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.

Results of radical cystectomy with Mainz pouch II diversion (single institution experience).

Evaluation of the peri- and postoperative morbidity in patients who underwent radical cystectomy and sigma-rectum pouch (Mainz pouch II) diversion with curative intent for invasive bladder cancer. We've reviewed 320 patients with invasive bladder cancer who underwnt radical cystectomy with lymphadenectomy and urinary diversion in our clinic from 1988 to 2011. In 134 (41.9%) patients Mainz pouch II diversion was performed. The results and complication rates have been analyzed in these patients. Intraoperaive injury of the rectum occurred in 2 (1.5%) patient, early complications were found in 40 (29.9%) and late complications in - 5 (3.7%) patients. Oral alkalization was necessary in 30 (22.4%) cases. 9 (6.7%) patients were hospitalized because of severe acidosis. Acute pyelonephritis developed in 8 (5.9%) patients. Hydronephrosis developed in 15 (11.2%) cases. In 7 (5.2%) patients dilatation of upper urinary tract was bilateral and in 8 (5.9%) - unilateral. In 4 (2.9%) patients stricture of the ureteral anastomosis was diagnosed. All patients were dry at day time. Only three (2.2%) patients (2 male and 1 female) needed pads at night time. All of these three patients were above 70 years old. Two patients underwent surgical intervention for interintestinal abscess. One patient was operated because of mechanical bowel obstruction 2 month after surgery. Perioperative mortality was 3.7%. Mainz Pouch II has a low morbidity and mortality rates. This form of diversion is method of choice for patients in whom the urethra cannot be used. In selected cases Mainz Pouch II is alternative to other types of continent diversion.