ABSTRACT
Extrasinusal ureterocaliceal anastomoses have been conducted in 27 patients, 21 adults and 6 children, in the Urological Clinic of the Hôpital Necker over the last 10 years. Principal indications, of much greater importance than tuberculosis, are pyelocaliceal lithiasis and certain anomalies of the pyeloureteral junction. In 15 cases, the operation was first choice therapy, while in the other 12 patients it was employed to treat a postoperative cicatriceal stenosis of the subpyelic portion of the ureter. "Peripheral" ureterocaliceal anastomosis (the ureter is sutured to a section of a calyx opened by partial nephrectomy) was carried out in 21 cases, and a "central" anastomosis, suturing the ureter to the base of a calyx after partial nephrectomy, in the 6 others. The most effective drainage method, employed in 14 patients without secretion leak, was nephrostomy at the side of a ureteral sound intubating the anastomosis. The two main postoperative complications were early anastomosis stenosis (6 cases), requiring a repeat operation, and fistulae necessitating prolonged ureteral drainage. Results have remained constant, and of the 25 cases followed up for an average of 2 years, 19 are still perfectly satisfactory (3 of these patients had had repeated ureterocaliceal anastomoses). Results were better after first than second choice ureterocaliceal anastomoses. It should logically be performed as the initial operation, therefore, when required because of the existing pathological condition: destroyed or inaccessible renal pelvis, inability to use the subpyelic portion of the ureter, or very marked pyelocaliceal distension requiring dependent drainage.
Subject(s)
Urinary Diversion , Adolescent , Adult , Aged , Child , Child, Preschool , Constriction, Pathologic , Female , Humans , Kidney/abnormalities , Kidney Calculi/surgery , Kidney Calices/surgery , Male , Methods , Middle Aged , Tuberculosis, Renal/surgery , Ureter/abnormalities , Ureter/surgery , Ureteral Diseases/surgery , Urinary Diversion/adverse effectsABSTRACT
Over the last 3 years, the authors restore intestinal continuity after ileo-colonic removal by end-to-side anastomosis according to Bloch's technic the colonic incision is made perpendicular to the peritoneal band. This type of anastomosis, in view of the mode of distribution of the colonic arterioles does not cause any loss of blood supply as is sometimes the case on the antemesocolic border of the incision when it is made on the band. The first results appear very encouraging as in the first thirty cases there was only one case of breakdown of sutures in the anastomosis. The latter was not due to the technic but to recutting of the ileum in an area with a poor blood supply.
