Errors and pitfalls in the management of acute urinary obstruction complicated by uraemia with special reference to stone.
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Biomedical subjects
Publications and source records attributed to E Proca.
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An observation is presented of a patient with right renal cancer that invaded the caecum and the ascendant colon, as well as the descending duodenum. Enlarged nephrectomy was performed and right hemi-colectomy and resection of the antero-lateral wall of the duodenum. Termino-terminal ileo-transversostomy was performed and the duodenal defect was "patched" with the last ileal loop and its serosa.
A case is discussed, of extensive ureteral stenosis that could not be solved by uveal intubation, neither by two ureterocalycostomies, in which total ureteroileoplasty gave immediately good results.
Two cases are presented, of transuretheral ureterostomy combined to cutaneous ureterostomy and total cystectomy (in a patient with invading neoplasia of the urinary bladder), or with a procedure of urinary derivation (in the second patient with complex urinary tuberculosis and advanced renal failure). The results obtained were very good.
Out of a total of 475 interventions for renal lithiasis, the author has performed only 15 partial nephrectomies, as compared with 118 total nephrectomies and 342 conservatory pyelotomies and nephrotomies. The type of intervention described should be limited to cases where the polar parenchyma is jeopardised--partial tactical nephrectomy should be abandoned.
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Comments are made in connection with a statistics concerning 41 pyeloplasties and 14 re-interventions for complications of pyeloplasties. The author reviews cases in which the reconstruction failed and stresses the problems related to the performance of the intervention and the post-operative care. Early post-operative urography is recommended, on extenation of the patient, in view of checking if the kidney is functional or not. Also the quality of pyelo-uretheral anastomosis is checked by this method.