Use of the Appendix to Replace a Ureter.

Case Report
By Lester W. Martin
Cincinnati, Ohio

O The v e r m i f o r m appendix w a s utilized as a

conduit f r o m t h e right renal pelvis t o t h e l e f t u r e t e r
w i t h satisfactory function a f t e r 3.5 yr.

INDEX WORDS: A p p e n d i x ; ureter.

N 8-yr-old boy with an initial diagnosis of

A posterior urethral valves was
because of complications following
referred
multiple
operations on the urinary tract. A combination
of infection, postoperative adhesions and opera-
tive injury had resulted in loss of the entire right
ureter. Both kidneys were hydronephrotic with
borderline renal function with BUN of 35 mg/dl
and creatinine 1.6 mg/dl. A tube nephrostomy
provided adequate drainage of the right kidney.
On the left side, a previous ureteroneocystos-
tomy had been performed. The ureter was
dilated but functioned without obstruction or
reflux. The posterior urethral valves had
previously been satisfactorily resected. The blad-
der was trabeculated but the patient voided with
control and with no residual urine.
To provide internal drainage of the right Fig. 1, Demonstration of the isoperistaltic placement
kidney, the appendix was utilized as a conduit of the appendix between the pelvis of the right kidney and
the left ureter.
from the pelvis of the right kidney to the left
ureter (Fig. 1). The right colon was mobilized.
The appendix, which was 8.0 cm in length, was it lay anterior to the aorta and vena cava and was
transected at its base, the stump ligated and completely retroperitoneal. Rubber Penrose
inverted in the conventional manner. The drains were placed to each retroperitoneal
mesoappendix was maintained intact to preserve anastomosis for drainage through stab incisions
the appendiceal blood supply. The tip of the through the respective right and left sides of the
appendix was excised, the lumen was determined abdomen. Six months later, stenosis of the proxi-
to be patent and its contents were evacuated by
irrigation with normal saline solution. An open
anastomosis was then accomplished from the From the Division of Pediatric Surgery, the Department
opened renal pelvis to the tip of the appendix of Surgery, College of Medicine, University of Cincinnati,
with 5-0 chromic catgut, incorporating the full and the Pediatric Surgical Service of the Children's Hospi-
tal Cincinnati, Ohio.
thickness of both the renal pelvis and the appen- Presented before the Twelfth Annual Meeting of the
dix for a watertight anastomosis. The proximal American Pediatric Surgical Association together with the
end of the appendix was then spatulated and an British Association of Pediatric Surgeons, Tarpon Springs,
open anastomosis accomplished to a longitudinal Florida, April 29-May 2, 1981.
opening in the mid left ureter, employing the Address reprint requests to Lester IV. Martin, M.D., The
Children's Hospital, 240 Bethesda Avenue, Cincinnati, Ohio
same anastomotic technique. At the completion 45229.
of the anastomosis, the appendix appeared well 9 1981 by Grune & Stratton, Inc.
vascularized, its peristalsis was from right to left, 0022-3468/81/1606-0004501.00/0

Journal of Pediatric Surgery, Vol. 16, No. 6 (December), 1981 799

800
real anastomosis was demonstrated by antigrade
nephrostogram. The anastomosis was revised
and the nephrostomy tube was removed.
During the subsequent 3.5 years, the patient
has remained free of symptoms and is off all
medications. The BUN is stable at 36 m g / d l
with a creatinine of 1.3 mg/dl. Radiographical-
ly, the status of the hydronephrotic kidneys has
remained stable. A percutaneous antigrade py-
elogram demonstrates a patent and functioning
appendiceal conduit with unusually active peri-
stalsis of the conduit and with prompt evacua-
tion of contrast media from the kidney.
DISCUSSION
Weinberg ~ of Rhodesia, in 1976 reported an
l l - y r follow-up of a patient with appendiceal
LESTER W. MARTIN
replacement of the lower ureter for schistosomal
stricture and credited Melinkoff 2 as the first to
use the appendix for ureteral replacement in
1912. Occasional subsequent reports have
appeared in the French and Polish literature, but
otherwise, our literature search proved unpro-
ductive.
Our satisfactory experience with one patient is
reported to direct attention to the possible use of
the appendix for ureteral replacement.
REFERENCES
1. Weinberg RW: Appendix ureteroplasty. Br J Urol
48:234, 1976
2. MelinkoffRE: Sur le replacement de l'uret~re par une
anse isol6e de l'intestin grEle. Rev Clin Urol 1:601-603,
1912