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Experience with more than 500 ileal conduit diversions in a 12 year period
532 a functioning kidney sterile environment.-B.
INTERNATIONAL
to be transplanted M. Henderson.
into
ABSTRACTS
OF
PEDIATBIC
SURGERY
a
URINARY DIVERSION BY ILEAL CONDUIT. A LONGTERM FOLLOW-UP. A. Kafetsioulis and 1. Swinney. Brit. J. Urol. 40:1-11, February 1968.
PYEZLOILEALURINARY CONDUIT: AN 8 YEAR ExPERIENCEIX 37 PATIENTS. J. M. Holland, H. K. A. Schirmer, L. R. King, R. P. Gibbons, and W. W. Scott. J. Urol. 99:427, 1968.
about one quarter of Seventy-two patients, whom were children, who had undergone urinary diversion by ileal conduit are reviewed. Early complications included 8 postoperative deaths which resulted from urinary or fecal fistula. Late complications: Stenosis of the stoma was usually associated with retraction and occurred mostly in children. Purulent discharge from the infected, defunctional bladder rarely responded to irrigation and secondary cystectomy was required. Stomal excoriation and phosphatic encrustation was usually due to lack of care in managing the appliance. In 6 patients, renal calculi formed. Four patients require continuous treatment for electrolytic imbalance; all had severe renal impairment
In a group of 37 patients with atonic dilated ureters the authors performed urinary diversion using an ileal conduit anastomosed to the renal pelvis or the uppermost portion of the ureter. This group of patients includes an 8-year-old boy with congenital urethral valves and bilateral hydronephrosis and a 7-year-old girl with vesicoureteral reflux associated with right hydronephrosis and hydrometer. Following the procedure renal function improved or became stabilized in 29 of the 31 patients still living. They conclude that pyeloileal conduit diversion is a reliable procedure and is indicated in those patients with badly damaged kidneys and nonfunctioning ureters.-B. M. Henderson. EXPERIENCE WITH MORE THAN 500 ILEAL CONDUIT DIVEKSIONS IN A 12 YEAR PERIOD. P. C. Parkhurst. J. Urol. 99:434, 1968. The author reviews 562 ileal conduit diversions, including 51 children, performed during a 12-yearperiod by 36 surgeons at the Massachusetts General Hospital. The overall mortality was 10 per cent, 61 patients, which included 52 patients with malignant disease. The postoperative complications fell into 3 main groups: cardiovascular, inflammatory, and technical. The author emphasizes the value of ileal loopograms in the presence of generalized peritoneal irritation, anuria, or when there is a possibility of retroperitoneal extravasation. In the presence of urinary extravasation catheters or some pump drainage of the conduit is suggested unless significant accumulations of urine develop either intraperitoneally or retroperitoneally. Under these circumstances the urine must be drained possibly by diverting it with nephrostomy or ureterostomy. A nephrostomy is also indicated in obstructed ureters. Should thrombosis of any portion of the conduit develop then an emergency procedure is required to replace it. He also feels that acute pyelonephritis requires nephrostomy and should sepsis be extensive and there be abscess formation a nephrectomy may become necessary. The author concludes that in spite of the complications arising foIlowing this procedure the ileal conduit remains the best form of urinary diversion available.-B. M. Henderson.
preoperatively. Pyelography demonstrated that 75 per cent of kidneys were of normal appearance postoperatively as compared with 64 per cent preoperatively. In nearly all cases preoperative hydronephrosis showed improvement following diversion. The authors are of the opinion that an attempt should be made to make a valvular entry of the ureter into the bowel--J. H. Johnston. UREMIA CAUSED BY URETERIC DIVERTICULUM. H. F. J. Weber. Wien. med. Wschr. 118:341, April 1968. True diverticula of the ureters ar-e very rare. A case of a 22-year-old male is presented, who suffered from hydronephrosis and urinary infection since childhood. At operation a true diverticulum of the left lower ureter was found which obstructed the ureter when filled with urine. Resection of the lower part of the ureter in connection with the diverticulum was necessary and ureteroneostomy performed. The postoperative course was uneventful, blood urea went down to normal levels, hydronephrosis decreased within half a year, but infection was still present when followed up. -G. Brandesky. URETERAL INVOLVEMENT IN REGIONAL ILEITIS (CROHN’S DISEASE). T. F. Schofield, W. G. St&, and 2’. Moore. J. Urol. 99:412, 1968. The authors present 2 cases of regional ileitis with associated symptoms, but without ileovesicle fistula, and they present a series of 10 patients with Crohn’s Disease, without urinary symptoms, who were studied by radioactive renography. These inchtded a 17-year-old girl and an 18-year-
INTERNATIONAL
to be transplanted M. Henderson.
into
ABSTRACTS
OF
PEDIATBIC
SURGERY
a
URINARY DIVERSION BY ILEAL CONDUIT. A LONGTERM FOLLOW-UP. A. Kafetsioulis and 1. Swinney. Brit. J. Urol. 40:1-11, February 1968.
PYEZLOILEALURINARY CONDUIT: AN 8 YEAR ExPERIENCEIX 37 PATIENTS. J. M. Holland, H. K. A. Schirmer, L. R. King, R. P. Gibbons, and W. W. Scott. J. Urol. 99:427, 1968.
about one quarter of Seventy-two patients, whom were children, who had undergone urinary diversion by ileal conduit are reviewed. Early complications included 8 postoperative deaths which resulted from urinary or fecal fistula. Late complications: Stenosis of the stoma was usually associated with retraction and occurred mostly in children. Purulent discharge from the infected, defunctional bladder rarely responded to irrigation and secondary cystectomy was required. Stomal excoriation and phosphatic encrustation was usually due to lack of care in managing the appliance. In 6 patients, renal calculi formed. Four patients require continuous treatment for electrolytic imbalance; all had severe renal impairment
In a group of 37 patients with atonic dilated ureters the authors performed urinary diversion using an ileal conduit anastomosed to the renal pelvis or the uppermost portion of the ureter. This group of patients includes an 8-year-old boy with congenital urethral valves and bilateral hydronephrosis and a 7-year-old girl with vesicoureteral reflux associated with right hydronephrosis and hydrometer. Following the procedure renal function improved or became stabilized in 29 of the 31 patients still living. They conclude that pyeloileal conduit diversion is a reliable procedure and is indicated in those patients with badly damaged kidneys and nonfunctioning ureters.-B. M. Henderson. EXPERIENCE WITH MORE THAN 500 ILEAL CONDUIT DIVEKSIONS IN A 12 YEAR PERIOD. P. C. Parkhurst. J. Urol. 99:434, 1968. The author reviews 562 ileal conduit diversions, including 51 children, performed during a 12-yearperiod by 36 surgeons at the Massachusetts General Hospital. The overall mortality was 10 per cent, 61 patients, which included 52 patients with malignant disease. The postoperative complications fell into 3 main groups: cardiovascular, inflammatory, and technical. The author emphasizes the value of ileal loopograms in the presence of generalized peritoneal irritation, anuria, or when there is a possibility of retroperitoneal extravasation. In the presence of urinary extravasation catheters or some pump drainage of the conduit is suggested unless significant accumulations of urine develop either intraperitoneally or retroperitoneally. Under these circumstances the urine must be drained possibly by diverting it with nephrostomy or ureterostomy. A nephrostomy is also indicated in obstructed ureters. Should thrombosis of any portion of the conduit develop then an emergency procedure is required to replace it. He also feels that acute pyelonephritis requires nephrostomy and should sepsis be extensive and there be abscess formation a nephrectomy may become necessary. The author concludes that in spite of the complications arising foIlowing this procedure the ileal conduit remains the best form of urinary diversion available.-B. M. Henderson.
preoperatively. Pyelography demonstrated that 75 per cent of kidneys were of normal appearance postoperatively as compared with 64 per cent preoperatively. In nearly all cases preoperative hydronephrosis showed improvement following diversion. The authors are of the opinion that an attempt should be made to make a valvular entry of the ureter into the bowel--J. H. Johnston. UREMIA CAUSED BY URETERIC DIVERTICULUM. H. F. J. Weber. Wien. med. Wschr. 118:341, April 1968. True diverticula of the ureters ar-e very rare. A case of a 22-year-old male is presented, who suffered from hydronephrosis and urinary infection since childhood. At operation a true diverticulum of the left lower ureter was found which obstructed the ureter when filled with urine. Resection of the lower part of the ureter in connection with the diverticulum was necessary and ureteroneostomy performed. The postoperative course was uneventful, blood urea went down to normal levels, hydronephrosis decreased within half a year, but infection was still present when followed up. -G. Brandesky. URETERAL INVOLVEMENT IN REGIONAL ILEITIS (CROHN’S DISEASE). T. F. Schofield, W. G. St&, and 2’. Moore. J. Urol. 99:412, 1968. The authors present 2 cases of regional ileitis with associated symptoms, but without ileovesicle fistula, and they present a series of 10 patients with Crohn’s Disease, without urinary symptoms, who were studied by radioactive renography. These inchtded a 17-year-old girl and an 18-year-