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PubMed1995

[Diagnosis of dysfunctions of replanted parathyroid gland tissue by bilateral analysis of intact parathyroid hormones in cubital vein blood. A prospective study].

AIM: In a prospective long-term follow-up study after operative therapy of hyperparathyroidism the value of bilateral determination of parathyroid hormone levels in cubital venous blood after total parathyroidectomy/autologous parathyroid gland reimplantation (musculus brachioradialis) for diagnosis of dysfunctioning grafted tissue is evaluated. PATIENTS AND MATERIAL: From August, 1, 1987 to March, 31, 1994 68 of 243 patients operated on for hyperparathyroidism underwent total parathyroidectomy. Autologous reimplantation of parathyroid gland was carried out simultaneously in 64 patients. Twice delayed reimplantation of cryopreserved tissue was carried out, and there was no reimplantation in two patients up to this day. Three patients were operated on for hyperfunctioning parathyroid autograft after former total parathyroidectomy/reimplantation. RESULTS: During follow-up 5 patients developed dysfunction of (reimplanted) parathyroid gland. Because of low or unprovable levels of intact parathormone the gradients of intact parathyroid hormone between grafted and nongrafted forearm were about 1:1 in postoperative hypoparathyroidism as well as in hypofunction of parathyroid gland. After successful replantation of cryopreserved parathyroid tissue gradients of intact parathyroid hormone increased (> 1:10). In hyperfunction of grafted parathyroid tissue hormone gradients were high (> 1:20 to 1:45,3) because of excessive high levels of intact parathormone in the cubital vein of the graft bearing arm. Successful reduction of parathyroid graft was followed by decrease of parathyroid hormone gradients. CONCLUSION: Regular follow-up of intact parathormone gradients together with intact parathyroid hormone levels and serumcalcium analysis allow the determination of parathyroid graft function. Also differentiation between graft dependent hyperparathyroidism and hyperfunctioning parathyroid tissue in the neck or mediastinum seems to be possible by bilateral determination of intact parathormone. Normal values or a normal range for intact parathyroid hormone gradients can not yet be defined.

Adult↗
PubMed1998

Ureteroneocystostomy: to drain or not to drain.

PURPOSE: Indications for the use of external abdominal drains after ureteral reimplantation are not well defined. We determine the nature of the drainage fluid as well as the current use of drains by pediatric urologists. MATERIALS AND METHODS: We prospectively evaluated 15 consecutive patients 7 months to 19 years old who underwent unilateral or bilateral intravesical ureteroneocystostomy for primary vesicoureteral reflux. All patients were treated with a urethral Foley catheter and closed suction Jackson-Pratt abdominal drain. Fluid from the Jackson-Pratt drain and Foley catheter was analyzed for urea and creatinine on postoperative day 1, and compared to serum values. The Foley catheter was removed after the urine became clear, and the Jackson-Pratt drain was removed after drainage was 5 ml. or less for 12 hours. In addition, a questionnaire was distributed to 268 pediatric urologists to determine current practice regarding the use of routine postoperative drains. RESULTS: Urea and creatinine from the Jackson-Pratt drains in all 15 patients were consistent with serum values. The Foley catheter and Jackson-Pratt drain were removed an average of 3 and 4 days postoperatively, respectively. There were 186 responses from the 268 questionnaires distributed (69.4%). Of the pediatric urologists surveyed 70.4% performed intravesical ureteral reimplantation exclusively, 5.9% extravesical reimplantation exclusively and 23.7% both techniques. Of the group surveyed 73.1% placed external abdominal Jackson-Pratt or Penrose drains, although 26.5% of those who routinely used external drains believed that they were probably unnecessary. Of the physicians who placed drains 53.7% believed that the drainage fluid had some component of urine. CONCLUSIONS: In our small prospective study group we demonstrated that external abdominal drainage fluid is consistent with serum despite the popular belief that it may have some component of urine. The gynecological literature has shown repeatedly that there is no increase in morbidity after radical hysterectomy and pelvic lymph node dissection when no external abdominal drains are used. Although to our knowledge there are no previous reports of drain use after ureteral reimplantation, 26.9% of pediatric urologists currently do not place external abdominal drains with no apparent increase in morbidity. Larger prospective cohorts with long-term followup are needed to address adequately the issue of whether drains are needed after uncomplicated ureteral reimplantation.

Adolescent↗
PubMed1982

Autoalloplast. An experimental and clinical study.

The concept of an autoalloplast offers the convenience of an alloplast and the safety and reliability of an autograft. An alloplast that acts as a scaffold for fibrous tissue ingrowth retains many of the characteristics of an autograft when reimplanted. Fibrous encapsulation is essential to the retention of all implanted impermeable synthetic materials. They then retain a potential for extrusion. Polyamide mesh, which allows the ingrowth of fibrous tissue, is a synthetic implant that circumvents the potential for extrusion. The fibrous tissue ingrowth provides substance to the graft, which permits precise carving with a scalpel after the initial implantation into a vascular area. A suitable period is necessary to allow fibrous tissue ingrowth. The incorporated mesh material is then harvested, shaped, and reimplanted into the augmentation site as an autoalloplast. A three-phase animal study to determine the feasibility of the autoalloplast concept is presented. It showed that fibrous incorporation of polyamide mesh occurs, and harvesting and reimplantation were feasible. It also demonstrated the superiority of the autoalloplast to withstand trauma without extrusion when compared with autogenous cartilage, polyamide mesh without fibrous assimilation, and Silastic. Since 1974, twenty-one humans have received successful implants with the autoalloplast. The patients have been followed up for two to 7 1/2 years, with all cases successful to date. The prospect of nurturing and biologically assimilating an implant in a safe and controlled area of a host and its subsequent reimplantation expands the field of reconstructive surgery and offers a practical method for managing certain facial deformities.

Animals↗
PubMed1994

Tracheal autograft revascularization and transplantation.

OBJECTIVE: No vascular pedicle can be obtained reasonably to provide revascularization of a tracheal graft by direct microvascular suture. This study is a morphometric analysis of epithelial regeneration, submucosal revascularization, and mucosal thickness of isolated, tracheal segments revascularized by a lateral thoracic fascial flap. The purpose of the first part of the study is to determine the optimal period of tracheal viability after isolation and revascularization. The second part consisted of a reimplantation of the revascularized autograft into its original tracheal location. DESIGN: A tracheal segment was excised in 30 animals, and the segment was wrapped in the lateral thoracic fascia. The segments were reviewed histologically and morphometrically 2 to 28 days after graft isolation and after injection of the lateral thoracic artery with a blue silicone dye. Twelve grafts were reimplanted. Six segments were reinserted in the original direction and six segments were reinserted in the opposite direction. Tracheal airway clearance was studied by observation of the movement of carbon particles placed at different locations on the native and transplanted tracheal mucosa. MEAN OUTCOME MEASURES: Tracheal autograft revascularization and reepithelialization. RESULTS: Histologic evaluation of the revascularized grafts revealed an optimal viability of the autograft 16 to 20 days after isolation. The autografts could be reimplanted successfully after this period. This demonstrated the viability of the isolated grafts after a revascularization period of 16 days. The original direction of the mucosal clearance was preserved after reimplantation. The clearance in the opposite direction, with the 180 degrees rotated segments, however, had no influence on survival.

Anastomosis, Surgical↗
PubMed1995

Complex abdominal and thoracoabdominal aortic aneurysm reconstruction.

Complex reconstructions of the abdominal aorta are required for aneurysms that require visceral or splanchnic revascularization, when the aorta is inflammatory or infected, when a fistula to the vena cava or bowel is present, and when the aneurysm involves the juxtarenal, pararenal segments, or the full length of the abdominal aorta. The technique for full-length abdominal and thoracoabdominal aortic reconstructions has been modified to separate the visceral and spinal cord revascularization from the body of the main graft. The visceral, renal, and intercostal arteries are not directly reimplanted into the aortic graft but rather into sidearm grafts using a patch inclusion technique. The reconstruction commences distally by anastomosing the main graft to the aortic bifurcation or to the iliac arteries as appropriate. The main graft is then anastomosed to the proximal aorta after which the aortic clamps are released to perfuse the lower limbs. The intercostal arteries are reimplanted into a posterior sidearm graft followed by visceral and renal artery reimplantation into an anterior sidearm graft. This technique reimplantation into an anterior sidearm graft. This technique reduces the period of left ventricular strain to the time taken to complete the upper aortic anastomosis. It also allows separate control of the visceral and intercostal implantations should bleeding occur, without the necessity to reclamp the main body of the graft.

Aorta, Abdominal↗
PubMed2003

[Temporary articulating spacer with antibiotic-impregnated cement for an infected knee endoprosthesis].

Two-stage reimplantation remains the gold standard in the treatment of late infected total knee arthroplasties. The reported disadvantages include difficult exposure at the time of reimplantation and less functional outcome by using static spacers. Patients who receive an articulating spacer retain a functional joint before second-stage reimplantation. This may reduce the disadvantages of static spacers (ligament contracture, extensor lag, arthrofibrosis). There is no difference in the success rates of eradicating infection (range: 90-96%). In a prospective study 24 consecutive patients were treated with an articulating spacer. The articulating spacer is made by cleaning and autoclaving the removed femoral component and the tibial polyethylene insert. These are reinserted during the same operation with antibiotic-loaded cement. The average time during which the spacer was in place was 16 weeks (range: 7-28 weeks). During an average follow-up period of 14.8 months (range: 5-33 months) one patient had a secondary reinfection. Use of an articulating spacer is economical and decreases the risk of complications in reimplantation with good functional outcome.

Anti-Bacterial Agents↗
PubMed1989

Clinical and hemodynamic course of infants and children with anomalous left coronary artery.

The clinical history of all 17 patients with anomalous left coronary artery presenting over the last 20 years was studied, with special emphasis on those who underwent reimplantation of the anomalous coronary artery into the aorta, a procedure that became our "treatment of choice" during this period. These patients were also evaluated for ventricular performance, residual mitral regurgitation, and wall integrity. Early in our experience with reimplantation, two patients died while we waited for them to achieve a more favorable size for surgery. Eight of nine survived reimplantation; three of these were under 1 year of age when operated upon. One of these eight patients has required additional mitral valvuloplasty, but all are doing well clinically up to 12 years after operation. Preoperative left ventricular ejection fraction of 0.37 +/- 0.16 increased to 0.67 +/- 0.07 (p less than 0.001) by 1 year after surgery, despite ventricular wall abnormalities in four patients. Thus reimplantation of the anomalous left coronary artery should be undertaken upon diagnosis, since surgery can be performed successfully in infancy, with resultant improvement in ventricular function and an adequate clinical condition for at least 12 years.

Adolescent↗
PubMed2005

Arterial switch operation for transposition of the great arteries with coronary arteries from a single aortic sinus.

BACKGROUND: The reimplantation of the coronary arteries from a single aortic sinus (single sinus coronary artery) in an arterial switch operation remains a technically challenging procedure. The technique of coronary transfer in this situation should be individualized depending on coronary ostial anatomy. We reviewed our techniques of coronary reimplantation with early and midterm results. METHODS: Among 103 patients who underwent arterial switch operations from March 1994 to June 2004, 16 (15.5%) had single sinus coronary artery (median age, 9 days; mean body weight, 3.5 kg). Fourteen patients (14/16, 87.5%) had coronary arteries from right facing sinus (sinus 2). Of these 14 patients, 11 had separate ostia including intramural course of the left coronary artery (n = 9) and 3 had single ostium. Two patients (2/16, 12.5%) had coronary arteries from left facing sinus (sinus 1) with single ostium. Aortic arch obstruction was associated in 5 patients. RESULTS: All 5 single sinus coronary arteries with single ostium were reimplanted with the trap-door technique. Of the 11 patients with separate ostia, 8 underwent coronary transfer with the aortocoronary flap technique and 3 with the double-button technique. Two of the 3 patients who underwent the double-button technique required left coronary artery bypass using left subclavian artery free graft as the salvaging procedure. There was one early death (1/16, 6.3%), which occurred during our earlier experience, in a patient who had arch anomaly and intramural left coronary artery. There was no late death. All but one patient had good ventricular function. CONCLUSIONS: All single sinus coronary artery with single ostium can be transferred with the trap-door technique with excellent results. The aortocoronary flap technique in those with separate ostia with or without intramural left coronary artery may be a good option. However, reimplantation of the intramural left coronary artery using separate coronary buttons should be performed with great care.

Anastomosis, Surgical↗
PubMed2003

Prevention of postoperative paraplegia during thoracoabdominal aortic surgery.

BACKGROUND: We present data showing the impact of sequential multisegmental aortic clamping accompanied by reimplantation of as many segmental arteries as possible on the prevention of postoperative paraplegia or paraparesis during thoracoabdominal aortic graft replacement. METHODS: Since 1987 we have performed graft replacements in 51 individuals undergoing thoracoabdominal aortic surgery using the technique of normothermic partial bypass with sequential multisegmental aortic clamping. The procedure was performed emergently in 10 patients and electively in 41 patients. The patients ranged in age from 22 to 82 years (mean, 57.6 +/- 13.8 years). Indications for surgery included dissecting thoracoabdominal aortic aneurysm (n = 19) and nondissecting thoracoabdominal aortic aneurysm (n = 32). The extent of aneurysm was Crawford type I in 19 patients, type II in 7 patients, type III in 12 patients, and type IV in 13 patients. Along the entire extent of aneurysm to be replaced, we reimplanted as many of the patent segmental arteries as feasible. RESULTS: Five patients died during hospitalization, for an in-hospital mortality rate of 9.8%. The number of aortic clampings per patient ranged from one to five (median, three). A total of 124 segmental arteries were reimplanted in 44 (86.3%) of 51 patients. Of the 124 arteries, 90 (72.6%) were distributed between T9 and L2. Postoperative paraplegia or paraparesis did not develop in any of the patients. CONCLUSIONS: Our results demonstrate that extensive reimplantation of segmental arteries using sequential multisegmental aortic clamping, accompanied by adequate intraoperative distal aortic perfusion, is effective in preventing spinal cord ischemia.

Adult↗
PubMed1999

Treatment of vesico-ureteric reflux in children with neuropathic bladder: a comparison of surgical and endoscopic correction.

BACKGROUND/PURPOSE: Vesico-ureteric reflux (VUR) is a common problem in children with neuropathic bladder. Lesser-degree VUR may be manageable by intermittent catheterization or by anticholinergics, but higher grades usually require surgical treatment. If left untreated, two thirds of such patients may experience deterioration of the upper renal tracts. The aim of this study was to compare the results of the STING (Subureteric Teflon Injection) technique with surgical ureteric reimplantation as treatment for VUR in neuropathic bladder. METHODS: From January 1981 to December 1996, 58 children with NB (81 ureters) were treated for VUR. STING and Cohen ureteroneocystotomy were performed in 40 and 41 ureters, respectively. Mean age was 4.5 years (STING) and 5.1 years (Cohen). RESULTS: Twenty-nine of 40 refluxing ureters (72.5%) were cured by STING, whereas Cohen eradicated reflux in 39 of 41 ureters (95.5%). No complications were observed in either group. All the ureters in which STING failed were treated successfully by Cohen ureteroneocystostomy. The 2 ureters still refluxing after surgical reimplantation were cured successfully by a single STING. The mean follow-up was 6.8 years in the Cohen group and 4.8 years in the STING group. During follow-up, no recurrence was observed in patients cured by open reimplantation. In the STING group, 2 previously cured ureters showed recurrence of VUR: both were treated successfully by a further STING. CONCLUSIONS: Open ureteral reimplantation is more effective than STING in correcting VUR in children with neuropathic bladder dysfunction. Nevertheless, the good success rate, the relative technical simplicity, outpatient nature, and rapid recovery point to STING as a safe and effective procedure for the initial treatment of VUR. Failure of STING does not preclude a successful open operation.

Adolescent↗
PubMed1995

Repair of the aortic valve in patients with aortic insufficiency and aortic root aneurysm.

Patients with aneurysms of the ascending aorta or aortic root frequently have aortic insufficiency despite normal aortic leaflets. The aortic valve dysfunction is caused by dilatation of the sinotubular junction, distortion or dilatation of the sinuses of Valsalva, annuloaortic ectasia, or a combination of these problems. In the case of annuloaortic ectasia, reconstruction of the aortic root is performed by reimplanting the aortic valve in a tubular Dacron graft (reimplantation). In the case of mild or no annuloaortic ectasia, reconstruction of the aortic root is performed by correcting the dilated sinotubular junction and replacement of the aortic sinuses if they are also dilated with an appropriately tailored Dacron graft (remodeling). From July 1989 to March 1994, 45 patients have had either reimplantation of the aortic valve (19 patients) or remodeling of the aortic root (26 patients). Fourteen patients had Marfan's syndrome, 11 had acute and five had chronic type A aortic dissection, and nine also had transverse arch aneurysm. There were two operative deaths, both in the remodeling group. One patient who had reimplantation needed composite replacement of the aortic valve and ascending aorta because of persistent aortic insufficiency after the repair. A young patient with Marfan's syndrome had progressive aortic valve dysfunction during a growth spurt and had aortic valve replacement 2 years after the initial operation. No other valve-related complication has occurred. The remaining 41 patients have only mild or no aortic insufficiency, and the repair remains stable from 1 to 58 months, mean 18 months. These two types of aortic valve reconstruction have provided excellent clinical results in carefully selected adult patients.

Adult↗
PubMed1997

The treatment of patients with infected implantable cardioverter-defibrillator systems.

OBJECTIVE: The purpose of this study was to evaluate the treatment of patients with infected implantable cardioverter-defibrillator systems. METHODS: Retrospective analysis was done of the cases of 21 patients treated for implantable cardioverter-defibrillator infection during an 11-year period. RESULTS: Of 723 cardioverter-defibrillator implantations (550 primary implants, 173 replacements), nine (1.2%) were complicated by early postoperative device-related infections. Late infections developed in two patients 19 and 22 months, respectively, after implantation. Ten other patients were transferred to our institution for treatment of cardioverter-defibrillator infection. The time from implantation to overt infection was 2.2 +/- 1.3 months, excluding the two late infections. The responsible organisms were Staphylococcus aureus (9), Staphylococcus epidermidis (6), Streptococcus hemolyticus (1), gram-negative bacteria (3), Candida albicans (1), and Corynebacterium (1). All patients were treated with intravenous antibiotic drugs. Total system removal was done in 15 patients and partial removal in 2; in 4, the cardioverter-defibrillator system was not explanted. There were no perioperative deaths. A new implantable cardioverter-defibrillator system was reimplanted in 7 patients after 2 to 6 weeks of antibiotic therapy. Ten patients were treated without reimplantation (2 arrhythmia operation, 8 antiarrhythmic drugs). Four patients (3 patients without explantation and 1 with partial system removal) were treated with maintenance long-term antibiotic therapy. During a mean follow-up of 21 +/- 2.8 months, no patient had clinical recurrence of infection. One patient treated with antiarrhythmic drugs without system reimplantation died suddenly. CONCLUSIONS: Infections that involve implantable cardioverter-defibrillator systems can be safely managed by removing the entire system with reimplantation after intravenous antibiotic therapy. In selected patients in whom the risk for system explantation is high and anticipated life expectancy is short, long-term antibiotic therapy to suppress low-virulence infections may represent an acceptable alternative.

Adult↗
PubMed2003

Continent colonic urinary reservoir (Florida pouch): long-term surgical complications (greater than 11 years).

PURPOSE: We analyzed the long-term results (greater than 10 years) of a continent cutaneous colonic urinary reservoir (Florida pouch), focusing primarily on the incidence of significant complications. MATERIALS AND METHODS: Between January 1986 and October 1991, 179 patients underwent continent cutaneous colonic urinary reservoir construction. Of these patients 105 died of primary disease or were lost to followup, leaving 38 males and 36 females with a mean followup of 133 months with adequate data for analysis who are the subject of this report. The surgical technique has been previously reported. Briefly, a detubularized right colonic segment forms the reservoir, a tapered external limb reinforced at the ileocecal valve level allows continent catheterization and the ureters are directly anastomosed to the pouch. The diseases that prompted urinary diversion included bladder cancer in 28 cases, conversion from another diversion in 12, neurogenic bladder in 11, interstitial cystitis in 10, crippling incontinence in 4, radiation cystitis in 6, hemorrhagic cystitis in 1, exstrophy in 1 and colon cancer in 1. A total of 146 direct ureterocolonic reimplantations were performed. RESULTS: Complications were grouped by etiology and the number of patients, including abdominal wall (peristomal hernia in 3 patients or 4%), external limb (incontinence in 5 or 6.7%, stomal stenosis in 3 or 4% and difficult catheterization in 1 or 1.4%), reservoir stones (4 or 5.4%), ureteral obstruction (primary reimplantation in 7 of 108 or 6.3%, repeat reimplantation in 4 of 24 or 16.4% and radiated ureters in 4 of 14 or 28.4%) and metabolic (persistent diarrhea in 2 or 2.7%, renal failure in 2 or 2.7% and low vitamin B12 in 3 or 4%). Severe acidosis developed in 4 individuals (5.5%). Of the 12 patients who underwent conversion from another type of diversion 7 (58%) experienced metabolic alterations. CONCLUSIONS: In the long term continent colonic reservoirs have an acceptable complication rate. The most common problem is ureteral obstruction, especially in patients who have previously undergone irradiation (28.4% versus 6.3%, Fisher's test p = 0.02). Patients in whom longer bowel segments were resected, such as those with conversion from another type of diversions, experienced a greater number of complications, especially ureteral obstruction associated with repeat reimplantation (16.4% versus 6.3%, Fisher's test p = 0.23) and metabolic derangements (58% versus 6.4%, Fisher's test p = 0.0001).

Acidosis↗
PubMed1994

Urinary undiversion in adults with myelodysplasia: long-term followup.

A total of 14 women and 6 men 19 to 39 years old (mean age 27 years) with myelodysplasia underwent undiversion 8 to 29 years (mean 16) after ileal conduit diversion. The main reasons for diversion were incontinence in 17 patients and failed ureteral reimplants in 3, and those for undiversion were a desire for an improved quality of life in 16, increasing hydronephrosis in 4 and stomal problems in 3. Preoperative assessment included upper and lower tract imaging, and video urodynamics. Operations on the ureters included reimplantation into an intussuscepted nipple valve in 8 patients, tunneled reimplants into a sigmoid augmentation in 3 and the ureters joined to either the bladder or lower ureter without interposing bowel in 9. All reimplantations were done with nonrefluxing techniques. A total of 18 patients underwent bladder augmentation and 2 women in whom cystectomy was performed for pyocystis underwent substitutions. Simultaneous continence procedures in 18 patients included trigonal tubularization in 2, artificial sphincter implantation in 2, a bladder neck sling in 5 or bladder neck tapering and a sling in 9. The patients were followed for a mean of 69 months (range 21 to 133). Eight patients required reintervention within 1 year for problems, such as anastomotic leak in 1, bladder neck obstruction in 1, incontinence in 1, artificial urinary sphincter revisions in 1 and bladder stones in 1. One patient had a recurrent renal calculus 10 years after undiversion. All patients experienced either persistence of normal upper tract appearance or improvement and/or stabilization of hydronephrosis. Mean bladder capacity was 77 cc preoperatively and 480 cc postoperatively, while mean pressure at capacity decreased from 50 to 14 cm. water with detubularized augmentation. Of the patients 17 are completely dry, 2 wear 1 pad per day and 1 has enuresis. All but 1 patient who voids with straining are on intermittent self-catheterization. All patients, on followup interviews, reported an improved quality of life without a stoma. We conclude that undiversion provides an improved quality of life and an acceptable morbidity rate. The choice of operation depends on the anatomy of the patient. We prefer a nonprosthetic type of incontinence procedure when intermittent self-catheterization is to be done. No long-term morbidity has yet been noted.

Adult↗
PubMed1992

Surgical results in the International Reflux Study in Children (Europe).

In the European part of the International Reflux Study in Children (7 participating centers) 151 infants and children were randomly allocated to surgical treatment of primary grades III and IV vesicoureteral reflux. Reimplantation was performed unilaterally in 65 patients and bilaterally in 86, for a total of 237 ureters reimplanted. The patients were followed at regular intervals for 5 years. Reflux was absent in 231 of the reimplanted ureters (97.5%) at the end of 5 years. No patient underwent reoperation for reflux. In 10 ureters (4.2%, 10 patients) obstruction developed postoperatively and 7 needed reoperation. All reoperations were performed on the left side. Of the obstructed kidneys new scars developed in 6 during the 5-year followup. Including these cases, the number of new renal scars was equal in the surgical and medical groups (20 each). The number of pyelonephritic episodes during followup was significantly less in the surgical group (without chemoprophylaxis) than in the medical group (on chemoprophylaxis). No kidneys were lost and no child became hypertensive. If voiding cystourethrography and excretory urography were normal 6 months postoperatively, the reflux had been permanently eradicated and postoperative obstruction could be ruled out. In this study the patients who underwent reimplantation had a 74% (112 of 151) chance of an uncomplicated postoperative course (no persisting reflux, obstruction, pyelonephritis or severe renal damage).

Child↗
PubMed1989

Open versus endoscopic surgery in the treatment of vesicoureteral reflux.

Surgical reimplantation of the ureters was compared to subureteral injection of polytetrafluoroethylene (Polytef) in the treatment of primary vesicoureteral reflux. Reflux was eliminated successfully in 98 per cent of the 76 ureters treated by reimplantation and in 70 per cent of the 40 ureters treated endoscopically. Although the surgical morbidity of endoscopic surgery appears to be less than that of open surgery, the patients undergoing endoscopic surgery required more hospital admissions, more anesthetics and more micturating cystourethrograms than did those in the reimplantation group. It is concluded that subureteral polytetrafluoroethylene injection does not represent a satisfactory substitute for reimplantation.

Child↗
PubMed1990

A continent colonic urinary reservoir: the Florida pouch.

A total of 92 patients underwent continent urinary diversion with an extended, detubularized right colonic segment as the urinary reservoir and the distal ileum as a continent catheterizable efferent system. In this series 65 patients were followed for 6 to 46 months (average 17 months). Our reservoir allows the accommodation of a large volume of urine; urodynamic studies in 28 patients demonstrated a maximum reservoir capacity varying between 550 and 1,200 cc (average 747 cc). Maximal reservoir pressures ranged from 10 to 58 cm. water (average 35 cm. water). Of the 127 ureterocolonic reimplantations 4 ureters were initially reimplanted with a modified Le Duc procedure, 26 ureters were managed subsequently with the Goodwin transcolonic approach and 91 reimplantations were done with a direct (nontunneled) mucosa-to-mucosa anastomosis. The overall success rates with each of the 3 techniques (absence of reflux and obstruction) were 75, 88.6 and 90.1%, respectively. Six megaureters underwent imbrication and direct reimplantation, and 3 of these (50%) became obstructed. Two converted ileal conduits were opened at the antimesenteric edge and were patched to the reservoir while the ureteroileal anastomosis was left undisturbed. One patient (1.5%) died of pulmonary embolism. Medical and surgical complications occurred only in the group who underwent simultaneous cystectomy and the over-all rate of complication was comparable to previous series with ileal conduits. The double row plication of the distal ileum and ileocecal valve allows for easy catheterization every 4 to 6 hours and 63 patients (97%) remain continent between catheterization. Four patients (6%) required reoperation for correction of incontinence or other complications. Our satisfactory experience with these patients makes this technique an excellent approach to achieving continent urinary diversion.

Colon↗
PubMed2002

Treatment of uretero-intestinal and ureterovesical strictures by Acucise balloon catheter.

OBJECTIVE: Acucise balloon catheter has been proposed as an alternative to open surgery for the treatment of strictures of the ureteropelvic junction because of its low morbidity and the short hospital stay following the endoscopic procedure. The objective of this study was to evaluate the results of this technique applied to patients developing strictures after surgical reimplantation of the ureterovesical (UV) or uretero-intestinal (UI) junction. MATERIAL AND METHODS: Between March 1997 and January 2000, 12 strictures (11 patients) were treated by Acucise balloon catheter via an antegrade and/or retrograde approach with double J stenting for an average of 6 weeks (range: 4-12 weeks): six uretero-ileal strictures (three Bricker, one uretero-ileoplasty, one enterocystoplasty and one Kock pouch) and six ureterovesical strictures (Lich-Grégoir or Paquin UV reimplantations after gynaecological, vascular or endoscopic surgery). The median postoperative follow-up was 16 months (range: 10-36 months). A good result was defined by the absence of recurrence of the stricture evaluated both clinically and radiologically (regression of stasis measured by IVU and/or ultrasonography). RESULTS: The mean operating time was 70 minutes and the mean hospital stay was 4.8 days (range: 3-14 days). Only one intraoperative complication was observed (migration of the double J stent to the kidney). The operation was successful in eight patients (75%). The success rate was 83% for ureterovesical strictures and 50% for uretero-ileal strictures. A history of previous irradiation appeared to be a factor of failure. CONCLUSION: The Acucise procedure is a minimally invasive and effective (75% success rate) treatment option for the treatment of postoperative stricture after ureteric reimplantations. In our department, this option is considered to be first-line treatment, as surgical reimplantation is reserved for failures of the endoscopic technique.

Adult↗