Ureteric injuries. Clinical and experimental studies.
The aim of the present study was to draw up some guidelines for the management of ureteric injuries. Clinical studies were undertaken to identify prognostic factors and guide selection of the best treatment option for each patient with a ureteric injury, and to determine the feasibility and efficacy of endourological treatment in the management of these injuries. Experimental studies were designed to develop a new surgical bladder elongation technique for the repair of extensive ureteric injuries and to determine the safety of double-J ureteric stents currently used for endourological procedures. The influence of previous radiotherapy, time of treatment, and site, kind and length of the ureteric injury on treatment outcome was studied in 137 injuries. The length of the injury was found to be the most important prognosticator of treatment outcome, probably because extensive injuries required diversions involving a high failure rate. Previous radiotherapy and late treatment also had negative prognostic significance, probably due to their frequent association with injury length. The feasibility and efficacy of endourological treatment were studied in 30 injuries. Attempt to perform endoscopic ureteric stenting failed in 14 cases. In the 16 successful ones, restoration of normal urinary tract and good long-term results were accomplished in all cases. Endourological treatment appeared to be particularly indicated for short injuries diagnosed early after the trauma. A new bladder elongation technique involving a particular Z-shaped incision of the bladder was studied in sheep. This bladder Z-plasty provided an average of 5.8 cm greater bladder elongation than the bladder psoas-hitch, with no complications or changes in bladder capacity. The effects of various double-J stent materials on pressure conditions in the upper urinary tract, on the urothelium, on urine precipitation (encrustation), and on urinary infection were investigated in vivo, in pig ureters, and in vitro, by cell cultures and bacterial adhesion assays. Pure polyurethane stents were found to cause long-lasting changes of renal pelvic dynamics and, consequently, to have deleterious effects on renal function. Stents made of "modified polyurethane" were found to be cytotoxic in vitro. Silicone and Hydro-Plus stents appeared to be the safest overall, as they caused less superficial epithelial destruction and host reaction than the others. Silicone stents, however, were found to be more prone than Hydro-Plus stents to encrustation.(ABSTRACT TRUNCATED AT 400 WORDS)
Cormio
L
L
Chair of Urology R, University of Bari, Italy.
D000818:Animals; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011859:Radiography; D012307:Risk Factors; D012756:Sheep; D013514:Surgical Procedures, Operative / Q000379:methods; D013552:Swine; D016896:Treatment Outcome; D014513:Ureter / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D014515:Ureteral Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy