THE USE OF BOWEL FOR BILATERAL URETER SUBSTITUTION: A CASE REPORT AND REVIEW OF LITERATURE.

Intestinal ureteral replacement remains a useful procedure for complex ureteral reconstruction. Bilateral ureteral substitution is more complicated procedure. There are some different methods of ureteroplasty. In our case we used Libertino modification. In this case we have examined safety and efficacy of this procedure, surgical outcome and impact on renal function. Our results were compared to literature findings. November 2013 year 52 years female patient underwent bilateral ureter replacement using the ileal segment of bowel. Exclusion criteria were elevated serum creatinine above to - 1.8 mg/dl, inflammatory bowel syndrome. Preoperatively we prepared patient with antibiotic therapy. Post-surgery was examined level of serum creatinine, dilatation of upper urinary tract, hematocrits, biochemical analysis, urinary tract infection, postoperative complications, and clinical outcomes. Follow-up protocol was carried out for up to 18 month. There were no intra-operative or postoperative mortality or significant complications in our case. There was no significant blood loss during operation. Blood transfusion was - 230ml. There was minor by-effect in the form of mucus production and there was needful oral treatment with bladder irrigation. During follow up, no excess metabolic abnormalities were encountered. Renal function was normal without any evidence of urinary obstruction. Urinary tract infection was only non-etiologic mean. According to our case and revive of literature ureteric substitution with ileal segment is a safe technique with a positive outcome. It uses of any kind ureteric injury: iatrogenic or idiopathic; unilateral or bilateral. It is not associated with excess mucus metabolic abnormalities and preserved renal function without urinary tract infection or obstruction.

Posterior vertical lumbotomy, a clinical case.

From 1986 till February 2007 in National Center of Urology 444 patients were operated (249 women and 195 men, mean age 48.6 years) with upper urinary tract diseases. For access to the kidney and upper urether posterior vertical lumbotomy approach was performed. 27 patients were operated bilaterally. Total 471 operations were done by this approach. The results of operations with Posterior vertical lumbotomy were compared with flank incision for a variety of parameters (mean operative time, number of doses of postoperative parenteral analgesics, duration of postoperative hospitalization, wound infection, incisional hernia). Comparative analysis show, that posterior vertical lumbotomy is much less traumatic incision.