[Strategy in preventing of uretero-intestinal anastomosis strictures in patients with low-pressure intestinal neobladder].
Ureteroileal stenoses occur in 1.2-20% patients with neobladders. They constitute a serious clinical complication since, as every obstruction of urine flow from the kidney. Ureteroileal stenoses develop usually within firs 6 to 12 months following the extended urological procedure such as radical cystectomy with the creation of ileal orthotopic neobladder. Ureteroileal stenosis belongs to the most difficult complications after creation of ileal neobladder. The experience of our clinic between 2001 and 2011 covers 3500 cases of patients with bladder cancer. 226 patients underwent cystectomy, 120 were treated with urinary diversion m. Bricker and 106 underwent low pressure ileal neobladder modo Studer. Ureters anastomosed with the intestine Michalowskis way of a flap. The authors performed 344 ureteroileal anastomoses, 212 ureteroileal anastomoses with the ileal neobladder modo Studer and 11 stenoses were detected, in 5 patients one-side, in 3 bilateral. In our practice there was altogether 11 detected stenoses which constitutes 5.18%. Based on our experience, in the course of radical removal of the bladder during the preparation of the least possible damage the blood supply ureter, ureter prior to implantation should be checked for leaks, catheter should be made of soft material. The performance of the left ureter to carry out the right side of the mesentery, be careful not without angulation. In the course of the uretero-intestinal anastomosis should not be stitched in place to destroy the vascular anastomosis of ureter to intestine anastomosis and the same should be done without tension. Protect the integrity of the anastomosis, aseptic oncology. Uretero-intestinal anastomosis performed without anti-reflux protection.
Katedra i Klinika Urologii, Collegium Medicum UJ, Kraków.
Wacław
W
Lipczyński
Barbara
B
Glazar
Małgorzata
M
Bak
Zygmunt F
ZF
Dobrowolski
Jacek
J
Kusionowicz
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control; D003251:Constriction, Pathologic / Q000517:prevention & control; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D013524:Surgical Flaps / Q000009:adverse effects; D014517:Ureteral Obstruction / Q000209:etiology / Q000517:prevention & control*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D016476:Urinary Reservoirs, Continent