture.
        Anat Rec (Hoboken). 2011; 294: 567-579
        • Dias Filho AC
        • Martinez CAT
        • Côrte MB
        • Maroccolo MVO
        Left ureteral appendiceal interposition: exercise caution and do not be mislead by postoperative radiological obstruction.
        Int Braz J Urol. 2018; 44: 400-402
        • Estevão-Costa J.
        Autotransplantation of the vermiform appendix for ureteral substitution.
        J Pediatr Surg. 1999; 34: 1521-1523
        • Richter A
        • Wit C
        • Vanderwinden JM
        • Wit J
        • Barthlen W
        Interstitial cells of cajal in the vermiform appendix in childhood.
        Eur J Pediatr Surg. 2009; 19: 30-33
        • Sanders KM
        • Koh SD
        • Ward SM
        Interstitial cells of cajal as pacemakers in the gastrointestinal tract.
        Annu Rev Physiol. 2006; 68: 307-343
        • Husmann DA
        • Spence HM.
        Current status of tumor of the bowel following ureterosigmoidostomy: a review.
        J Urol. 1990; 144: 607-610