101
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Weinberg AC, Xie HW, Hardy BE, Skinner DG. Nonrefluxing ileal ureteral replacement using the intussuscepted ileal nipple: laboratory studies. J Urol 1990; 144:1041-3. [PMID: 2398552 DOI: 10.1016/s0022-5347(17)39654-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A new technique for nonrefluxing ureteral replacement using ileum has been developed. Five adult mongrel dogs were operated using this nonrefluxing ileal ureteral technique. Subsequent reoperation showed in every case the preservation of renal function, a nonrefluxing system and no evidence of pyelonephritis or hydronephrosis. Based on the intussuscepted ileal nipple used in the Kock continent ileostomy, this technique has application in candidates for urinary undiversion, situations of ureteral loss due to trauma and fibrosis, and in patients with tuberculous strictured ureters.
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Affiliation(s)
- A C Weinberg
- Children's Hospital, USC School of Medicine, Los Angeles
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102
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WISE KENDALLL, CARSON CULLEYC. Ileocecal Substitution in the Treatment of Severe Ureteroscopy-Related Ureteral Trauma: Report of Three Cases. J Endourol 1990. [DOI: 10.1089/end.1990.4.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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103
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Benson MC, Ring KS, Olsson CA. Ureteral reconstruction and bypass: experience with ileal interposition, the Boari flap-psoas hitch and renal autotransplantation. J Urol 1990; 143:20-3. [PMID: 2294254 DOI: 10.1016/s0022-5347(17)39852-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A total of 18 patients underwent an operation for extensive ureteral loss from 1980 to 1986. The indications included recurrent calculi, retroperitoneal fibrosis, surgical trauma and tumor. Of the patients 10 had construction of an ileal ureter (4 had bilateral reconstruction), 6 had creation of a psoas hitch with a Boari bladder tube and 2 were treated by autotransplantation. Mean duration of followup was 4.8 years. The procedure was successful in 17 patients. There were no apparent differences among the groups. Selection criteria and potential complications are discussed with regard to each technique. These procedures provide an excellent means for reconstruction of the urinary tract in patients who have failed other treatments.
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Affiliation(s)
- M C Benson
- Department of Urology, Columbia University College of Physicians and Surgeons, J. Bentley Squier Urologic Clinic, Columbia Presbyterian Medical Center, New York, New York
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104
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Waters WB, Herbster G, Jablokow VR, Reda DJ. Ureteral replacement using ileum in compromised renal function. J Urol 1989; 141:432-6. [PMID: 2913371 DOI: 10.1016/s0022-5347(17)40788-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ureteral replacement by ileum is an accepted technique in a highly selective patient population. Two major contraindications in using an ileal ureter are compromised renal function (serum creatinine greater than 2) and a functionally abnormal bladder. We used ileum to bridge a ureteral defect in animals with half of a solitary kidney and low grade azotemia to see if the antirefluxing mechanism of the lower ureter prevented further deterioration in renal function. Twelve female mongrel dogs underwent a right nephrectomy, followed by a left partial nephrectomy six weeks later. Group I (six dogs) had a six cm. segment of ileum interposed between the upper and lower ureteral segments (nonrefluxing). Group II (five dogs) had a ten cm. segment of ileum placed from the upper third of the ureter to the bladder (refluxing). Cystograms, intravenous pyelograms, serum electrolytes, BUN and creatinine were obtained preoperatively, six weeks after the right nephrectomy, one month after left partial nephrectomy and six months after ileal replacement prior to sacrifice. The BUN and creatinine deteriorated in Group II compared to Group I, p = .02 and p = 0.4 respectively (Mann-Whitney test). The BUN and creatinine also deteriorated between one month after left partial nephrectomy and six months after ileal replacement within Group II, p = .07 and p = .14, respectively (Wilcoxon matched-pairs test) but not in Group I. These data suggest that the antirefluxing mechanism of the lower ureter might prevent further deterioration in renal function. We feel that ileum can be used with caution, as an interposition in compromised renal function.
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Affiliation(s)
- W B Waters
- Section of Urology, V.A. Hospital, Hines, Illinois
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105
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Moriya Y, Hojo K, Sawada T. En bloc excision of lower ureter and internal iliac vessels for locally advanced upper rectal and rectosigmoid cancer. Use of ileal segment for ureteral repair. Dis Colon Rectum 1988; 31:872-8. [PMID: 3180960 DOI: 10.1007/bf02554852] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Eight patients who received en bloc excision of the ureter and internal iliac vessels for locally advanced upper rectal and rectosigmoid cancer were reported. Indications, techniques, functional results of the ileal ureter, and prognosis of these patients are discussed. Although three patients died of recurrent tumor--one of transperitoneal spread and two of liver metastasis--none of them developed local recurrent growth. As a replacement for the resected ureter, ileal substitution was applied in all eight patients--unilateral in six patients and bilateral in two. Serum creatinine and electrolyte patterns were within the normal range in all patients. A voiding cystogram showed no reflux to the anastomosed ureter, and a mild reflux to the ileal segment. The patients had excellent prognoses with regard to local control and also satisfactory functional results with the ileal ureter. The authors recommend that this procedure be applied to patients with locally advanced cancer such as those in this series.
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Affiliation(s)
- Y Moriya
- Department of Surgery, National Cancer Center Hospital, Tokyo, Japan
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106
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McMullin ND. Urinary tract reconstruction in children. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1988; 58:619-29. [PMID: 3178601 DOI: 10.1111/j.1445-2197.1988.tb07572.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The successful introduction of clean intermittent catheterization and increased awareness of urinary tract physiology and urodynamics have been the basis for recent major advances in urinary tract reconstructive surgery. Surgical techniques are now available to manage anatomical and functional deficiencies of any isolated or combined components of the urinary tract. The high incidence of unsatisfactory long-term results with ileal conduit diversion has led to increased popularity in urinary tract undiversion and greater utilization of reconstructive principles. As with any new surgical field of endeavour, new operative techniques are appearing at a rapid rate. In particular, there has been a recent proliferation of surgical procedures that provide a continent, low pressure, catheterizable reservoir for urine storage. Most children with major urinary tract deficiencies can now be offered socially and cosmetically unobtrusive surgical solutions without jeopardizing renal function.
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107
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108
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109
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Future aspects of renal transplantation. World J Urol 1988; 6:136-139. [PMID: 21151858 DOI: 10.1007/bf00326630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
New and exciting advances in renal transplantation are continuously being made, and the horizons for organ transplantation are bright and open. This article reviews only a few of the newer advances that will allow renal transplantation to become even more widespread and successful. The important and exciting implications for extrarenal organ transplantation are immediately evident.
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110
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Abstract
Among our 56 patients who have undergone urinary tract reconstruction with intact bladders 45 have required some compensation for lost ureteral length. Of these patients 33 had only distal ureteral loss and underwent reconstruction with a combination of a psoas hitch, transureteroureterostomy and primary reimplantation. Four patients with more extensive ureteral loss underwent a Boari flap procedure, and of the 8 patients with major ureteral loss 6 had small bowel interposition and 2 have had renal autotransplantation to compensate for lost ureteral length. All patients are well with stable renal function at 1 to 7-year followup.
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111
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WHELAN JPAUL, LOCKE R, NEWMAN ROBERTC, FINLAYSON BIRDWELL. Ureteral Stricture Secondary to Endourologic Procedures: A Case Leading to Autotransplantation and Review of Treatment Options. J Endourol 1987. [DOI: 10.1089/end.1987.1.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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112
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Bodie B, Novick AC, Rose M, Straffon RA. Long-term results with renal autotransplantation for ureteral replacement. J Urol 1986; 136:1187-9. [PMID: 3534311 DOI: 10.1016/s0022-5347(17)45278-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
From 1970 to 1984 renal autotransplantation was performed on 23 patients to replace all or a major portion of the ureter. The conditions necessitating ureteral replacement were postoperative ureteral injury in 16 cases, recurrent renal colic in 4, urinary undiversion in 2 and an atonic ureter in 1. Six patients presented with a solitary kidney and 1 underwent staged bilateral autotransplantation. After autotransplantation urinary continuity was restored by ureteroneocystostomy in 11 patients, pyelovesicostomy in 7, ureteroureterostomy in 2, pyeloureterostomy in 2 and ureterosigmoidostomy in 1. Postoperatively, there was no mortality and all but 1 of the autotransplanted kidneys functioned immediately. Two kidneys required removal postoperatively owing to bleeding. Currently, 20 patients are alive with functioning renal autotransplants at intervals of 1.5 to 14 years. The current serum creatinine level in these patients ranges from 1.1 to 2.2 mg. per dl., which in each case is improved or stable compared to the preoperative determination. Only 1 patient has experienced chronic bacteriuria. We conclude that renal autotransplantation provides excellent long-term treatment for patients who require ureteral replacement.
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113
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114
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Kromann B, Steven K, Hald T, Olsson C. The use of the Boari-flap and psoas-bladder hitch technique in the repair of a high ureteric lesion. A case report. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1986; 20:233-4. [PMID: 3787202 DOI: 10.3109/00365598609024502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Combining the bladder-psoas hitch Boari-flap technique makes it possible to replace the entire ureter. The operation was used successfully in one patient with an extensive proximal ureter lesion. This method can be used in patients with reduced renal function, since the continuity of the urinary tract is preserved; it requires a normal bladder wall and bladder capacity exceeding 400 ml.
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115
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Olsson CA, Norlén LJ. Combined Boari bladder flap-psoas bladder hitch procedure in ureteral replacement. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1986; 20:279-84. [PMID: 3810057 DOI: 10.3109/00365598609024512] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Uncomplicated injuries to the ureter are commonly treated with end-to-end ureteroureterostomy or reimplantation into the bladder. The Boari bladder flap and the psoas bladder hitch have been used separately when distal ureteral replacement is required. In cases of more extensive ureteral damage extending above the pelvic rim, more complex procedures have been performed. These procedures (transureteroureterostomy, intestinal replacement or renal autotransplantation) often represent a considerable surgical challenge and may be associated with numerous complications. Combining the principles of the psoas bladder hitch and Boari flap affords the clinician a means of traversing extensive ureteral defects with standard surgical techniques. We report herein patients with ureteral damage who have undergone replacement of various lengths of ureter with combined psoas hitch/Boari flap procedures. The technique is suitable for traversing ureteral defects at least to the lower pole of the kidney. An obvious advantage is that the replacement utilizes only normal urinary tract, it does not endanger ipsilateral kidney nor contralateral ureter or kidney and can be employed in patients with decreased renal function. In our experience ureteral replacement with the combination of the psoas bladder hitch and Boari bladder flap is an excellent method which is surgically simpler and safer than the other methods described for more extensive ureteral injuries.
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116
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Abstract
We report 2 successful cases of ileal conduit diversion from a bivalved kidney. Both patients had a single kidney and were in chronic renal failure. Cutaneous diversion had malfunctioned because of intrarenal obstruction of tuberculous origin. The kidney was bivalved and anastomosed to an isolated ileal segment. The lower end of the ileal segment was brought to the abdominal skin as a stoma. Postoperatively, renal function was aggravated temporarily. During the followup periods of 2 years and 1 year 6 months neither patient had evidence of renal deterioration. This type of urinary diversion seems acceptable for relieving infundibular stricture with chronic renal failure.
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117
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Casale AJ, Colodny AH, Bauer SB, Retik AB. The use of bowel interposed between proximal and distal ureter in urinary tract reconstruction. J Urol 1985; 134:737-40. [PMID: 4032584 DOI: 10.1016/s0022-5347(17)47415-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The replacement of lost ureter with bowel interposition is a feasible alternative in the reconstruction of the urinary tract. When adequate ureteral length is not present, interposition of a portion of small bowel between the proximal and distal ureteral segments is an option that minimizes the amount of bowel in the urinary tract. This, in turn, reduces mucus production and electrolyte absorption in the reconstructed urinary tract, and allows for more bowel to remain as part of the functioning gastrointestinal tract. This procedure allows use of the antirefluxing function of the normal ureterovesical junction when present. We have used successfully interposition of the small bowel between the proximal and distal ureteral segments for undiversion in 5 children. Generally, we strive to join urothelium to urothelium without the use of bowel in urinary tract reconstruction but when this is not feasible, bowel interposition has been a useful option.
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118
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Waters WB, Acino SM, Herbster G, Jablokow VR. Urinary undiversion using the existing ileal loop and distal right ureter. J Urol 1985; 134:809-12. [PMID: 4032597 DOI: 10.1016/s0022-5347(17)47444-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Urinary undiversion is an accepted technique in a highly selective patient population. We reconstructed the urinary tract in six female mongrel dogs. A 15 cm. segment of ileum was isolated, both ends were closed and bowel continuity re-established. The proximal two-thirds of each ureter were anastomosed to the proximal end of the ileal segment. The distal one-third right ureteral segment, in continuity with the bladder, was anastomosed end-to-side to the distal ileal segment. Information from the intravenous pyelograms, renal function tests, electrolytes and pathological studies showed normal upper tracts without dilatation or obstruction, preservation of renal function and normal electrolytes except for mild hyperchloremia in all 6 animals. There was chronic pyelonephritis in one animal and mild focal renal inflammation in two animals. The uretero-ileal anastomoses were patent and the ureters were not dilated. The interposed ileum functions well as a conduit and does not become a reservoir over time. We believe incorporating ileum into the urinary tract in this technique of undiversion is a safe and effective clinical alternative in selected patients.
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119
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Affiliation(s)
- Terry W. Hensle
- From the Department of Pediatric Urology, Babies Hospital, Columbia-Presbyterian Medical Center, Columbia University and College of Physicians and Surgeons, New York, New York
| | - Kevin A. Burbige
- From the Department of Pediatric Urology, Babies Hospital, Columbia-Presbyterian Medical Center, Columbia University and College of Physicians and Surgeons, New York, New York
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120
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121
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Waltzer WC, Frischer Z, Gonder M. Ureteral replacement with ileum in transverse colon conduit. Int Urol Nephrol 1984; 16:285-9. [PMID: 6535778 DOI: 10.1007/bf02081862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A case of replacement of a damaged ureter with ileum, in a previously constructed transverse colon conduits, is reported. This is an attractive surgical alternative that deserves a place as a reconstructive procedure in the management of ureteral complications following urinary diversion.
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122
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Abstract
During the last 4 years we treated 11 patients with obstructed kidneys and intrapelvic strictures, which were owing to tuberculosis in 9 and renal stone surgery in 2. Pan-caliceal ileoneocystostomy was performed in all 11 cases. The entire caliceal system was anastomosed to an ileal ureter and, thus, relieved the obstruction. The result of this operation was most gratifying. Although 1 patient died of anastomotic leakage and sepsis the morbidity was low.
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123
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Vatandaslar F, Reid RE, Freed SZ, Smey P, Kogan SJ, Goldsmith D, Bernstein R, Levitt SB. Ileal segment replacement of ureter. I. Effects on kidney of refluxing vs nonrefluxing ileovesical anastomosis. Urology 1984; 23:549-58. [PMID: 6730123 DOI: 10.1016/0090-4295(84)90069-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Unilateral partial ureteral obstruction was induced in 32 dogs followed by total ileal replacement of the obstructed ureter. The morphologic and functional effects on the kidney using a freely refluxing versus a nonrefluxing ileovesical anastomosis were compared, as well as the effect of total tapering of the reimplanted ileal segment. The tapered ileovesical anastomosis proved more reliable for prevention of reflux than the nontapered technique. Reflux prevention does not appear necessary for maintaining renal morphology and function when bladder function is normal and the observation period short. Total tapering of the ileal segment did not prove to be advantageous in protecting against hyperchloremic acidosis in this short-term canine study.
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124
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Vatandaslar F, Reid RE, Freed SZ, Smey P, Kogan SJ, Goldsmith D, Berstein R, Levitt SB. Ileal segment replacement of ureter. II. Dynamic characteristics of refluxing, nonrefluxing, and totally tapered ileal ureter. Urology 1984; 23:559-64. [PMID: 6730124 DOI: 10.1016/0090-4295(84)90070-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The pressure characteristics and cinefluoroscopic appearances of a refluxing, nonrefluxing, and totally tapered ileal " neoureter " were compared in 22 dogs with normal bladder function. The totally tapered ileal segment with a reflux preventing ileovesicostomy simulates normal ureteral peristalsis most closely on cinefluoroscopic evaluation. Pressure gradients across the ileovesical junction though were similar in refluxing and nonrefluxing ileovesicostomies , as well as in totally tapered ureters.
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125
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Light JK, Scott FB. Total reconstruction of the lower urinary tract using bowel and the artificial urinary sphincter. J Urol 1984; 131:953-6. [PMID: 6708234 DOI: 10.1016/s0022-5347(17)50725-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We report 3 cases in which the lower urinary tract was reconstructed using bowel. In each instance the cuff was placed around the bowel to provide a continence mechanism. The 2 patients in whom the sigmoid colon was used have sporadic diurnal incontinence with nocturnal enuresis. Urodynamic evaluation has shown that this is secondary to high pressures generated within the closed sigmoid loop. The ileocecocolonic segment is preferable for reconstruction of the lower urinary tract, since the pressure developed within the bowel is significantly lower. The use of the artificial urinary sphincter around the bowel extended the versatility of the device.
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126
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127
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128
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Pettersson S, Brynger H, Henriksson C, Nilson AE, Ranch T. Autologous renal transplantation with direct pyelocystostomy in the treatment of recurrent renal calculi. BRITISH JOURNAL OF UROLOGY 1983; 55:154-61. [PMID: 6340787 DOI: 10.1111/j.1464-410x.1983.tb06544.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Six male patients with severe recurrent urinary calculus disease underwent renal autotransplantation with direct pyelocystostomy to allow spontaneous passage of stones. The only serious complication was an early renal vascular thrombosis with graft loss in one patient who had been operated on three times before with ipsilateral partial resections for nephrolithiasis. The other five patients did well (observation time 4-34 months). Their renal function has remained unchanged. Autotransplantation with direct pyelocystostomy should be considered in patients with multiple recurrent stones of the upper urinary tract, especially when some degree of obstruction has developed or when other predisposing anomalies prevail.
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129
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Abstract
Late stricture is a well known complication of ileal loops. We herein report on late stricture in 5 patients in whom bowel was used as a substitute ureter in closed, nondiverted urinary tracts. This late complication mandates the need to provide continuing followup indefinitely in patients in whom bowel segments are incorporated in the urinary tracts.
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130
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131
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Chary KS, Rao MS, Palaniswamy R. Vesicopyelostomy using a tubed bladder flap-multiple psoas hitch technique to an orthotopic kidney. J Urol 1982; 127:129-31. [PMID: 7057484 DOI: 10.1016/s0022-5347(17)53641-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A case is reported in which a long upper ureteral stricture, resulting from a failed pyeloureteroplasty, was repaired using a pedicle bladder tube. A vesico-psoas hitch was performed as the initial procedure. A 17 cm. long bladder flap was based posteriorly and extended across the dome and the anterior wall onto the contralateral posterolateral aspect of the bladder. Stepwise stretching and hitching of the bladder flap to the psoas major muscle at 5 places ensured successful bridging of the gap without compromising its vascularity. At followup cystography the bladder tube was noted to accommodate the reflux of contrast material, preventing its entry into the pelviocaliceal system. The patient regained a bladder capacity of about 300 ml. This procedure should be considered before ileal ureteral replacement or autotransplantation in cases of extensive ureteral loss.
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132
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Abstract
Undiversion is an interesting phenomenon but may in part be self-limiting. As the experience with techniques in reconstruction increases, the need for diversion may give way to that of earlier correction of the original pathology, Thus, reversal of diversion by offering a wealth of experience in reconstruction may well lead to its own demise. Nevertheless, even with newer reconstructive techniques, there is, to date, a definite place for diversion of the urinary tract in the pediatric age group and there are now many pediatric patients still to be considered candidates for undiversion
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133
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134
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Nabizadeh I, Reid RE, Henderson JL. Simplified nonrefluxing ileovesical anastomosis. Experimental study and clinical application. Urology 1981; 18:11-4. [PMID: 7257032 DOI: 10.1016/0090-4295(81)90487-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A simplified ileovesical anastomosis is herein described. It prevents vesicoileal reflux and allows for unimpeded efflux of urine into the bladder. The technique involves implanting 3 inches of distal ileum into a denuded muscular bed in the bladder. Vesical mucosa grows over the ileum creating an effective valvular mechanism. Experimental work done on the canine bladder and the use of this technique in 2 patients is described.
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135
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136
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137
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Abstract
Ureteral strictures occurring after ureterolithotomy may not be recognized until obstruction or recurrent stone impaction occurs in the area. We describe our treatment of this problem in 9 patients. Management varied from conservative treatment in patients having no discernible renal function on the affected side to various forms of reconstruction or reimplantation, depending upon the situation and site of the stricture. All patients were followed for a minimum of 2 years without complications. The etiopathogenesis and other methods of treatment available for this problem are discussed.
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138
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Martorana G, Carmignani G, Giberti C, Belgrano E, Pescatore D, Giuliani L. La Calcolosi Renale Dopo Sostituzione Dell'Uretere Con Ansa Ileale. Urologia 1980. [DOI: 10.1177/039156038004700405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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139
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Abstract
Renal autotransplantation as an alternative to ileal interposition has been done successfully in patients with repetitive episodes of renal colic. Urinary tract continuity has been re-established by anastomosis of a Boari tube directly to the renal pelvis. This has resulted in easy egress of recurrent calculi without pain. Furthermore, the musculature of the Boari tube seems to be adequate for prevention of vesicorenal reflux. The procedure has been devoid of electrolyte and mucous urinary retention problems associated with ileal interpositionand it is advocated as an alternative in the management of such patients when medical therapy fails.
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140
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