[A direct uretero-enteroanastomosis: a return to the past?].
The authors analyse their experience with ureter implantations into a small intestinal retaining reservoir--both direct and antireflux. From 1994 to 2004 orthotopic replacement of the urinary bladder (UB) with an ileal segment was performed in 62 patients (59 males, 3 females) for UB cancer (n = 55), microcystis (posttraumatic, radiation-induced, tuberculous) (n = 7). Orthotopic replacement of the UB was made according to VIP (vesica ileale Padovano) technique with creation of antireflux uretero-enteroanastomoses by Le Duc (group 1, 43 patients, 82 anastomoses) and Hautmann technique in modification of Lippert-Theodorescu (group 2, 14 patients, 28 direct uretero-enteroanastomoses). A direct uretero-enteroanastomosis was performed by Nesbit and Bricker technique. Five patients were withdrawn from the final analysis: 3 of them died early after the surgery because of complications, 2 patients died due to progression within 3 and 4 months after the operation. A total length of the ileac segment used for UB repair in both groups was 60 cm. Upper urinary tracts (UUT) and kidneys after the operation were assessed by the results of ultrasonic investigation of the caliceropelvic system, kidneys, UB, residual urine, serum creatinine, excretory urography, spiral CT (on demand), etc., after recovery of miction (3-4 weeks after operation), 3 and 6 (+cystography) after the operation, 12 months after the operation and annually. Comparison of the results of direct and antireflux anastomoses suggests a conclusion that a high rate of strictures due to antireflux anastomoses provoking UUT and renal dysfunction makes their benefit doubtful. Antireflux bypass ureteral surgery with neocystis of low pressure seems unjustified. In creation of capable uroreservoir of low pressure a direct implantation of the ureter into it is simple to do and less risky in respect to development of anastomotic stricture and damage to the renal function.
A V
AV
Morozov
K A
KA
Pavlenko
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D007668:Kidney / Q000378:metabolism / Q000502:physiology; D008297:Male; D008875:Middle Aged; D014513:Ureter / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D014718:Vesico-Ureteral Reflux / Q000601:surgery