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Long term follow-up of ureteroneocystostomy without anti-reflux technique
278
INTERNATIONAL
A group of 7 patients with dilated adynamic ureters is presented. In 4, renal function was severely impaired and in 6 cases ureterovesical reflux was also present. Urethral obstruction was present in 3 patients and 4 had neurogenic bladders. Pyeloileocutaneous diversion was performed in 6 cases when aged 3 years or less, in 4 of these at 9 months or less. In 5 children the ureters were left intact at the time of diversion. Postoperative complications were frequent and included recurrent pyelonephritis, stoma1 stenosis, redundant loop, hyperchloremic acidosis, pyoureter, bowel wound infection, progressive renal obstruction, failure, renal calculi, perforated loop, perinephric abscess, and epididymitis. The authors point out that in 6 patients at least one abdominal procedure had been performed prior to pyeloileal diversion. Following the operation anatomical improvement was demonstrable in 5 cases, in 1 the previous progressive deterioration was stabilized, and in 1 child renal failure progressed causing death 45 years later. Direct ileal anastomosis can eliminate the functional obstruction caused by dilated adynamic ureters and if left intact at the time of diversion, it is possible that, some time in the future, normal urinary tract drainage may be reestablished.-B. M. Henderson.
ABSTRACTS
OF PEDIATRIC
SURGERY
A REVIEW OF A SERIESOF URETEROVESICOPLASTIES. J. A. Hutch, D. R. Smith, and R. Osborne. J. Urol. 100:28%289 (September) 1968.
This paper describes a series of 245 ureterovesicoplasties done on 140 patients. The follow-up period ranged from 6 months to I2 years and during that time all patients were studied with at least one cinecystogram postoperatively. They also had an excretory urogram, urine analysis, urine cultures, determinations of blood pressure, urea nitrogen, and a careful urological history. In most cases cause of the reflux was at the ureterovesical junction. In 3 patients there was demonstrable urethral obstruction, and in 14 vesicoureteral reflux was associated with duplication of the urinary tracts, ureterocele or ectopic ureters. Reflux was iatrogenic in 3 patients. It developed postoperatively in 5 patients who had undergone operations for correction of ureterocele or excision of large sacules near the urethral hiatus. The study included 94 children under 13 years of age. Reflux was successfully stopped in 220 of the 245 ureters. The operation performed included the Hutch I, Hutch II, Politano-Leadbetter procedure, combined Hutch I-Hutch II, and combined Hutch IIPolitano-Leadbetter and Pacquin operation. The bladder neck was not operated on in most patients and the authors are convinced that by not performing this procedure, serious complications were avoided. There has been 1 death, occurring 8 years postoperatively in a 20-year-old man. In 25 LONG TERM FOLLOW-UP OF URETERONEOCYScases reflux recurred postoperatively, but in spite TosToMy WITHOUT ANTI-REFLUX TECHNIQUE. of this these patients were clinically improved. A. F. LaZEi, and J. Lapides. J. Urol. 100:441Second and third operations were required in some 444 (October) 1968. cases because of recurring pyelonephritis. Obstruction occurred in 10 ureters and in 2 patients the This is a study of 8 patients in whom ureteroobstruction was bilateral. Bricker loop diversion neocystostomy was performed by bringing the was necessary in I of these cases, another reureter straight through the bladder wall and suturquired nephrostomy drainage and 2 required ing it in place by a fish-mouth technic. No attempt nephrectomy. Postoperative obstruction was probwas made to perform an antireflux operation. Inably due to the mucosa growing around or under dications for the operation included ureteral injury the intravesical ureter. Hypertension occurred in during operation, the removal of vesical divertic7 and uremia developed in 18 cases. In those ulum into which the ureter had emptied, giant patients in whom reflux was successfully removed, ureterocele with hydronephrosis and hydroureter there was a dramatic fall in the incidence of and ureteral injury during vesical neck-plasty. pyelonephritis. Just over half of the kidneys studThis series included 4 children. They were folied in this series showed radiographic changes lowed from 2 to 10.5 years and all are in good of pyelonephritis and in none was there progreshealth with normal renal function and uninfected sion of these changes postoperatively. Urine beurine. Six patients had normal excretory urograms came sterile and remained uninfected in 97 and 2 showed improvement over the preoperative patients following ureterovesicoplasty.-B. M. ones. They were not examined for vesicoureteral Henderson. reflux because of the risk of producing infection TUBELESS CYSTOSTOMY IN CHILDREN.. T. E. Bell, following catheterization. The authors conclude A. 0. Hoodin, and A. T. Euans. J. Urol. 100: that reflux not complicated by other abnormalities 459461 (October) 1968. is harmless-B. M. Henderson.
INTERNATIONAL
A group of 7 patients with dilated adynamic ureters is presented. In 4, renal function was severely impaired and in 6 cases ureterovesical reflux was also present. Urethral obstruction was present in 3 patients and 4 had neurogenic bladders. Pyeloileocutaneous diversion was performed in 6 cases when aged 3 years or less, in 4 of these at 9 months or less. In 5 children the ureters were left intact at the time of diversion. Postoperative complications were frequent and included recurrent pyelonephritis, stoma1 stenosis, redundant loop, hyperchloremic acidosis, pyoureter, bowel wound infection, progressive renal obstruction, failure, renal calculi, perforated loop, perinephric abscess, and epididymitis. The authors point out that in 6 patients at least one abdominal procedure had been performed prior to pyeloileal diversion. Following the operation anatomical improvement was demonstrable in 5 cases, in 1 the previous progressive deterioration was stabilized, and in 1 child renal failure progressed causing death 45 years later. Direct ileal anastomosis can eliminate the functional obstruction caused by dilated adynamic ureters and if left intact at the time of diversion, it is possible that, some time in the future, normal urinary tract drainage may be reestablished.-B. M. Henderson.
ABSTRACTS
OF PEDIATRIC
SURGERY
A REVIEW OF A SERIESOF URETEROVESICOPLASTIES. J. A. Hutch, D. R. Smith, and R. Osborne. J. Urol. 100:28%289 (September) 1968.
This paper describes a series of 245 ureterovesicoplasties done on 140 patients. The follow-up period ranged from 6 months to I2 years and during that time all patients were studied with at least one cinecystogram postoperatively. They also had an excretory urogram, urine analysis, urine cultures, determinations of blood pressure, urea nitrogen, and a careful urological history. In most cases cause of the reflux was at the ureterovesical junction. In 3 patients there was demonstrable urethral obstruction, and in 14 vesicoureteral reflux was associated with duplication of the urinary tracts, ureterocele or ectopic ureters. Reflux was iatrogenic in 3 patients. It developed postoperatively in 5 patients who had undergone operations for correction of ureterocele or excision of large sacules near the urethral hiatus. The study included 94 children under 13 years of age. Reflux was successfully stopped in 220 of the 245 ureters. The operation performed included the Hutch I, Hutch II, Politano-Leadbetter procedure, combined Hutch I-Hutch II, and combined Hutch IIPolitano-Leadbetter and Pacquin operation. The bladder neck was not operated on in most patients and the authors are convinced that by not performing this procedure, serious complications were avoided. There has been 1 death, occurring 8 years postoperatively in a 20-year-old man. In 25 LONG TERM FOLLOW-UP OF URETERONEOCYScases reflux recurred postoperatively, but in spite TosToMy WITHOUT ANTI-REFLUX TECHNIQUE. of this these patients were clinically improved. A. F. LaZEi, and J. Lapides. J. Urol. 100:441Second and third operations were required in some 444 (October) 1968. cases because of recurring pyelonephritis. Obstruction occurred in 10 ureters and in 2 patients the This is a study of 8 patients in whom ureteroobstruction was bilateral. Bricker loop diversion neocystostomy was performed by bringing the was necessary in I of these cases, another reureter straight through the bladder wall and suturquired nephrostomy drainage and 2 required ing it in place by a fish-mouth technic. No attempt nephrectomy. Postoperative obstruction was probwas made to perform an antireflux operation. Inably due to the mucosa growing around or under dications for the operation included ureteral injury the intravesical ureter. Hypertension occurred in during operation, the removal of vesical divertic7 and uremia developed in 18 cases. In those ulum into which the ureter had emptied, giant patients in whom reflux was successfully removed, ureterocele with hydronephrosis and hydroureter there was a dramatic fall in the incidence of and ureteral injury during vesical neck-plasty. pyelonephritis. Just over half of the kidneys studThis series included 4 children. They were folied in this series showed radiographic changes lowed from 2 to 10.5 years and all are in good of pyelonephritis and in none was there progreshealth with normal renal function and uninfected sion of these changes postoperatively. Urine beurine. Six patients had normal excretory urograms came sterile and remained uninfected in 97 and 2 showed improvement over the preoperative patients following ureterovesicoplasty.-B. M. ones. They were not examined for vesicoureteral Henderson. reflux because of the risk of producing infection TUBELESS CYSTOSTOMY IN CHILDREN.. T. E. Bell, following catheterization. The authors conclude A. 0. Hoodin, and A. T. Euans. J. Urol. 100: that reflux not complicated by other abnormalities 459461 (October) 1968. is harmless-B. M. Henderson.