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Long-Term Clinical Followup after Pyelocystostomy
0022-5347 /81/1262-0253$02.00/0
Vol. 126, Printed in
THE JOURNAL OF UROLOGY
CopyTight © 1981 by The Williams & Wilkins Co.
LONG-TERM CLINICAL ERIC LINDSTEDT, SVEN-ERIK BERGENTZ
AND
TORE LINDHOLN1
From the Department of Surgery, Malmo" General Hospital, Malmo" and the Departments of Urology and Nephrology, Lunds Lasarett, Lund, Sweden
ABSTRACT
In March 1971 a 32-year-old man with necrosis of the meter to a anastomosis of the transplant renal to the bladder. The rn ,u,.,,0,,,v,,,u 5 later. This surgical technique has been used ~~,,uv" in 3 additional cases. F'urthe:r this procedure are suggested. Anastomosis of the :renal pelvis to the bladdex in a young boy with renal dystopia and hydronephrosis was reported >50 ago. 1 There have been a few reports of pyelocystostomy as procedure after necrosis of the ureter in an allotransRenewed interest in this drainage technique was stimthe report of Pettersson and associates- 5 They used of operation with autotransplantation of the kidney for treatment of well differentiated carcinoma of the pelvis and ureter, and later for patients in whom a nv·.,.,,nrn,,,-.v for hyd.ronephrosis had failed. The adult kidney seems to tolerate free reflux the absence of infection, at least in the eady nn,o::i-.,.,,,~,.,. However, the long-term effects seem less well ~-.,u,-~. we discuss the status of our previously reported almost 9 years after ,u,,.,,,,n;;u anastomosis. CASE REPORT
man, 38 07 05, with chronic glomerulonephritis stage kidney failure, was on chronic intermittent heuntil December 29, 1970 when a cadaveric was transplanted to the iliac fossa. Postoperatively, urine leakage and a nephrostomy was performed on afanuary 10, 1971. At reoperation on March 16 the ureter was necrotic and a side-to-side anastomosis was performed between the renal pelvis and the bladder l), for short periods of urine leakage from the abdominal wound up to 3 months postoperatively the did vveU..
excretion of contmst material. and Central part of renal pel.vis
Clinical condition remained he became rehabilitated and the urine remained 1979 51 chromium, eth"' "'"'"''"1,c. acid clearance was 78 ml per minute 1980
mscussmN Anastomosing the of a tn1n;;p1.ance the bladder is an a!Jµ,c;auu,; and often easy to urine outflow in cases when nutrition of the u.reter is Jble or when necrnsis of the ureter differenhat,ed ureteral or liurn renal unit can be examined and recun-ent
Fm, L Renal pelvis is anastomosed to bladder side-to-side Accepted for publication October 10, 1980.
253
254
LINDSTEDT, BERGENTZ AND LINDHOLM
can be treated early if renal autotransplantation and pyelocystostomy are done. 5 If pyeloplasty fails in a case of hydronephrosis the results after reoperation in situ are often poor and autotransplantation of the kidney becomes an attractive alternative. Recurrent stone formation in cases of cystinuria or renal tubular acidosis would also seem to give indications for this operation. The followup of our patient shows that excellent renal function can be preserved for a long time after pyelocystostomy, which also was demonstrated in a recent experimental study. 6 Thus, more frequent use of this operation should be encouraged. It seems probable that high bladder pressure during micturition would be dangerous in these cases. Examination for signs of bladder outlet obstruction is essential and early transurethral prostatic resection or bladder neck incision is recommended. During the last year 3 additional patients underwent pyelocystostomy. In 1 patient allotransplantation was done a11d ureteral necrosis developed. Another patient had a ureteral tumor and underwent autotransplantation. Both cases were successful. The third patient had bilateral pelvic carcinoma and l kidney had been removed previously. About a third of the remaining kidney was left after extracorporeal partial nephrec-
tomy. This piece was autotransplanted and the major calix was anastomosed to a Boari bladder flap. Urine leakage from the anastomosis, wound infection and uncontrollable bleeding from the remaining renal parenchyma necessitated nephrectomy. REFERENCES 1. Hess, E.: Pyelocystostomy (pyelocystostomosis) in crossed renal
dystopia. J. Urol., 22: 667, 1929. 2. Bennett, A.H.: Pyelocystostomy in a renal allograft. Amer. J. Surg., 125: 633, 1973. 3. Herwig, K. R. and Konnak, J. W.: Vesicopyelostomy: a method for urinary drainage of the transplanted kidney. J. Urol., 109: 955, 1973. 4. Lindstedt, E., Bergentz, S. E. and Lindholm, T.: Pyelocystostomy used as a treatment of ureteric necrosis after kidney transplantation. Scand. J. Urol. Nephrol., 9: 85, 1975. 5. Pettersson, S., Brynger, H., Johansson, S. and Nilson, A. E.: Extracorporeal surgery and autotransplantation for carcinoma of the pelvis and ureter. Scand. J. Urol. Nephrol., 13: 89, 1979. 6. Danforth, D. N., Jr., Javadpour, N., Bergman, S. M. and Terrill, R.: Pressure effects of urinary reflux studied with renal autotransplantation and pyelocystostomy. Urology, 15: 17, 1980.
Vol. 126, Printed in
THE JOURNAL OF UROLOGY
CopyTight © 1981 by The Williams & Wilkins Co.
LONG-TERM CLINICAL ERIC LINDSTEDT, SVEN-ERIK BERGENTZ
AND
TORE LINDHOLN1
From the Department of Surgery, Malmo" General Hospital, Malmo" and the Departments of Urology and Nephrology, Lunds Lasarett, Lund, Sweden
ABSTRACT
In March 1971 a 32-year-old man with necrosis of the meter to a anastomosis of the transplant renal to the bladder. The rn ,u,.,,0,,,v,,,u 5 later. This surgical technique has been used ~~,,uv" in 3 additional cases. F'urthe:r this procedure are suggested. Anastomosis of the :renal pelvis to the bladdex in a young boy with renal dystopia and hydronephrosis was reported >50 ago. 1 There have been a few reports of pyelocystostomy as procedure after necrosis of the ureter in an allotransRenewed interest in this drainage technique was stimthe report of Pettersson and associates- 5 They used of operation with autotransplantation of the kidney for treatment of well differentiated carcinoma of the pelvis and ureter, and later for patients in whom a nv·.,.,,nrn,,,-.v for hyd.ronephrosis had failed. The adult kidney seems to tolerate free reflux the absence of infection, at least in the eady nn,o::i-.,.,,,~,.,. However, the long-term effects seem less well ~-.,u,-~. we discuss the status of our previously reported almost 9 years after ,u,,.,,,,n;;u anastomosis. CASE REPORT
man, 38 07 05, with chronic glomerulonephritis stage kidney failure, was on chronic intermittent heuntil December 29, 1970 when a cadaveric was transplanted to the iliac fossa. Postoperatively, urine leakage and a nephrostomy was performed on afanuary 10, 1971. At reoperation on March 16 the ureter was necrotic and a side-to-side anastomosis was performed between the renal pelvis and the bladder l), for short periods of urine leakage from the abdominal wound up to 3 months postoperatively the did vveU..
excretion of contmst material. and Central part of renal pel.vis
Clinical condition remained he became rehabilitated and the urine remained 1979 51 chromium, eth"' "'"'"''"1,c. acid clearance was 78 ml per minute 1980
mscussmN Anastomosing the of a tn1n;;p1.ance the bladder is an a!Jµ,c;auu,; and often easy to urine outflow in cases when nutrition of the u.reter is Jble or when necrnsis of the ureter differenhat,ed ureteral or liurn renal unit can be examined and recun-ent
Fm, L Renal pelvis is anastomosed to bladder side-to-side Accepted for publication October 10, 1980.
253
254
LINDSTEDT, BERGENTZ AND LINDHOLM
can be treated early if renal autotransplantation and pyelocystostomy are done. 5 If pyeloplasty fails in a case of hydronephrosis the results after reoperation in situ are often poor and autotransplantation of the kidney becomes an attractive alternative. Recurrent stone formation in cases of cystinuria or renal tubular acidosis would also seem to give indications for this operation. The followup of our patient shows that excellent renal function can be preserved for a long time after pyelocystostomy, which also was demonstrated in a recent experimental study. 6 Thus, more frequent use of this operation should be encouraged. It seems probable that high bladder pressure during micturition would be dangerous in these cases. Examination for signs of bladder outlet obstruction is essential and early transurethral prostatic resection or bladder neck incision is recommended. During the last year 3 additional patients underwent pyelocystostomy. In 1 patient allotransplantation was done a11d ureteral necrosis developed. Another patient had a ureteral tumor and underwent autotransplantation. Both cases were successful. The third patient had bilateral pelvic carcinoma and l kidney had been removed previously. About a third of the remaining kidney was left after extracorporeal partial nephrec-
tomy. This piece was autotransplanted and the major calix was anastomosed to a Boari bladder flap. Urine leakage from the anastomosis, wound infection and uncontrollable bleeding from the remaining renal parenchyma necessitated nephrectomy. REFERENCES 1. Hess, E.: Pyelocystostomy (pyelocystostomosis) in crossed renal
dystopia. J. Urol., 22: 667, 1929. 2. Bennett, A.H.: Pyelocystostomy in a renal allograft. Amer. J. Surg., 125: 633, 1973. 3. Herwig, K. R. and Konnak, J. W.: Vesicopyelostomy: a method for urinary drainage of the transplanted kidney. J. Urol., 109: 955, 1973. 4. Lindstedt, E., Bergentz, S. E. and Lindholm, T.: Pyelocystostomy used as a treatment of ureteric necrosis after kidney transplantation. Scand. J. Urol. Nephrol., 9: 85, 1975. 5. Pettersson, S., Brynger, H., Johansson, S. and Nilson, A. E.: Extracorporeal surgery and autotransplantation for carcinoma of the pelvis and ureter. Scand. J. Urol. Nephrol., 13: 89, 1979. 6. Danforth, D. N., Jr., Javadpour, N., Bergman, S. M. and Terrill, R.: Pressure effects of urinary reflux studied with renal autotransplantation and pyelocystostomy. Urology, 15: 17, 1980.