Experience of managing neonates and breastfed in-fants with grade IV bilateral hydronephrosis

To analyze the clinical cases of four patients with grade IV bilateral hydronephrosis. Ultrasound examination of the urinary system was used as the main examination method. During the first stage of surgical treatment, all children underwent preliminary urinary diversion; a month later, the results were assessed. The result of the preliminary urinary diversion was the implementation of the Heines-Andersen-Kucher reconstructive operation. According to the control ultrasound performed a month after the nephrostomy, pelvis on the nephrostomy was reduced in all cases, parenchyma thickness increased by an average of 4.5 times, improvement in intragranular blood flow was noted. Evaluation of the effectiveness of pyeloplasty was carried out according to three criteria: restoration of urodynamics, restoration of kidney function and the presence of infectious complications. The parenchyma of the operated kidney grew by an average of 3 times, the pelvis decreased by an average of 3.5 times. Restoration of intrarenal blood flow to the cortical layer, inclusive, was noted in 5 of 8 renal units. Before pyeloplasty, there were marked changes in the renal parenchyma and a decrease in its function by an average of 34 14 %; a year after reconstructive surgery, the changes became moderate, there was an improvement in renal function, a decrease in function by 25 10 %. In our opinion, the starting method for providing urgent surgical care to neonates and breastfed infants with grade IV GN is preliminary urinary diversion, which allows us to determine the functional reserve of the renal parenchyma, delay reconstructive surgery, thereby giving time for the restoration of renal function and avoiding organ-carrying surgery.

Download Full-text

Comparative analysis of Bricker versus Wallace ureteroenteric anastomosis and identification of predictors for postoperative ureteroenteric stricture

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02413-4 ◽

2021 ◽

Author(s):

U Krafft ◽

O Mahmoud ◽

J Hess ◽

J.P Radtke ◽

A Panic ◽

...

Keyword(s):

Renal Function ◽

Urinary Diversion ◽

Surgical Care ◽

University Hospital ◽

Stricture Formation ◽

Significant Difference ◽

The Individual ◽

The University ◽

Anastomotic Techniques

Abstract Purpose Ureteroenteric anastomosis after cystectomy is usually performed using the Bricker or Wallace technique. Deterioration of renal function is the most common long-term complication of urinary diversion (UD). To improve surgical care and optimize long-term renal function, we compared the Bricker and Wallace anastomotic techniques and identified risk factors for ureteroenteric strictures (UES) in patients after cystectomy. Material and methods Retrospective, monocentric analysis of 135 patients who underwent cystectomy with urinary diversion at the University Hospital Essen between January 2015 and June 2019. Pre- and postoperative renal function, relevant comorbidities, prior chemo- or radiotherapy, pathological findings, urinary diversion, postoperative complications, and ureteroenteric strictures (UES) were analyzed. Results Of all 135 patients, 69 (51.1%) underwent Bricker anastomosis and 66 (48.9%) Wallace anastomosis. Bricker and Wallace groups included 134 and 132 renal units, respectively. At a median follow-up of 14 (6–58) months, 21 (15.5%) patients and 30 (11.27%) renal units developed UES. We observed 22 (16.6%) affected renal units in Wallace versus 8 (5.9%) in Bricker group (p < 0.001). A bilateral stricture was most common in Wallace group (69.2%) (p < 0.001). Previous chemotherapy and 90-day Clavien-Dindo grade ≥ III complications were independently associated with stricture formation, respectively (OR 9.74, 95% CI 2–46.2, p = 0.004; OR 4.01, 95% CI 1.36–11.82, p = 0.013). Conclusion The results of this study show no significant difference in ureteroenteric anastomotic techniques with respect to UES development regarding individual patients but suggest a higher risk of bilateral UES formation in patients undergoing Wallace anastomosis. This is reflected in the increased UES rate under consideration of the individual renal units.

Download Full-text

Re: Xiao-Dong Jin, Simone Roethlisberger, Fiona C. Burkhard, Frédéric Birkhaeuser, Harriet C. Thoeny, Urs E. Studer. Long-term Renal Function After Urinary Diversion by Ileal Conduit or Orthotopic Ileal Bladder Substitution. Eur Urol 2012;61:491–7

European Urology ◽

10.1016/j.eururo.2012.05.038 ◽

2012 ◽

Vol 62 (3) ◽

pp. e55-e56 ◽

Cited By ~ 1

Author(s):

Mathieu Rouanne ◽

Thierry Lebret ◽

Henry Botto

Keyword(s):

Renal Function ◽

Urinary Diversion ◽

Ileal Conduit ◽

Bladder Substitution

Download Full-text

Urinary Diversion in Infants with Primary High-Grade Vesicoureteric Reflux, Urinary Sepsis and Renal Function Impairment

Urologia Internationalis ◽

10.1159/000072678 ◽

2003 ◽

Vol 71 (3) ◽

pp. 275-279 ◽

Cited By ~ 1

Author(s):

G. Mattioli ◽

P. Buffa ◽

M. Torre ◽

C. Carlini ◽

A. Pini Prato ◽

...

Keyword(s):

Renal Function ◽

Urinary Diversion ◽

Vesicoureteric Reflux ◽

High Grade ◽

Renal Function Impairment ◽

Function Impairment ◽

Urinary Sepsis

Download Full-text

Urinary diversion: Anatomo-physiological assumptions

Urologia Journal ◽

10.1177/039156039205900202 ◽

1992 ◽

Vol 59 (2) ◽

pp. 9-15

Author(s):

F. Di Tonno ◽

M. De Antoni ◽

V. Ruvolo ◽

D. Lavelli

Keyword(s):

Renal Function ◽

Physical Properties ◽

Urinary Diversion ◽

Intestinal Mucosa ◽

Current Literature ◽

Personal Experience ◽

Intestinal Segment ◽

Physiological Conditions ◽

Clinical Consequences ◽

Urinary Reservoir

The basic anatomical and physiological conditions needed for preparation of a good functioning urinary reservoir are analyzed according to current literature and personal experience. Owing to the need for a schematic and concise exposition, the text has been subdivided under five headings: (I) Metabolic considerations: a) the segment used; b) the duration of contact between intestinal mucosa and urine; c) the size of the exposed intestinal surface. (II) Renal function. (Ill) Physical properties of the reservoir: a) contractility; b) configuration; c) accommodation; d) viscoelasticity. (IV) Carcinogenesis: a) statistical considerations; b) ethiopathogenesis. (V) Clinical consequences of the removal of a normally functioning intestinal segment.

Download Full-text

Quality of life assessment in patients with acute limb ishemia

Medical and Social Expert Evaluation and Rehabilitation ◽

10.17816/mser34594 ◽

2020 ◽

Vol 23 (2) ◽

pp. 15-18

Author(s):

Gennady V. Sinyavin ◽

Aleksandr N. Kosenkov ◽

Ivan A. Vinоkurоv ◽

Gevorg V. Mnatsakanjan ◽

Sanija N. Odinokova ◽

...

Keyword(s):

Quality Of Life ◽

Blood Flow ◽

Lower Limb ◽

Short Form ◽

Surgical Care ◽

Limb Ischemia ◽

Life Assessment ◽

Quality Of Life Assessment ◽

Lower Limb Ischemia

Background. In conditions of permanent progress in the quality of surgical care in various areas of surgery, it is very important to allow patients themselves to evaluate provided treatment. Aims: this paper analyzes the quality of life in individuals with acute lower limb ischemia who have undergone lower limb revascularization surgery. Materials and methods. An assessment of the quality of life of 122 patients with acute lower limb ischemia (ALI) of II degree who were treated at the Moscow Сity Сlinical Hospital оf S.S. Yudin from 2016 to 2018 (average age 72.1 14.7 years) was performed. The quality of life was assessed using the medical Outcomes Study-Short Form (MOS SF-36) quality of life assessment methodology. Results. When assessing the quality of life of patients, it was found that the psychological and physical components of patients health are significantly affected by the angiotropic effect of the affecting factor associated with the presence of diabetes mellitus. 1 month after surgical restoration of blood flow against the background of the initial embolism, 83.6% of the respondents who did not suffer from diabetes noted a persistent improvement in their General condition and quality of life. Conclusion. This method of assessing the quality of life after surgical restoration of blood flow in patients with acute lower limb ischemia can be used in angiosurgical practice and clearly reflects of patient satisfaction with the treatment.

Download Full-text

Comparative impact of continent and incontinent urinary diversion on long-term renal function after radical cystectomy in patients with preoperative chronic kidney disease 2 and chronic kidney disease 3a

International Journal of Urology ◽

10.1111/iju.12770 ◽

2015 ◽

Vol 22 (7) ◽

pp. 651-656 ◽

Cited By ~ 16

Author(s):

Boris Gershman ◽

Manuel S Eisenberg ◽

R Houston Thompson ◽

Igor Frank ◽

Dharam Kaushik ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Radical Cystectomy ◽

Urinary Diversion

Download Full-text

HIGH URINARY DIVERSION WITH AN ILEAL CONDUIT IN CHILDREN

PEDIATRICS ◽

10.1542/peds.40.5.816 ◽

1967 ◽

Vol 40 (5) ◽

pp. 816-821

Author(s):

James M. Holland ◽

Lowell R. King ◽

Horst K. A. Schirmer ◽

William Wallace Scott

Keyword(s):

Renal Function ◽

Urinary Diversion ◽

Ileal Conduit

High ileal diversion has been performed on 26 children with destroyed ureteral function in the authors' experience. Fifteen were azotemic when diverted. Renal function has improved or stabilized in 21 of the 23 patients (91%) who survived operation followed for as long as 8 years. Pyelographic appearance has improved or stabilized in 34 of 39 kidneys (87%) in these children. Ten patients were diverted more than 5 years ago. Renal function has improved or stabilized in all seven who are now alive. High ileal diversion has thus proved to be safe and reliable. Although azotemic children also can be salvaged, the authors advocate earlier high diversion of kidneys drained by badly dilated and poorly functioning ureters.

Download Full-text

Short- and Long-Term Evaluation of Renal Function after Radical Cystectomy and Cutaneous Ureterostomy in High-Risk Patients

Journal of Clinical Medicine ◽

10.3390/jcm9072191 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2191

Author(s):

Massimiliano Creta ◽

Ferdinando Fusco ◽

Roberto La Rocca ◽

Marco Capece ◽

Giuseppe Celentano ◽

...

Keyword(s):

Renal Function ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Kidney Injury ◽

Risk Patients ◽

Term Evaluation ◽

Gfr Decline ◽

American Society ◽

American Society Of Anesthesiologists ◽

Cutaneous Ureterostomy

Deterioration of renal function has been reported after radical cystectomy (RC) with urinary diversion. We investigated renal function changes in elderly bladder cancer (BCa) patients who underwent RC with cutaneous ureterostomy (CU) urinary diversion. We performed a retrospective, observational study. BCa patients aged ≥75 with an American Society of Anesthesiologists (ASA) class greater than II were included. Glomerular filtration rate (GFR) was the main outcome measure. GFR values were recorded preoperatively, at discharge, at 6-month follow-up, and yearly up to 60 months. A total of 70 patients with a median age of 78.0 years were identified. Median preoperative GFR was 74.3 mL/min/1.73 m2 and declined significantly to 54.6 mL/min/1.73 m2 after 6 months (p < 0.001). A gradual GFR decline was observed thereafter, reaching a median value of 46.2 after 60 months. Preoperative GFR and acute kidney injury were significant predictors of fast deterioration of GFR and of 25% deterioration of GFR after 12 months. Elderly BCa patients with high comorbidity rates undergoing RC with CU should be carefully informed about the risk of GFR deterioration and the need for adequate monitoring.

Download Full-text

Techniques of internai urinary diversion without bowel interruption

Urologia Journal ◽

10.1177/039156039506200332 ◽

1995 ◽

Vol 62 (3) ◽

pp. 489-492

Author(s):

A. Trinchieri

Keyword(s):

Renal Function ◽

Urinary Diversion ◽

Simple Technique ◽

Viable Alternative ◽

Electrolyte Imbalance ◽

Continent Urinary Diversion ◽

Renal Function Deterioration

Internai urinary diversions date back more than 100 years to when ureterosigmoidostomy was introduced by Simon. Urinary diversion to the rectum is a simple technique of continent urinary diversion but can cause troublesome complications such as electrolyte imbalance, pyelonephritis and renal function deterioration. Improvement of the techniques of internai urinary diversion have reduced the risk of such complications. When the urethra cannot be preserved, internai urinary diversion provides a viable alternative to external diversion.

Download Full-text