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Ureterosigmoidostomy: A 15 year experience
INTERNATIONAL
ABSTRACTS
OF PEDIATRIC
VESICO-URETERICREFLUX IN INFANTS AND DREN. B. O’Donnell, M. A. Lynch. Brit. J. Urol. 41:6-13
Moloney,
(February),
CHIL-
and
V.
1969.
A series of 119 cases of primary ureteric reflux in infants and children followed for a minimum of 4 years was reviewed. Reflux was graded as regards severity into mild, moderate, severe, and profound. The results obtained in respect of reflux, urinary infection, kidney growth, and kidney scarring were assessed in children treated in 4 ways: 1. No treatment (Nonattenders, etc.) 19 patients. This group fared badly in all respects. 2. Chemotherapy alone. 79 patients. Patients with mild or moderate reflux did well as regards cure of reflux and kidney growth. However, only one third were cured of infection. 3. Surgery (Leadbetter-Politano-operation) and short-term chemotherapy. 8 patients. This small miscellaneous group is incapable of analysis. 4. Surgery and long-term chemotherapy. 30 patients. 7 had bladder neck surgery: one was cured of reflux. 21 had antireflux procedures; 19 of these were cured of reflux; the 2 failures each had nephrectomy and one is dead. The group as a whole was satisfactory as regards kidney growth and the prevention of scarring, but almost half were on chemotherapy 4 years or more after surgery. It is concluded by the authors that long-term chemotherapy is the most important factor in treatment. Ureteral reimplantation is advisable when relapses of infection occur while the patient is on chemotherapy and when reflux worsens or kidney growth is impaired. If kidney scarring has already occurred, the authors consider that the control of infection by any means is more difficult. There is a large group of patients who do not need surgery for reflux. There is a small group with advanced disease for whom surgery is inadvisable. This leaves about one third or one quarter of children with reflux who will benefit from a satisfactory reflux-preventing operation. -J.
H. Jolmsfon.
URETEROSIGMOIDOSTOMY:A 15 YEAR EXPERIENCE. D. F. Williams, G. V. Burkolder, and W. E. Goodwin. J. Urol. 101:168-170 (Febru-
ary),
493
SURGERY
1969.
This is an analysis of 57 patients in whom the large bowel had been used for urinary diversion. Their ages varied from 3 months to 80 years. The commonest indication for the procedure was carcinoma of the bladder. Fifty-one of these patients underwent ureterosigmoidostomy. Pyelonephritis occurred in 45 per cent of the patients, hydronephrosis in 3.5 per cent, which was generally due
to stricture but was also associated with reflux. Renal stones were seen in 3 patients and hyperchloremic acidosis was seen in 16 of 51 patients. In 12 of the 51 patients who underwent ureterosigmoidostomy, another form of urinary diversion became necessary because of either protracted diarrhea, recurrent pyelonephritis, stricture of the anastomosis, or severe electrolyte imbalance. Four of these patients have subsequently died. Eight patients died as a direct result of ureterosigmoidostomy. In 6 cases a rectal bladder and proximal sigmoid colostomy was the method of urinary diversion chosen, and in none of these was there significant immediate postoperative complication and in only 3 were there later complications, none of which were disabling. In reviewing the autopsies, pyelonephritis was found in 67 per cent and in only 45 per cent of these patients had pyelonephritis been recognized clinically. The authors conclude that ureterosigmoidostomy, although not ideal, may be the preferred form of urinary diversion in certain situations. When complications arise it may become necessary to separate the fecal and urinary streams. The formation of a rectal bladder with diversion colostomy has been of value both as a primary procedure and following failure of ureterosigmoidostomy.-B. M. Henderson. MEASUREMENTAND CONTROL OF BOWEL PRESSURE IN URETERO-COLIC ANASTOMOSIS.0. Daniel and M. L. Singh. Brit. J. Urol. 41:32-39. (Febru-
ary),
1969.
The authors have found by pressure studies that upper tract back pressure and serious renal damage can follow chronic vesical retention with overflow when the bladder pressure is substantially less than that recorded simultaneously within the sigmoid colon. Clearly, therefore, in some instances ureterocolic anastomosis is potentially more damaging to renal function than unrelieved chronic overflow incontinence. A method of measuring intracolonic pressure is described in detail. The authors advise that, if intracolonic pressure following maximal stimulation with morphine and prostigmine exceeds 20 cm. of water, ureterocolonic anastomosis should be accompanied by sigmoid myotomy. In the latter procedure, a longitudinal incision is made through the colonic musculature. Strips of peritoneum taken from the margins of the abdominal incision and applied as free grafts to the exposed colonic mucosa reduce the incidence of fistulous discharge. An external drain must be brought from the site of the myotomy and ureterocolonic anastomosis. -J. H. Johnsion.
ABSTRACTS
OF PEDIATRIC
VESICO-URETERICREFLUX IN INFANTS AND DREN. B. O’Donnell, M. A. Lynch. Brit. J. Urol. 41:6-13
Moloney,
(February),
CHIL-
and
V.
1969.
A series of 119 cases of primary ureteric reflux in infants and children followed for a minimum of 4 years was reviewed. Reflux was graded as regards severity into mild, moderate, severe, and profound. The results obtained in respect of reflux, urinary infection, kidney growth, and kidney scarring were assessed in children treated in 4 ways: 1. No treatment (Nonattenders, etc.) 19 patients. This group fared badly in all respects. 2. Chemotherapy alone. 79 patients. Patients with mild or moderate reflux did well as regards cure of reflux and kidney growth. However, only one third were cured of infection. 3. Surgery (Leadbetter-Politano-operation) and short-term chemotherapy. 8 patients. This small miscellaneous group is incapable of analysis. 4. Surgery and long-term chemotherapy. 30 patients. 7 had bladder neck surgery: one was cured of reflux. 21 had antireflux procedures; 19 of these were cured of reflux; the 2 failures each had nephrectomy and one is dead. The group as a whole was satisfactory as regards kidney growth and the prevention of scarring, but almost half were on chemotherapy 4 years or more after surgery. It is concluded by the authors that long-term chemotherapy is the most important factor in treatment. Ureteral reimplantation is advisable when relapses of infection occur while the patient is on chemotherapy and when reflux worsens or kidney growth is impaired. If kidney scarring has already occurred, the authors consider that the control of infection by any means is more difficult. There is a large group of patients who do not need surgery for reflux. There is a small group with advanced disease for whom surgery is inadvisable. This leaves about one third or one quarter of children with reflux who will benefit from a satisfactory reflux-preventing operation. -J.
H. Jolmsfon.
URETEROSIGMOIDOSTOMY:A 15 YEAR EXPERIENCE. D. F. Williams, G. V. Burkolder, and W. E. Goodwin. J. Urol. 101:168-170 (Febru-
ary),
493
SURGERY
1969.
This is an analysis of 57 patients in whom the large bowel had been used for urinary diversion. Their ages varied from 3 months to 80 years. The commonest indication for the procedure was carcinoma of the bladder. Fifty-one of these patients underwent ureterosigmoidostomy. Pyelonephritis occurred in 45 per cent of the patients, hydronephrosis in 3.5 per cent, which was generally due
to stricture but was also associated with reflux. Renal stones were seen in 3 patients and hyperchloremic acidosis was seen in 16 of 51 patients. In 12 of the 51 patients who underwent ureterosigmoidostomy, another form of urinary diversion became necessary because of either protracted diarrhea, recurrent pyelonephritis, stricture of the anastomosis, or severe electrolyte imbalance. Four of these patients have subsequently died. Eight patients died as a direct result of ureterosigmoidostomy. In 6 cases a rectal bladder and proximal sigmoid colostomy was the method of urinary diversion chosen, and in none of these was there significant immediate postoperative complication and in only 3 were there later complications, none of which were disabling. In reviewing the autopsies, pyelonephritis was found in 67 per cent and in only 45 per cent of these patients had pyelonephritis been recognized clinically. The authors conclude that ureterosigmoidostomy, although not ideal, may be the preferred form of urinary diversion in certain situations. When complications arise it may become necessary to separate the fecal and urinary streams. The formation of a rectal bladder with diversion colostomy has been of value both as a primary procedure and following failure of ureterosigmoidostomy.-B. M. Henderson. MEASUREMENTAND CONTROL OF BOWEL PRESSURE IN URETERO-COLIC ANASTOMOSIS.0. Daniel and M. L. Singh. Brit. J. Urol. 41:32-39. (Febru-
ary),
1969.
The authors have found by pressure studies that upper tract back pressure and serious renal damage can follow chronic vesical retention with overflow when the bladder pressure is substantially less than that recorded simultaneously within the sigmoid colon. Clearly, therefore, in some instances ureterocolic anastomosis is potentially more damaging to renal function than unrelieved chronic overflow incontinence. A method of measuring intracolonic pressure is described in detail. The authors advise that, if intracolonic pressure following maximal stimulation with morphine and prostigmine exceeds 20 cm. of water, ureterocolonic anastomosis should be accompanied by sigmoid myotomy. In the latter procedure, a longitudinal incision is made through the colonic musculature. Strips of peritoneum taken from the margins of the abdominal incision and applied as free grafts to the exposed colonic mucosa reduce the incidence of fistulous discharge. An external drain must be brought from the site of the myotomy and ureterocolonic anastomosis. -J. H. Johnsion.